Updates & Analysis

On November 20th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule on benefit and payment parameters for benefit year 2017. Key provisions of the proposed rule would include modifications to payment parameters, network adequacy requirements, the Small Business Health Options Program, and the re-enrollment process for coverage purchased through the federal…

On November 16th, the Centers for Medicare and Medicaid Services (CMS) issued a final rule to establish the Comprehensive Care for Joint Replacement (CJR) Model to test mandatory retrospective bundled Medicare payments for hip and knee replacements, referred to as lower extremity joint replacements (LEJRs). The first performance year (PY) for the five-year model will…

On October 29th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule on discharge planning requirements for hospitals, long-term care hospitals, inpatient rehabilitation facilities, critical access hospitals, and home health agencies. The proposed rule implements the discharge planning requirements of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The attached…

On October 30th, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the Calendar Year (CY) 2016 Medicare Physician Fee Schedule (PFS). The final rule includes modifications to existing physician quality reporting programs including the Physician Quality Reporting System (PQRS) and the Physician Value-Based Payment Modifier (Value Modifier). The final rule…

On October 29th, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the Calendar Year (CY) 2016 Medicare home health prospective payment system. The final rule will update the payment rates for home health agencies (HHAs) for CY 2016 and aims to move home health toward value-based payments. CMS projects that…

The Dormitory Authority of the State of New York (DASNY) has released a Request for Applications (RFA) for $50 million in funding for the Nonprofit Infrastructure Capital Investment Program (NICIP). Under this program, non-profit human services organizations may be eligible for grants of between $50,000 and $1 million for capital projects. Attached please find a…

On October 30th, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the Calendar Year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The final rule updates Medicare payment policies and rates for hospital outpatient departments, ASCs, and partial hospitalization services furnished by community…

The New York State Department of Health (DOH) has released two Requests for Applications (RFAs) for the Essential Health Care Provider Support (EHCPS) Program. The main grant (available here) will provide up to $300 million to support the creation of financially sustainable health systems through hospital mergers, consolidations, and other restructuring activities. The secondary grant,…

On September 29th, the Office of Health Insurance Programs (OHIP) and the Centers for Medicare & Medicaid Services (CMS) held a forum on the future of long-term care services in New York, which outlined a proposal to create an enhanced managed long-term care (MLTC) initiative called MLTC Plus as well as some planned changes to…

On August 28th, the Health Resources and Services Administration (HRSA) issued a proposed Omnibus Guidance on the 340B Drug Pricing Program (340B Program). The 340B Program provides eligible safety net providers with discounted prices on outpatient drugs. As of January 1, 2015, there were 11,530 registered entities and 644 drug manufacturers participating in the 340B…

On August 25th, the Centers for Medicare and Medicaid Services (CMS) released Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) Performance Year (PY) 2014 results (which can be found here). Attached are the results for the 26 MSSP ACOs with beneficiaries residing in New York State (NYS).  Of note, the results do not include data…

On July 30th, the Centers for Medicare and Medicaid Services (CMS) issued a final rule (which can be found here) to update the Fiscal Year (FY) 2016 Medicare payment rates under the prospective payment system (PPS) for skilled nursing facilities (SNFs). The attached document summarizes several major provisions of the final rule.