Updates & Analysis

On July 21st, the New York State Department of Health (NYSDOH) held an applicant conference/webcast on the Vital Access Provider Assurance Program (VAPAP) transformation plan. VAPAP applicants will work with corresponding Performing Provider System (PPS) leads and a Technical Assistance (TA) team to submit transformation plans to the State by August 31, 2015. The State…

On July 13th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (which can be found here) for long-term care facilities. Unlike the annual Skilled Nursing Facility payment rule issued in April of this year, the newly released proposal modernizes conditions of participation for long-term care facilities, which had not been updated since…

On July 9th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (which can be found here) to establish the Comprehensive Care for Joint Replacement (CCJR) Model to test mandatory retrospective bundled Medicare payments for hip and knee replacements, referred to as lower extremity joint replacements (LEJRs). CMS proposes to begin this five-year…

On July 8th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (which can be found here) for the Calendar Year (CY) 2016 Medicare Physician Fee Schedule (PFS). Provisions of the proposed rule include modifications to existing physician quality reporting programs including the Physician Quality Reporting System (PQRS) and the Physician Value-Based Payment…

On July 7th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (which can be found here) for the Calendar Year (CY) 2016 Medicare home health prospective payment system (HH PPS). The proposed rule would update the payment rates for home health agencies (HHAs) for CY 2016 and aims to move the HH…

On July 1st, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for the Calendar Year 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System (available here). The proposed rule updates Medicare payment policies and rates for hospital outpatient departments, ASCs, and partial hospitalization services furnished by community…

On June 4th, the Centers for Medicare and Medicaid Services (CMS) released a final rule (found here) updating the Medicare Shared Saving Program (MSSP), in which over 400 Accountable Care Organizations (ACOs) now participate. The final rule aims to make it more attractive for participants to take on additional risk and incorporates successful elements of the…

On May 26th, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (available here) on managed care in Medicaid and the Children’s Health Insurance Program (CHIP).  The proposed rule would align the rules governing Medicaid managed care with those of other major sources of coverage, including coverage through Qualified Health Plans (QHP) and Medicare…

On April 14th, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 (available here). The bill would permanently repeal the Sustainable Growth Rate (SGR) formula that perennially projects significant cuts to physician payments and replace it with a new payment formula. The bill also extends funding for the Children’s Health Insurance Program…

OVERVIEW On April 6th, the Centers for Medicare and Medicaid Services (CMS) released the 2016 Rate Announcement and Call Letter, which makes payment and policy updates to Medicare Advantage (MA) and Medicare Part D prescription drug plans. This comes after CMS accepted comments on the Advance Notice and draft Call Letter that was released on…

CAPITAL FUNDING The laws governing the $1.2 billion Capital Restructuring Financing Program (CRFP) have been modified to specify that “funds shall be awarded regionally in proportion to the applications received from the Request for Application (RFA) issued by or before May 1, 2015.” The following new appropriations will be available from the Department of Health…