CMS Proposes Coverage with Evidence Development for Chimeric Antigen Receptor (CAR) T-cell Therapy
Feb 15, 2019 - The Centers for Medicare and Medicaid Services proposed a National Coverage Determination which would require Medicare to cover a new form of cancer therapy, CAR T-cell therapy. There is presently no national Medicare policy for this therapy, leaving it up to local Medicare Administrative Contractor's discretion whether to cover it.
Source: Centers for Medicare and Medicaid Services
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HHS Launches Innovative Payment Model with New Treatment and Transport Options to More Appropriately and Effectively Meet Beneficiaries’ Emergency Needs
Feb 14, 2019 - Announcement from the Center for Medicare and Medicaid Innovation about a new payment model for emergency ambulance services, the Emergency Triage, Treat and Transport (ET3) model. ET3 aims to allow Medicare Fee-For-Service (FFS) beneficiaries to receive the most appropriate level of care at the right time and place. CMS anticipates a Summer 2019 release date of the request for applications (RFA) for Medicare-enrolled ambulance suppliers and providers.
Source: U.S. Department of Health and Human Services
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CMS: Medicaid Program; Final FY 2017 and Preliminary FY 2019 Disproportionate Share Hospital Allotments, and Final FY 2017 and Preliminary FY 2019 Institutions for Mental Diseases Disproportionate Share Hospital Limits Federal Register
Feb 11, 2019 - Announces the final federal share Disproportionate Share Hospital (DSH) allotments for fiscal year (FY) 2017 and the preliminary federal share DSH allotments for FY 2019. This notice also describes the methodology used to determine amounts of states' FY DSH allotments. The notice is effective March 13, 2019.
Source: Federal Register
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CMS: Agency Information Collection Activities: Submission for OMB Review; Comment Request
Feb 1, 2019 - The Centers for Medicare and Medicaid Services is seeking comment on the following information collections: 1) Generic Clearance for the Health Care Payment Learning and Action Network; and 2) Transparency in Coverage Reporting by Qualified Health Plan Issuers. Comments are due by March 4, 2019.
Source: Federal Register
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CMS: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program-Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; Provisions From the Medicare Shared Savings Program-Accountable Care Organizations Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder Under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act; Correction Federal Register
Jan 31, 2019 - Notice from the Centers for Medicare and Medicaid Services correcting technical errors in the November 23, 2018 notice of the same title. This notice is effective January 31, 2019 and applicable beginning January 1, 2019.
Source: Federal Register
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CMS Proposes Medicare Advantage and Part D Payment and Policy Updates to Maximize Competition and Coverage
Jan 30, 2019 - The Centers for Medicare and Medicaid Services (CMS) released proposed changes to Medicare Advantage and Part D plans. These changes are intended to increase competition, increase plan choices and benefits, and help address the opioid epidemic.
Source: Centers for Medicare and Medicaid Services
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The Hospital Value Incentive Program: Measuring and Rewarding Meaningful Hospital Quality
Jan 30, 2019 - Blog post from the Medicare Payment Advisory Commission (MedPAC) discussing their recent recommendation to Congress to replace the four current hospital quality payment programs with one program. The Hospital Value Incentive Program (HVIP) encourages the delivery of better-quality hospital care for beneficiaries, catalyzes change in the delivery system, considers differences in providers' patient populations, and reduces provider burden.
Source: The MedPAC Blog
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NQF and the Aetna Foundation Launch Social Determinants of Health Initiative to Identify Quality and Payment Innovations
Jan 24, 2019 - Press release from the National Quality Forum (NQF) and the Aetna Foundation announcing a joint, nine-month effort to identify quality and payment innovations that will address social determinants of health (SDOH) and reduce health disparities. This initiative will identify practices addressing SDOH from around the country and bring together leaders to develop repeatable, scalable recommendations related to integrating quality and payment programs.
Source: National Quality Forum
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CMS Announces New Model to Lower Drug Prices in Medicare Part D and Transformative Updates to Existing Model for Medicare Advantage
Jan 18, 2019 - The Centers for Medicare and Medicaid Services' (CMS) Center for Medicare and Medicaid Innovation announced a new payment model for Medicare Part D plans as well as updates to the Medicare Advantage Value-Based Insurance Design (VBID) model. These models aim to lower drug prices and to create new ways to meet the healthcare needs of specific populations, prevent disease, and expand the use of telehealth.
Source: Centers for Medicare and Medicaid Services
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Efforts to Expand Access to Oral Health Care to Continue in 2019
Jan 15, 2019 - Looks at trends in the expansion of access to oral healthcare and makes prediction about 2019. Includes discussion of states that expanded Medicaid, dental therapy legislation, dental therapy training programs, and industry changes like medical-dental integration, value-based purchasing, and practice consolidation.
Source: Pew Charitable Trusts
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