Tagged with Compliance

CMS Finalizes Rule to Update and Modernize PACE

CMS has announced the release of a final rule designed to “update and modernize” the Programs of All-Inclusive Care for the Elderly (PACE) program, based upon best practices in caring for frail and elderly individuals.

New Jersey – Mental Health Parity Legislation Signed Into Law

The Governor of New Jersey has signed legislation that will enhance enforcement of mental health parity laws in the state. The law aims to improve transparency and accountability by requiring insurers to provide coverage consistent with federal requirements of the Mental Health Parity Act of 2008.

CMS Proposes to Lift Regulations, Ease Provider Burden

Last month, CMS released a proposed rule to remove some of the Medicare participation requirements currently in place for health care facilities. According to the press release, the agency estimates that policies from the proposed rule could potential save hospitals and other facilities approximately $1.12 billion annually.

New Jersey Medicaid Issues Telehealth Coverage and Reimbursement Guidance

October 2018 ~ The New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) issued a newsletter to NJ FamilyCare (NJFC) providers to clarify the requirements for the provision and billing of NJFC services via telehealth and telemedicine. The guidance comes as a follow-up to the New Jersey Telemedicine and Telehealth…

New Hampshire House and Senate Approve Medicaid Expansion Bill

The New Hampshire House Health and Human Services Committee and Senate have passed legislation to reauthorize the state’s Medicaid expansion program for an additional five years, as well as add work requirements, and will also transition beneficiaries from the individual insurance exchange into a managed care model.

CMS 2019 Medicare Advantage Part I Advance Notice Released

CMS has released Part One of the 2019 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part D Payment Policies, containing proposed changes to the Part C Risk Adjustment Model and the use of encounter data.

CMS Issues Clarification around Texting Patient Orders

CMS, on December 28th, issued a Survey and Certification Memorandum (S&C Memo) to state survey agencies to clarify and reinforce its position that it prohibits physicians and health care providers from texting orders.

Cigna Requirement to Precertify Oncology Medications

Cigna has implemented an integrated oncology management program which requires providers to precertify certain medical oncology medications through a national ancillary provider (instead of Cigna), including primary chemotherapy, and supportive drugs, such as medical injectables and infusions.

Medicare Advantage Policy and Technical Changes for Contract Year 2019

CMS has submitted a proposed rule that, if finalized, would revise the Medicare Advantage program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations to implement certain provisions of the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act.

NJ – DHS Expands Behavioral Health Benefits Covered Under NJ FamilyCare

The New Jersey Department of Human Services (DHS) last month announced that it has expanded the list of covered health benefits available to align behavioral health coverage for Medicaid Long Term Services and Supports (MLTSS), Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), and Division of Developmentally Disabled (DDD) MCO members participating in the New Jersey FamilyCare (NJFC) Medicaid managed care program.

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