Tagged with Compliance

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.

TX – House Passes Bill to Allow Virtual Visits

The Texas House of Representatives has passed a bill, by unanimous vote, that will enable physicians licensed in the state to supply telemedicine services to patients they have never met in person.

Transition Period Extended for Compliance with HCBS Criteria

CMS issued an Informational Bulletin providing additional clarity on provisions of the final regulation defining home and community-based service (HCBS) settings. The bulletin indicates that that states may take an additional three years to ensure compliance with criteria of a HCBS setting. The agency says this additional time “will be helpful to states to ensure compliance activities are collaborative, transparent and timely.”

CMS gives over 800K Physicians Reprieve from MACRA Reporting in 2017

CMS has sent over 800,000 letters to clinicians, with notification that they will not be evaluated under the MACRA Merit-based Incentive Payment System (MIPS) in 2017. Federal officials predict only about one-third of clinicians will have to file quality reports this year under the new Medicare payment system.

MGMA, AMA Request Delay in 2015 Edition Certified EHR

In a letter to CMS and the Office of the National Coordinator for Health Information Technology, MGMA, along with 100 medical organizations, requested a deferment for the required use of 2015 Edition CEHRT in the QPP or Medicaid MU Program. The letter recommends that use of 2015 CEHRT remain voluntary until such technology is widely available, no sooner than January 2019.

OIG Final Rule Expands Exclusion Authorities

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued a final rule expanding the authority to exclude individuals and entities from federal health care programs.

New Final Rule Targets Pass-Through Payments

CMS’ newest Medicaid managed care final rule will prevent increases in pass-through payments as well as the addition of new pass-through payments beyond those in place when the pass-through payment transition periods were established.

NJ – OIG Report Reveals Improper Medicaid Payments

A report released by the HHS Office of Inspector General (OIG) states, over a four-year span, New Jersey has received an estimated $95 million in improper Medicaid payments. According to the report, “The deficiencies occurred because the state … did not adequately monitor [its] partial care services program to ensure that providers complied with [the program’s] requirements.”

NY – Section 1115 Medicaid Waiver Extended

New York’s Section 1115 Medicaid waiver has been extended for an additional five years, through March 2021. Known as the Partnership Plan, the waiver has been renamed the Medicaid Redesign Team (MRT) Demonstration in recognition of the ongoing MRT efforts to transform the health care delivery system and will extend authorities for New York to continue to operate its demonstration with modest modifications.