Tagged with Compliance

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.

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.