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999 Articles Matching "cms"

Payment Reform Paves The Way For Expanding Home-Based Primary Care

Jun 06, 2019 , NewsLine - Healthcare Professionals
The field of home-based primary care (HBPC) received extraordinary news as the US Department of Health and Human Services (HHS), in collaboration with the Centers for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI), announced its groundbreaking CMS Pri......
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CMS Releases Guidance To Help States Better Monitor ‘Spread Pricing’ That Can Increase Drug Costs

May 21, 2019 , Kaiser Health News
Over the past year, so-called "spread pricing" has generated controversy over allegations that pharmacy benefit managers pocket portions of payments that should go to state programs. CMS is trying to mitigate that with new guidance. In other pharmaceutical news: a false advertising lawsuit, a dispute over immunotherapy, a health-tracking forum, and more....
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NACDS, NCPA react to CMS’ new drug pricing rule

May 18, 2019 , Drug Store News - Retail
NACDS, and NCPA reacted with disapproval after a final drug pricing rule excluded reforms to pharmacy DIR fees. Read More...
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CMS issues new guidance addressing “spread pricing” in Medicaid

May 17, 2019 , Drug Store News - Retail
CMS' new guidance clarifies how current regulations require “spread pricing” to be accounted for in the calculation of Medical Loss Ratios. Read More...
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CMS's Physician Compare website falls short in statistical review

May 10, 2019 jonah.comstock@mobihealthnews.com (Jonah Comstock), Mobile Health News
Researchers say 99.7% of physicians' profiles lack individual quality data and 77% lack group...
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Cardon Children's Medical Center

Federal Regulations Weren’t The Reason Insurers Shied Away From Selling Over State Lines, Health Companies Say

May 08, 2019 , Kaiser Health News
CMS wants to make it easier for insurers to sell across state lines, but those companies say it's not regulations that are stopping them. "These states have each taken a different approach, none of which has, to date, resulted in insurers offering comprehensive health insurance in a state in which it is not licensed," the National Association of Insurance Commissioners said in a comment letter. "This shows that the impediments to interstate sales are not in federal law but are inherent in the...
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Tennessee To Seek Controversial Medicaid Block Grant Waiver In Move That Will Test How Far CMS Is Willing To Go

May 07, 2019 , Kaiser Health News
The Trump administration has been studying whether it legally can allow states this leeway, and Democratic lawmakers have vowed to fight block grants if CMS approves them. Critics say that shifting to block grants would leave states with little option other than to slash Medicaid enrollment and benefits. News on Medicaid comes out of Kansas and Iowa, as well....
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Fired-Up Wisconsin Governor Says He’s Not Giving Up On Medicaid Expansion, Even After Lawmakers Block Plan

May 04, 2019 , Kaiser Health News
"I’m here today with a message for the people of Wisconsin: I’m going to fight like hell for Medicaid expansion and I need your help to get it done," said Gov. Tony Evers (D-Wis.) Meanwhile, CMS finalizes a rule on union dues, Tennessee lawmakers are at an impasse over block grants, a nonprofit must return Medicaid funds to Delaware, and the number of uninsured kids is on the rise....
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CMS approves Livongo as enrolled provider for Medicare Advantage

May 01, 2019 dave.muoio@himssmedia.com (Dave Muoio), Mobile Health News
In addition, the company's diabetes management program will soon be available to qualifying Cambia Health Solution...
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Medicare buy-in option beginning at 55 the most likely expansion route, says former CMS chief

Apr 27, 2019 , Healthcare Business News
If everything goes right for Democrats in the 2020 election, the most likely Medicare expansions are not the ones getting the headlines now, says a former Medicare...
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Insurers To Be Allowed To Prevent Drug Coupons From Applying To Annual Limit On Out-Of-Pocket Costs In Some Cases

Apr 20, 2019 , Kaiser Health News
CMS will allow insurers to implement the restrictions when there's a generic drug available to the patient. CMS argues that the rule would encourage patients to use generic drugs and lower drug...
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Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals

Apr 17, 2019 , Kaiser Health News
The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care...
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Calif.-Based Sutter Health Agrees To $30M Settlement Over Allegations Of Submitting Inflated Diagnosis Codes To CMS

Apr 16, 2019 , Kaiser Health News
The Department of Justice alleges that Sutter and its affiliates submitted diagnosis codes that inflated the risk scores for certain beneficiaries in their care. “With some one-third of people in Medicare now enrolled in managed care...plans, large health care systems such as Sutter can expect a thorough investigation of claimed enrollees’ health status,” said Steven J. Ryan, special agent in charge with the Office of Inspector General for the U.S. Department of Health and Human...
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CMS's Seema Verma: Medicare for All is 'the greatest threat to innovation in healthcare'

Apr 10, 2019 laura.lovett@himssmedia.com (Laura Lovett), Mobile Health News
Verma also discussed the new AI Health Outcomes Challenge to speed up...
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New CMS ruling expands telehealth access to Medicare Advantage patients

Apr 09, 2019 laura.lovett@himssmedia.com (Laura Lovett), Mobile Health News
The new ruling will expand access geographical and plans will have more flexibility in payment...
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CMS Ignores Federal Judge Ruling To Approve Medicaid Work Rules in Utah

Mar 30, 2019 , Kaiser Health News
Work helps make people healthier, CMS chief Seema Verma said in approving Utah’s waiver request to tie government health benefits to employment or volunteer work. But Judge James Boasberg has said that isn’t the goal of...
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CMS May Expand Use Of A Procedure That Allows Doctors To Replace The Aortic Heart Valve Without Open-Heart Surgery

Mar 28, 2019 , Kaiser Health News
The proposed policy follows on the heels of recent studies that found the alternative way of replacing an aortic heart valve is safe and effective....
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CMS Issues Guidance To Help Determine If Assisted-Living Facilities Are Meeting Medicaid Funding Requirements

Mar 26, 2019 , Kaiser Health News
The new guidance all applies to group homes and home-based care settings. In other news, the number of providers participating in CMS' advanced bundled payment model has...
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CMS Report Reveals Interesting Statistics on Provider Participation in Quality Payment Program

Mar 26, 2019 , Healthcare Business News
March 25—CMS first annual report: Most clinicians avoid a negative payment adjustment under...
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March 25-29: What Events Are Coming in Health Care

Mar 22, 2019 , Healthcare Business News
March 21—Next week’s healthcare finance events and developments include the deadline to submit comments on changes to the CMS hospital overall star ratings....
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