NQF Recommends Measures for Federal Quality Programs

The National Quality Forum’s Measures Applications Partnership (MAP) has issued its annual recommendations to the Centers for Medicare & Medicaid Services on quality measures under consideration for federal quality programs.   The MAP expressed support for 10, conditional support for 60, declined to support two, and declined to support seven with potential for mitigation. A detailed […]

CMS Finalizes Medicare Advantage Risk Adjustment Data Validation Rule

The Centers for Medicare & Medicaid Services (CMS) issued a rule that finalizes technical details regarding the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. This is the program that CMS uses to recover improper risk adjustment payments made to MA plans.   Final policies include:  Additional information is available in a CMS fact sheet.  

CMS Issues Proposed Payment Updates for MA, Part D Programs for CY 2024

The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2024 advance notice for the Medicare Advantage (MA) and Part D prescription drug programs.   CMS estimates that MA revenue would increase by 1.03% compared to the prior year. Comments are due by 2 p.m. (PT) on March 3 and the final […]

CalAIM Long-Term Care Carve-In

To increase access to comprehensive care coordination, care management, and a broad array of services for Medi-Cal beneficiaries, CalAIM is standardizing Medi-Cal Long-Term Care (LTC) across the state. Effective January 1, all managed care plans must authorize and cover medically necessary LTC services at Skilled Nursing Facilities.