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 […]
CHA to Host Webinar on Medi-Cal Long-Term Care
CHA will host a Feb. 3 webinar on changes to Medi-Cal long-term care (LTC), which is being standardized across the state under California Advancing and Innovating Medi-Cal.
CMS Releases Additional Information on Converting to a Medicare Rural Emergency Hospital
The Centers for Medicare & Medicaid Services (CMS) released additional information about the enrollment process that is required for critical access hospitals and rural prospective payment system hospitals with 50 or fewer beds to convert to a Medicare rural emergency hospital (REH).
CMS Announces 2023 Accountable Care Model Participation
The Centers for Medicare & Medicaid Services (CMS) has announced that more than 700,000 health care providers and organizations are participating in at least one of three accountable care models in 2023.
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.
CMS Awards First Round of GME Residency Slots to Hospitals Serving Underserved Communities
The Centers for Medicare & Medicaid Services has awarded 200 new Medicare-funded graduate medical education residency slots to hospitals serving rural and underserved communities.
CHA Issues Summary of Proposed Changes to Medicare Advantage, Part D Plans
CHA has issued a members-only summary, prepared by Health Policy Alternatives, Inc., of the proposed changes to Medicare Advantage (MA) and Part D programs for contract year 2024.
CHA Issues Summary of Proposals to Streamline Prior Authorization Process for Certain Plans
CHA has issued a members-only summary, prepared by Health Policy Alternatives, Inc., of the proposed rule recently issued by the Centers for Medicare & Medicaid Services that would streamline prior authorization processes for Medicare Advantage, Medicaid managed care, and federally facilitated marketplace health plans.