Submitted Electronically RE: CMS-1609-P: ISSUE # 1: Solicitation of Comments on Definitions of Terminal Illness and Related Conditions :

Size: px
Start display at page:

Download "Submitted Electronically RE: CMS-1609-P: ISSUE # 1: Solicitation of Comments on Definitions of Terminal Illness and Related Conditions :"

Transcription

1 June 20, 2014 Submitted Electronically Ms. Marilyn B. Tavenner Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services 200 Independence Avenue, SW Washington, DC RE: CMS-1609-P: Medicare Program; FY 2015 Hospice Wage index and Payment Rate Update; Hospice Quality Reporting Requirements and process and Appeals for Part D Payments of Drugs for Beneficiaries Enrolled in Hospice Dear Ms. Tavenner: LeadingAge appreciates the opportunity to comment on this proposed regulation. The members of LeadingAge and affiliates touch the lives of 4 million individuals, families, employees and volunteers every day. The LeadingAge community (www.leadingage.org) includes 6,000 notfor-profit organizations in the United States, 39 state partners, hundreds of businesses, research partners, consumer organizations, foundations and a broad global network of aging services organizations that reach over 30 countries. The work of LeadingAge is focused on advocacy, education, and applied research. We promote home health, hospice, community-based services, adult day service, PACE, senior housing, assisted living residences, continuing care communities, nursing homes as well as technology solutions and person-centered practices that support the overall health and wellbeing of seniors, children, and those with special needs. We provide comments below on the following sections of the proposed rule: Definitions of Related Conditions; Process and appeals for Part D payment for drugs while beneficiaries are under a hospice election; Future development of the Hospice Quality Reporting Process; Public Availability of Data Submitted; Proposed Adoption of the CAHPS Hospice Survey for the FY 2017 Payment Determination; Adoption of Electronic Health Records by hospice agencies; Timeframes for filing the Notice of Election and Notice of Termination/Revocation; and the proposed changes to the Hospice Election form. ISSUE # 1: Solicitation of Comments on Definitions of Terminal Illness and Related Conditions : We agree there is a need to improve the definition of related conditions in order

2 Page 2 to strengthen and clarify the current concepts of hospice care under the Medicare hospice benefit. CMS clinical collaborative effort solicits comments on the following definitions: TERMINAL ILLNESS: Abnormal and advancing physical, emotional, social and/or intellectual processes which diminish and/or impair the individual s condition such that there is an unfavorable prognosis and no reasonable expectation of a cure; not limited to any one diagnosis or multiple diagnoses, but rather it can be the collective state of diseases and/or injuries affecting multiple facets of the whole person, are causing progressive impairment of body systems, and there is a prognosis of a life expectancy of six months or less. RELATED CONDITIONS: Those conditions that result directly from terminal illness; and/or result from the treatment or medication management of terminal illness; and/or which interact or potentially interact with terminal illness; and/or which are contributory to the symptom burden of the terminally ill individual; and/or are conditions which are contributory to the prognosis that the individual has a life expectancy of 6 months or less. COMMENT: LeadingAge believes that longstanding, pre-existing conditions; and comorbidities and the maintenance of comorbidities should not be considered related conditions. We have no recommendations for revisions to the current definition of terminal illness. RECOMMENDATION: We request that CMS include in the definition of related conditions : Clarification that longstanding and / or pre-existing condition are excluded Exclusion of comorbidities that do not have a direct causal connection to the illness that contributed to the prognosis that the individual has a life expectancy of 6 months or less. ISSUE #2: Process and appeals for Part D payment for drugs while beneficiaries are under a hospice election: In section III.I, CMS is soliciting comments on the process that Part D plan sponsors could use to coordinate with Medicare hospices in determining coverage of drugs for hospice beneficiaries and resolving disagreements between the parties. COMMENTS: According to the Part D Payment for Drugs for Beneficiaries Enrolled in Hospice Final 2014 Guidance released on March 10, 2014, the beneficiary s appointed representative, or the prescriber has a number of ways to contact the Part D sponsor to request a coverage determination. The prescriber may provide a verbal explanation to the Part D sponsor regarding why the drug is unrelated to the terminal illness or related conditions or complete the Prior Approval form and submit it to the Part D sponsor via fax or mail. At times, the hospice provider may have to contact either the prescriber or the Part D sponsor in order to explain why the drug is unrelated to the terminal illness or related conditions. The guidance also states that the applicable adjudication time frame is 24 hours (for expedited requests) or 72 hours (for standard requests) from the time the explanation of un-relatedness to the terminal illness or related conditions is received from the hospice provider or prescriber.

3 Page 3 LeadingAge believes the problem with determining coverage responsibility may be due to the lack of understanding and consistency of the terms, Terminal Illness and Related Conditions. Additionally, the guidance CMS has given on who is responsible for paying for specific medications assumes that Medicare hospice beneficiaries will be appropriately educated at the pharmacy counter about how to secure a coverage determination from their Part D plan when prior authorization is required. Finally, LeadingAge is concerned that many Medicare beneficiaries who are denied a medication at the pharmacy counter will not receive this education and may be unaware of their appeal rights, especially since the existing standardized pharmacy notice is not tailored to situations involving hospice. This means that hospice patients, with a limited life expectancy, will lack clear, concise and targeted information about how to secure a medication when refused at the pharmacy counter. RECOMMENDATION: LeadingAge recommends the following: CMS should suspend the current policy directing Part D plans to place prior authorization requirements on all prescriptions for hospice beneficiaries. CMS needs to develop and disseminate a pharmacy notice that is tailored to situations involving hospice CMS should develop additional guidance for all Part D sponsors to follow when determining if a Medicare hospice beneficiary s medication should or should not be paid through Part D. The guidance should address the use of medications for longstanding diseases and diseases that occur due to reasons not related to the terminal illness. CMS needs to develop a dispute resolution process effective FY 2015 to address cases where the hospice provider and Part D sponsor fail to coordinate the payment for their medication benefits Hospice providers should be permitted to initiate the prior approval process before submission of a claim under Part D to avoid any issues associated with data lags or the workload associated with fulfilling prior approvals. CMS should establish and require the use of a standard Prior Approval form to facilitate the process CMS should include hospice-related complaints in the Medicare Part D sponsors star rating to identify Part D sponsors that are above the regional average for denials of payment for medications for hospice beneficiaries. ISSUE # 3: Future development of the Hospice Quality Reporting Process. CMS believes that future development of the Hospice Quality Reporting Process (HQRP) should address existing measure gaps by focusing on two primary opportunities: Expand measures already in use in other quality reporting programs that could apply to the HQRP

4 Page 4 Develop new measures if no suitable measures are ready for implementation or expansion. CMS is particularly interested in outcome measures for symptom management, particularly pain, as well as measures of patient reported outcomes. At present, it is planned to use NQF #1634 for Pain Screening and NQF #1637 Pain Assessment COMMENTS: LeadingAge is pleased the NQF 1634 Pain Screening may be completed using verbal, numeric, visual analog, rating scales designed for use with non-verbal patients, or other standardized tools. The flexibility in this screening tool will allow the hospice provider to screen for pain in verbal or non-verbal, cognitively impaired or oriented patients enrolled in hospice for 7 or more days. LeadingAge is also pleased the NQF 1637 Pain Assessment that notes the implementation of a pain assessment within 24 hours is being considered. There has been extensive research done on both of these measures. RECOMMENDATION: Although extensive research has been done on these two outcome measures, we recommend that CMS continue to ask for stakeholder input concerning the reliability and validity of the measures prior to public reporting. ISSUE # 4: Public Availability of Data Submitted. Under section 1814(i)(5)(E) of the Act, the Secretary is required to establish procedures for making any quality data submitted by hospices available to the public. The Secretary is also authorized to report quality measures that relate to services furnished by a hospice on the CMS Web site. Hospices will begin data collection in CY 2014 (Q3). The data from CY 2014 (Q3, Q4) will not be used for assessing the validity and reliability of the quality measures. Data collected by hospices during Q1 3 CY 2015 will be analyzed starting in CY Decisions about whether to report some or all of the quality measures publicly will be based on the findings of analysis of the CY 2015 data. In addition, as noted, the Affordable Care Act requires that reporting be made public on a CMS Web site and that providers have an opportunity to review their data prior to public reporting. CMS states in the proposed rule that Public reporting may occur during FY 2017, allowing ample time for data analysis, review of measures appropriateness for use for public reporting, and allowing hospices the required time to review their own data prior to public reporting. COMMENTS: LeadingAge recommends that when developing future proposals concerning public reporting of hospice quality data, CMS address the diversity in the patient characteristics of the Medicare beneficiaries being served under hospice, as well as the location of where they are being served. The diversity in Medicare hospice patient s characteristics include: Where hospice services are provided: Community hospice / Skilled Nursing Facility based hospice care Length of time in hospice: Short length of stay hospice/ long length of stay hospice Age: Pediatric/ adult and older adult

5 Page 5 Clinical condition: Neurological disorders, Cancer, etc. Availability of family support It is important that the public have a valid assessment of the Medicare beneficiaries being served by the specific hospice providers as they review the data in each quality measure. RECOMMENDATION: We encourage CMS to continue to ask for stakeholder input concerning the reliability and validity of the measures prior to public reporting in order to demonstrate the ability of the measures to distinguish between the quality of services provided. The public should have access to information on where hospice services are provided, the length of time in hospice, the age of the hospice patient, the clinical condition of the hospice patient and the availability of family support. This information should be included with the quality measures on the CMS website used to report individual hospice quality. ISSUE # 5: Proposed Adoption of the CAHPS Hospice Survey for the FY 2017 Payment Determination. In the Hospice FY 2015 Proposed rule, the process of adopting the CAHPS Hospice survey is described. The monthly surveys would begin on April 1, COMMENTS: LeadingAge believes this timeframe may not be sufficient to adequately finalize the survey questions, approve, train and hire vendors, complete the dry run and correct any concerns that may arise from the dry run. Our conclusion is based on the history of the implementation of the CAHPS Home Health Survey, as well as the special and complex needs of individuals served by hospice, including the terminally ill patient and the family and friends. Also, we know that primary caregivers of patients who died within 48 hours of admission to hospice care are excluded from completing the CAHPS Hospice Survey. According to the March 2014 MedPAC Commission Report to Congress, over a quarter of Medicare hospice decedents enter hospice in the last week of life, a length of stay that is thought to be less benefit to patients. 1 Growth in long-stays has slowed in recent years. LeadingAge is concerned that the data from the CAHPS Hospice Survey may vary based on how long an individual on hospice is utilizing the service. Not for profit hospices tend to have significantly lower average lengths of stay compared to for profit hospices. In 2012, the average length of stay for a for-profit hospice was 105 days compared to 69 days for not for profit hospice providers. 2 It is important that the CAHPS Hospice survey document the length of stay in order to provide an accurate picture of the caregiver s perception of the quality of care the hospice provided to meet the special and complex needs of terminally ill patients and their family and friends. RECOMMENDATION: We encourage CMS to: 1 Medicare Payment Advisory Commission, Report to the Congress: Variation and Innovation in Medicare (Washington: MedPAC, March 2014), chap ibid

6 Page 6 Determine in the dry run if the amount of time the individual receives hospice services impacts the results of the CAHPS Home Health Survey Report the results of the CAHPS Home Health Survey based on time frames, such as 7 days or less, 8 days to a month and more than a month. Consider beginning the monthly surveys in January ISSUE #6: Electronic Health Records. CMS is soliciting feedback and input from providers on topics such as decision support, whether hospices have adopted an EHR and if so, what functional aspects of the EHR do hospices find most important (for example, the ability to send or receive transfer of care information, ability to support medication orders /medication reconciliation); does the EHR used in the hospice setting support interoperable document exchange with other healthcare providers (for example, acute care hospitals, physician practices, and skilled nursing facilities? In addition to seeking public input on the feasibility and desirability of electronic health record adoption and use of HIE in hospices, CMS is also interested in public comment on the need to develop and the benefits and limitations of implementing electronic clinical quality measures for hospice providers. COMMENTS: LeadingAge finds that its hospice members that are part of a continuum of care that may include a hospital system, physician practice, home health agency, PACE, skilled nursing facility, assisted living facility and continuing care retirement community have adopted electronic health records. These not for profit hospices state that the electronic health records help them improve and maintain the continuity in communication among the various disciplines caring for the hospice patient. The plan of care and each professional s notes are easily accessible by everyone involved in the care of the hospice patient. The electronic health record is especially useful in maintaining the accuracy of medication orders and ensuring respect of patient s desires when up to date Advance Directives are maintained and exchanged. Our hospice members that are part of a continuum of care state they try to use the same EHR software vendor as the other providers in their organization, such as home health. The major barrier is that the hospice electronic health record is frequently not interoperable with the electronic health records used in the hospital or physician s office. Also, small hospices and /or hospices in rural/frontier areas tend to have lower financial margins and less access to capital in order to implement an electronic health record system. RECOMMENDATION 3 : Low-interest loan programs could be established to fund initial investment in the health IT infrastructure and accelerate EHR adoption. 3 LeadingAge CAST 2013 HER for Long-Term and Post-Acute Care: A Primer on Planning and vendor selection mer_on_planning_and_vendor_selection.pdf (June 2013)

7 Page 7 The Centers for Medicare and Medicaid Services (CMS) should provide additional funding, including payment incentives tied to quality improvement and/ or cost savings, to accelerate EHR adoption among hospice providers, particularly smaller (stand-alone) hospice providers and those operating in rural areas. Mandate the development and use of uniform standards to govern Health Information Exchange (HIE). More work is needed to create a uniform standard for electronic health information exchange so all providers are speaking the same language when they participate in statewide or regional health information networks. These uniform standards would ensure that all Continuity of Care Documents (CCD), including the Consolidated Clinical Document Architecture (C-CDA), Advance Directives, pharmacy orders and medication reconciliation documents contain common data elements and use the same vocabulary. Government officials should review and adjust regulations that inhibit the seamless exchange of electronic information. For example, regulations in some states make it difficult to transmit pharmacy orders electronically due to regulators discomfort with electronic signatures. In addition, regulations governing how patients consent to the exchange of their health information can create barriers to health information exchange. ISSUE # 7: Proposed Timeframes for Filing the Notice of Election and Notice of Termination/Revocation (a) in section VI. The regulations at (a) would be revised to require hospices to file a NOE within 3 calendar days after the effective date of election; the regulations at and would be revised to require filing of the Notice of Termination or Revocation (NOTR) within 3 calendar days after the effective date of a beneficiary s discharge or revocation, if they have not already filed a final claim. CMS is proposing that when the NOE is filed beyond this 3 day period, the hospice providers would be liable for the services furnished during the days from the effective date of hospice election to the date of NOE filing. COMMENTS: The proposed requirement to file a Notice of Election with its Medicare claims processing contractor within 3 days after the effective date of the election statement and the requirement to file a Notice of Termination of Election within 3 days is an issue for small and/or rural/frontier hospice agencies. RECOMMENDATION: We encourage CMS to consider revising this date to 7 calendar days to allow for small, rural and frontier hospice agencies that may have limited administrative staff available to meet the proposed reporting requirement timely.

8 Page 8 ISSUE # 8: Proposed Changes to the Election Statement ( ) - Including the attending physician on the Hospice Election form. The Medicare Audit Contractors are reporting that the NPI of the attending physician was sometimes changed, and was different from the NPI reported on the Notice of Election. CMS is proposing that the election statement include the patient s choice of attending physician, if the individual wants to change the attending physician, they must file a signed statement identifying the new attending physician and the effective date. COMMENT: Over a third of hospice patients have had multiple providers submit Part B claims as the attending physician using a modifier. It is common practice that the patient s primary care physician may be the attending physician ordering hospice, but the primary care physician refers to a specialist, such as an oncologist for ongoing coverage. Having multiple physicians involved in the patient s treatment does not necessarily mean that the hospice patient did not choose the attending physician that would be writing the orders for hospice services. There is no indication that having multiple physicians reported on the Notice of Election is not in line with the Hospice Condition of Participation stating that the hospice patient chose the attending physician. RECOMMENDATION: LeadingAge recommends that CMS wait until the adoption of the CAHPS Hospice Survey and more data is available to determine the patient s and caregiver s satisfaction with hospice services, including their choices of attending physician. We also believe that legislation needs to be passed that will increase the frequency of surveys of hospice providers. Adding more information to the Election statement, as well as increasing the number of documents that need to be signed by the hospice patient is not the most efficient and accurate method of ensuring the hospice patient is choosing the physician that will order the hospice care. Feedback from patients and caregivers and oversight through the survey process is a more effective way of ensuring that the Hospice Conditions of Participation choice of physician requirement is met. Again, LeadingAge appreciates the opportunity to comment on this proposed rule. We hope our comments will be helpful to you. Please do not hesitate to contact us if you have any questions or would like further discussion. We look forward to our continued work with you on this and related issues. Sincerely, Cheryl Phillips, MD Senior VP Public Policy and Advocacy

Impact of Wage Index Changes (6 th year of BNAF phase out and wage index changes): minus 0.7 percentage points

Impact of Wage Index Changes (6 th year of BNAF phase out and wage index changes): minus 0.7 percentage points TOPIC PROPOSED RULE SUMMARY COMMENT Rates and Estimated hospital market basket update: 2.7 percent Aggregate Cap PROPOSAL Impact of ACA Reductions: minus 0.7 percentage points Impact of Wage Index Changes

More information

FY2015 Hospice Wage Index Proposed Rule

FY2015 Hospice Wage Index Proposed Rule FY2015 Hospice Wage Index Proposed Rule To: NHPCO Members From: NHPCO Health Policy Team Date: May 6, 2014 Summary of FY2015 Hospice Wage Index Proposed Rule On Friday, May 2 2014, CMS released the FY2015

More information

FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Proposed Rule

FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Proposed Rule June 24, 2015 Andrew Slavitt Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services Attention: CMS- 1629-P, Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850

More information

June 2, 2014. RE: File Code CMS-1608-P. Dear Ms. Tavenner:

June 2, 2014. RE: File Code CMS-1608-P. Dear Ms. Tavenner: . June 2, 2014 Marilyn Tavenner Centers for Medicare & Medicaid Services Room 445-G, Hubert H. Humphrey Building 200 Independence Avenue SW Washington, DC RE: File Code CMS-1608-P Dear Ms. Tavenner: The

More information

September 4, 2012. Submitted Electronically

September 4, 2012. Submitted Electronically September 4, 2012 Ms. Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1589-P P.O. Box 8016 Baltimore, MD 21244-8016

More information

September 4, 2012. Dear Acting Administrator Tavenner:

September 4, 2012. Dear Acting Administrator Tavenner: Ms. Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1358-P P.O. Box 8016 Baltimore, MD 21244-8016 RE: CMS-1358-P; Medicare

More information

May 7, 2012. Submitted Electronically

May 7, 2012. Submitted Electronically May 7, 2012 Submitted Electronically Secretary Kathleen Sebelius Department of Health and Human Services Office of the National Coordinator for Health Information Technology Attention: 2014 edition EHR

More information

All Part D Plan Sponsors and Medicare Hospice Providers. Tracey McCutcheon, MHSA, MBA, Acting Director Medicare Drug Benefit and C & D Data Group

All Part D Plan Sponsors and Medicare Hospice Providers. Tracey McCutcheon, MHSA, MBA, Acting Director Medicare Drug Benefit and C & D Data Group DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE TO: FROM: All Part D Plan Sponsors and Medicare

More information

Incorporating Medicare Part D into the Hospice Admissions And Medication Management Process. Compliance for Hospice Providers.

Incorporating Medicare Part D into the Hospice Admissions And Medication Management Process. Compliance for Hospice Providers. Compliance Guide National Hospice and Palliative Care Organization Regulatory & Compliance www.nhpco.org/regulatory Incorporating Medicare Part D into the Hospice Admissions And Medication Management Process

More information

RE: Advancing Interoperability and Health Information Exchange

RE: Advancing Interoperability and Health Information Exchange April 21, 2013 Ms. Marilyn Tavenner Acting Administrator, Chief Operating Officer Centers for Medicare and Medicaid Services Department of Health and Human Services 7500 Security Boulevard Baltimore, MD

More information

Navigating CMS Guidance on Part D Callene Bentoncoury, RN, BSN, MA Administrator, Casa de la Luz Hospice Julia Choate, RN, BSN Director of Quality &

Navigating CMS Guidance on Part D Callene Bentoncoury, RN, BSN, MA Administrator, Casa de la Luz Hospice Julia Choate, RN, BSN Director of Quality & Navigating CMS Guidance on Part D Callene Bentoncoury, RN, BSN, MA Administrator, Casa de la Luz Hospice Julia Choate, RN, BSN Director of Quality & Compliance, Casa de la Luz Hospice Greg Dyke, Rph President

More information

April 28, 2014. Submitted electronically via www.regulations.gov

April 28, 2014. Submitted electronically via www.regulations.gov April 28, 2014 Department of Health and Human Services Office of the National Coordinator for Health Information Technology Attention: 2015 Edition EHR Standards and Certification Criteria Proposed Rule

More information

CMS-14612-P Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations Proposed Rule 79 Fed. Reg. 72760 (December 8, 2014)

CMS-14612-P Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations Proposed Rule 79 Fed. Reg. 72760 (December 8, 2014) American Cancer Society Cancer Action Network 555 11 th Street, NW Suite 300 Washington, DC 20004 202.661.5700 www.acscan.org Marilyn Tavenner Administrator Centers for Medicare & Medicaid Services Department

More information

1900 K St. NW Washington, DC 20006 c/o McKenna Long

1900 K St. NW Washington, DC 20006 c/o McKenna Long 1900 K St. NW Washington, DC 20006 c/o McKenna Long Centers for Medicare & Medicaid Services U. S. Department of Health and Human Services Attention CMS 1345 P P.O. Box 8013, Baltimore, MD 21244 8013 Re:

More information

January 3, 2012. RE: Comments submitted at http://www.regulations.gov.

January 3, 2012. RE: Comments submitted at http://www.regulations.gov. January 3, 2012 RE: Comments submitted at http://www.regulations.gov. Marilyn Tavenner, Acting Administrator U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services Attention:

More information

December 3, 2010. Dear Administrator Berwick:

December 3, 2010. Dear Administrator Berwick: Donald Berwick, M.D. Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, DC 20201

More information

Re: Medicare and Medicaid Programs Electronic Health Record Incentive Program Stage 2

Re: Medicare and Medicaid Programs Electronic Health Record Incentive Program Stage 2 May 7, 2012 Ms. Marilyn Tavenner Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-0044-P Mail Stop C4-26-05 7500 Security Boulevard

More information

Submitted via the Federal erulemaking Portal: http://www.regulations.gov

Submitted via the Federal erulemaking Portal: http://www.regulations.gov Page 1 June 10, 2013 Submitted via the Federal erulemaking Portal: http://www.regulations.gov The Honorable Marilyn Tavenner Administrator Centers for Medicare & Medicaid Services U.S. Department of Health

More information

Re: CMS 3819-P, Medicare and Medicaid Programs; Conditions of Participation for Home Health Agencies; Proposed Rule, Oct. 9, 2014.

Re: CMS 3819-P, Medicare and Medicaid Programs; Conditions of Participation for Home Health Agencies; Proposed Rule, Oct. 9, 2014. Marilyn B. Tavenner Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W., Room 445-G Washington, D.C. 20201 Re: CMS 3819-P, Medicare and Medicaid

More information

Timeline: Key Feature Implementations of the Affordable Care Act

Timeline: Key Feature Implementations of the Affordable Care Act Timeline: Key Feature Implementations of the Affordable Care Act The Affordable Care Act, signed on March 23, 2010, puts in place health insurance reforms that will roll out incrementally over the next

More information

Strengthening Community Health Centers. Provides funds to build new and expand existing community health centers. Effective Fiscal Year 2011.

Strengthening Community Health Centers. Provides funds to build new and expand existing community health centers. Effective Fiscal Year 2011. Implementation Timeline Reflecting the Affordable Care Act 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access

More information

8/14/2012 California Dual Demonstration DRAFT Quality Metrics

8/14/2012 California Dual Demonstration DRAFT Quality Metrics Stakeholder feedback is requested on the following: 1) metrics 69 through 94; and 2) withhold measures for years 1, 2, and 3. Steward/ 1 Antidepressant medication management Percentage of members 18 years

More information

Medicare Part D Hospice Care Hospice Information for Medicare Part D Plans

Medicare Part D Hospice Care Hospice Information for Medicare Part D Plans P. O. Box 31397 Tampa, FL 33631 Medicare Part D Hospice Care Hospice Information for Medicare Part D Plans Table of Contents Introduction...2 Background...2 Purpose...2 1) To document that a drug is unrelated

More information

CAHPS Hospice Survey. What the Heck Does That Mean? What we will discuss today. Direction of CMS Policy THE ROAD TO PUBLIC REPORTING IN HOSPICE

CAHPS Hospice Survey. What the Heck Does That Mean? What we will discuss today. Direction of CMS Policy THE ROAD TO PUBLIC REPORTING IN HOSPICE CAHPS Hospice Survey What the Heck Does That Mean? Charlene Ross, MBA, MSN, RN Consultant/Educator R&C Healthcare Solutions & Hospice Fundamentals 602-740-0783 charlene@rchealthcaresolutions.com 1 What

More information

HOSPICE SERVICES. This document is subject to change. Please check our web site for updates.

HOSPICE SERVICES. This document is subject to change. Please check our web site for updates. HOSPICE SERVICES This document is subject to change. Please check our web site for updates. This provider manual outlines policy and claims submission guidelines for claims submitted to the North Dakota

More information

CMS NEWS. October, 25, 2012 (202) 690-6145

CMS NEWS. October, 25, 2012 (202) 690-6145 DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 CMS NEWS FOR IMMEDIATE RELEASE Contact: CMS Media Relations October,

More information

March 15, 2010. Dear Dr. Blumenthal:

March 15, 2010. Dear Dr. Blumenthal: March 15, 2010 David Blumenthal, MD, MPP National Coordinator Office of the National Coordinator for Health Information Technology (ONCHIT) Department of Health and Human Services ATTN: HITECH Initial

More information

A Comprehensive Case Management Program to Improve Access to Palliative Care. Aetna s Compassionate Care SM

A Comprehensive Case Management Program to Improve Access to Palliative Care. Aetna s Compassionate Care SM A Comprehensive Case Management Program to Improve Access to Palliative Care Aetna s Compassionate Care SM Our chief want in life is somebody who shall make us do what we can. Ralph Waldo Emerson Marcia

More information

Re: Medicare and Medicaid Programs; Electronic Health Record Incentive Program Modifications to Meaningful Use in 2015 through 2017; Proposed Rule

Re: Medicare and Medicaid Programs; Electronic Health Record Incentive Program Modifications to Meaningful Use in 2015 through 2017; Proposed Rule Submitted Electronically Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attn: CMS-3311-P P.O. Box 8013 Baltimore, MD 21244-1850

More information

Strategies for Success in the CMS Medicare Advantage Star Quality Ratings

Strategies for Success in the CMS Medicare Advantage Star Quality Ratings Strategies for Success in the CMS Medicare Advantage Star Quality Ratings The National Pay for Performance Summit February 20, 2013, San Francisco, CA Theresa C. Carnegie Mintz, Levin, Cohn, Ferris, Glovsky

More information

Medicare Benefit Policy Manual

Medicare Benefit Policy Manual Medicare Benefit Policy Manual Chapter 9 - Coverage of Hospice Services Under Hospital Insurance Transmittals for Chapter 9 10 - Requirements - General 20 - Certification and Election Requirements Table

More information

Appeals Provider Manual 15

Appeals Provider Manual 15 Table of Contents Overview... 15.1 Commercial Member appeals... 15.1 Self-insured groups... 15.1 Traditional/CMM Members... 15.1 Who may appeal... 15.1 How to file an internal appeal on behalf of the Member...

More information

Request for Comment Regarding the Stage 3 Definition of Meaningful Use of Electronic Health Records (EHRs)

Request for Comment Regarding the Stage 3 Definition of Meaningful Use of Electronic Health Records (EHRs) January 14, 2013 Farzad Mostashari, MD, ScM National Coordinator for Health Information Technology Chair, Health IT Policy Committee Office of the National Coordinator for Health Information Technology

More information

VIEW FROM WASHINGTON. Judi Lund Person, MPH Vice President, Compliance and Regulatory Leadership, NHPCO

VIEW FROM WASHINGTON. Judi Lund Person, MPH Vice President, Compliance and Regulatory Leadership, NHPCO 1 VIEW FROM WASHINGTON Judi Lund Person, MPH Vice President, Compliance and Regulatory Leadership, NHPCO Today we will discuss 2 Sequestration what s the latest New research on hospice cost savings Basic

More information

(http://www.regulations.gov/#!documentdetail;d=cms-2013-0155-10181) File # CMS-2013-0155-10181

(http://www.regulations.gov/#!documentdetail;d=cms-2013-0155-10181) File # CMS-2013-0155-10181 January 27, 2014 Marilyn Tavenner, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-4159-P P.O. Box 8013 Baltimore, MD 21244-8013 Re: Final

More information

Hospice care services

Hospice care services Hospice care services Summary of change: Effective February 1, 2015, hospice services will be a covered benefit covered by Amerigroup Louisiana, Inc. Amerigroup Louisiana, Inc. recognizes the importance

More information

MEDICARE RECOVERY AUDIT CONTRACTORS AND CMS S ACTIONS TO ADDRESS IMPROPER PAYMENTS, REFERRALS OF POTENTIAL FRAUD, AND PERFORMANCE

MEDICARE RECOVERY AUDIT CONTRACTORS AND CMS S ACTIONS TO ADDRESS IMPROPER PAYMENTS, REFERRALS OF POTENTIAL FRAUD, AND PERFORMANCE Department of Health and Human Services OFFICE OF INSPECTOR GENERAL MEDICARE RECOVERY AUDIT CONTRACTORS AND CMS S ACTIONS TO ADDRESS IMPROPER PAYMENTS, REFERRALS OF POTENTIAL FRAUD, AND PERFORMANCE Daniel

More information

Medical and Rx Claims Procedures

Medical and Rx Claims Procedures This section of the Stryker Benefits Summary describes the procedures for filing a claim for medical and prescription drug benefits and how to appeal denied claims. Medical and Rx Benefits In-Network Providers

More information

Key Features of the Affordable Care Act, By Year

Key Features of the Affordable Care Act, By Year Page 1 of 10 Key Features of the Affordable Care Act, By Year On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll

More information

Request for Information on Assessing Interoperability for MACRA (HHS-ONC-2016-0008)

Request for Information on Assessing Interoperability for MACRA (HHS-ONC-2016-0008) June 3, 2016 Dr. Karen DeSalvo, M.D., M.P.H., M.Sc. National Coordinator for Health Information Technology U.S. Department of Health and Human Services 330 C Street SW Washington, D.C. 20024 Re: Request

More information

RE: CMS-3819-P; Medicare and Medicaid Programs; Conditions of Participation for Home Health Agencies

RE: CMS-3819-P; Medicare and Medicaid Programs; Conditions of Participation for Home Health Agencies January 6, 2015 Marilyn Tavenner Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445 G Attention: CMS-3819-P Hubert H. Humphrey Building, 200 Independence

More information

Re: Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

Re: Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations February 6, 2015 Marilyn Tavenner, Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1461-P P.O. Box 8013 Baltimore, Md. 21244-8013 Re: Medicare

More information

Comprehensive Summary of CMS Final Rule

Comprehensive Summary of CMS Final Rule Comprehensive Summary of CMS Final Rule On Tuesday, November 2, 2010, the Centers for Medicare and Medicaid Services (CMS) issued a final rule to update the Home Health Prospective Payment System (HHPPS)

More information

Managed Long-Term Care in Medicaid:

Managed Long-Term Care in Medicaid: Managed Long-Term Care in From Families USA June 2012 Managed Long-Term Care in Medicaid: What Advocates Need to Know As of May 2012, only 16 states were using managed care plans to provide long-term care

More information

April 22, 2013. Re: Advancing Interoperability and Health Information Exchange. Dear Dr. Mostashari,

April 22, 2013. Re: Advancing Interoperability and Health Information Exchange. Dear Dr. Mostashari, Farzad Mostashari, MD, ScM National Coordinator for Health Information Technology Department of Health and Human Services Office of the National Coordinator for Health Information Technology Hubert H.

More information

Medicare Program; Request for Information to Aid in the Design and Development of a

Medicare Program; Request for Information to Aid in the Design and Development of a CMS-3328-NC This document is scheduled to be published in the Federal Register on 11/20/2015 and available online at http://federalregister.gov/a/2015-29623, and on FDsys.gov DEPARTMENT OF HEALTH AND HUMAN

More information

January 4, 2016 VIA ELECTRONIC SUBMISSION

January 4, 2016 VIA ELECTRONIC SUBMISSION January 4, 2016 VIA ELECTRONIC SUBMISSION Acting Administrator Andy Slavitt Centers for Medicare & Medicaid Services Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244-8016

More information

Health Insurance Reform at a Glance Implementation Timeline

Health Insurance Reform at a Glance Implementation Timeline Health Insurance Reform at a Glance Implementation Timeline 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access

More information

Administrative Code. Title 23: Medicaid Part 205 Hospice Services

Administrative Code. Title 23: Medicaid Part 205 Hospice Services Title 23: Medicaid Administrative Code Title 23: Medicaid Part 205 Hospice Services Table of Contents Table of Contents Title 23: Division of Medicaid... 1 Part 205: Hospice Services... 1 Part 205 Chapter

More information

HOSPICE INFORMED CONSENT

HOSPICE INFORMED CONSENT HOSPICE INFORMED CONSENT PATIENT NAME: INSTRUCTIONS: This form is used to acknowledge receipt of our Orientation Booklet and confirm your understanding and agreement with its contents. Your signature below

More information

HIMSS Public Policy Initiatives in 2015: Using Health IT to Enable Healthcare Transformation Jeff Coughlin Senior Director Federal & State Affairs

HIMSS Public Policy Initiatives in 2015: Using Health IT to Enable Healthcare Transformation Jeff Coughlin Senior Director Federal & State Affairs HIMSS Public Policy Initiatives in 2015: Using Health IT to Enable Healthcare Transformation Jeff Coughlin Senior Director Federal & State Affairs March 26, 2015 Agenda Meaningful Use Stage 3 NPRM 2015

More information

December 5, 2014. Submitted Electronically

December 5, 2014. Submitted Electronically December 5, 2014 Submitted Electronically Ms. Nancy J. Griswold Chief Administrative Law Judge Office of Medicare Hearings and Appeals U.S. Department of Health and Human Services 1700 N. Moore Street

More information

Hospice Widespread edits

Hospice Widespread edits Hospice Widespread edits Befriend this foe to prevent claim denials Beth Noyce, RN, BSJMC, HCS-D D, COS-C C Clinical Educator & QA Specialist and Dana Walling, RN, COS-C Director of Nursing, Branch Manager

More information

An Internist s Practical Guide to Understanding Health System Reform

An Internist s Practical Guide to Understanding Health System Reform An Internist s Practical Guide to Understanding Health System Reform Prepared by: ACP s Division of Governmental Affairs and Public Policy Updated October 2013 How to cite this guide: American College

More information

MEDICARE HOSPICES HAVE FINANCIAL INCENTIVES TO PROVIDE CARE IN ASSISTED LIVING FACILITIES

MEDICARE HOSPICES HAVE FINANCIAL INCENTIVES TO PROVIDE CARE IN ASSISTED LIVING FACILITIES Department of Health and Human Services OFFICE OF INSPECTOR GENERAL MEDICARE HOSPICES HAVE FINANCIAL INCENTIVES TO PROVIDE CARE IN ASSISTED LIVING FACILITIES Daniel R. Levinson Inspector General January

More information

CMS-1461-P Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

CMS-1461-P Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations February 6, 2015 Ms. Marilyn Tavenner Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services 7500 Security Boulevard Baltimore, Maryland 21244 RE: CMS-1461-P Medicare

More information

OFFICE OF INSPECTOR GENERAL

OFFICE OF INSPECTOR GENERAL DEPARTMENT OF HEALT H AND HUMA.l~ SERVIC ES OFFICE OF INSPECTOR GENERAL WASHI NGTON, DC 2020 1 MAY 0 3 2013 TO: Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services FROM: Stuart

More information

Medicare Supplemental Insurance: Medigap: Choosing a plan that fits your needs

Medicare Supplemental Insurance: Medigap: Choosing a plan that fits your needs Medicare Supplemental Insurance: Medigap: Choosing a plan that fits your needs Medicare Supplemental Insurance (also called Medigap) helps consumers cover the financial gap created between Medicare Part

More information

CHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes

CHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes CHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes Understanding CCM Chronic Care Management (CCM) is defined as the non-face-to-face services provided to Medicare

More information

January 18, 2012. Dear Ms. Tavenner:

January 18, 2012. Dear Ms. Tavenner: January 18, 2012 Marilyn Tavenner, RN, BSN, MHA Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services 200 Independence Avenue, SW Washington, D.C. 20201

More information

Tel: 571-527-1520 Fax: 571-527-1521 2121 Crystal Drive, Suite 750, Arlington, VA 22202 www.vnaa.org

Tel: 571-527-1520 Fax: 571-527-1521 2121 Crystal Drive, Suite 750, Arlington, VA 22202 www.vnaa.org June 30, 2014 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1609-P P.O. Box 8010 Baltimore, MD 201244-8010 SUBJECT: Medicare Program: FY2015 Hospice Wage

More information

June 15, 2015 VIA ELECTRONIC SUBMISSION

June 15, 2015 VIA ELECTRONIC SUBMISSION Charles N. Kahn III President & CEO June 15, 2015 VIA ELECTRONIC SUBMISSION Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention:

More information

June 25, 2012. Re: CMS-1588-P; Proposed Quality Reporting Requirements for Ambulatory Surgical Centers (ASCs)

June 25, 2012. Re: CMS-1588-P; Proposed Quality Reporting Requirements for Ambulatory Surgical Centers (ASCs) VIA ELECTRONIC DELIVERY Marilyn Tavenner, Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1588-P Room 445-G Hubert H. Humphrey Building

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Discharge Planning

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Discharge Planning DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services ICN 908184 October 2014 This booklet was current at the time it was published or uploaded onto the web. Medicare policy

More information

3M s unique solution for value-based health care

3M s unique solution for value-based health care A quick guide to 3M s unique solution for value-based health care Part 2: The era of and Current trends industry changes Volume-based health care Value-based health care ICD-9 ICD-10 Inpatient care Outpatient

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES. Electronic Health Records Hospital Inpatient Quality Data Reporting

DEPARTMENT OF HEALTH AND HUMAN SERVICES. Electronic Health Records Hospital Inpatient Quality Data Reporting DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-3278-NC] Medicare Program; Request for Information on Hospital and Vendor Readiness for Electronic Health Records Hospital

More information

Utah Medicaid Hospice Care Provider Training

Utah Medicaid Hospice Care Provider Training Utah Medicaid Hospice Care Provider Training Presented By: The Division of Medicaid and Health Financing Bureau of Authorization and Community Based Services October 2012 1 Hospice Training Topics Client

More information

ADVANCING HIGHER EDUCATION IN NURSING

ADVANCING HIGHER EDUCATION IN NURSING September 4, 2012 Submitted via www.regulations.gov Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attn: CMS 1590 P P.O. Box 8010

More information

(RIN) 0906-AB08; 340-B

(RIN) 0906-AB08; 340-B October, 2015 Ms. Krista Pedley Director, Office of Pharmacy Affairs (OPA) Health Resources and Services Administration (HRSA) 5600 Fishers Lane, Mail Stop 08W05A Rockville, Maryland 20857 Re: Regulatory

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES. Medicare Program; Request for Applications for the Medicare Care Choices Model

DEPARTMENT OF HEALTH AND HUMAN SERVICES. Medicare Program; Request for Applications for the Medicare Care Choices Model DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-5512-N] Medicare Program; Request for Applications for the Medicare Care Choices Model AGENCY: Centers for Medicare

More information

RE: CMS-0033-P, Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule (Vol. 75, No. 8), January 13, 2010

RE: CMS-0033-P, Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule (Vol. 75, No. 8), January 13, 2010 The Honorable Kathleen Sebelius Secretary Department of Health and Human Services 200 Independence Avenue, SW Washington, DC 20201 RE: CMS-0033-P, Medicare and Medicaid Programs; Electronic Health Record

More information

Rural Implications of Changes to the Medicare Hospice Benefit Policy Brief August 2013

Rural Implications of Changes to the Medicare Hospice Benefit Policy Brief August 2013 Rural Implications of Changes to the Medicare Hospice Benefit Policy Brief August 2013 Editorial Note: During its April 2013 meeting in Grand Junction, Colorado, the National Advisory Committee on Rural

More information

Advance Care Planning Services

Advance Care Planning Services September 8, 2015 Andrew Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence, Ave., S.W.

More information

SMD# 13-001 ACA #23. Re: Health Home Core Quality Measures. January 15, 2013. Dear State Medicaid Director:

SMD# 13-001 ACA #23. Re: Health Home Core Quality Measures. January 15, 2013. Dear State Medicaid Director: DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 SMD# 13-001 ACA #23 Re: Health Home Core Quality

More information

4. Program Regulations

4. Program Regulations Table of Contents iv 437.401: Introduction... 4-1 437.402: Definitions... 4-1 437.403: Eligible Members... 4-2 437.404: Provider Eligibility... 4-3 437.405: Out-of-State Hospice Services... 4-3 437.406:

More information

Center for Medicare and Medicaid Innovation

Center for Medicare and Medicaid Innovation Center for Medicare and Medicaid Innovation Summary: Establishes within the Centers for Medicare and Medicaid Services (CMS) a Center for Medicare & Medicaid Innovation (CMI). The purpose of the Center

More information

December 5, 2006. Reference File Code: CMS-4119-P. Dear Sir or Madam:

December 5, 2006. Reference File Code: CMS-4119-P. Dear Sir or Madam: Page 1 of 5 1101 Pennsylvania Avenue Suite 600 Washington, DC 20004-2514 202.756.2227 202.756.7506 [fax] www.accp.com Department of Government & Professional Affairs December 5, 2006 Centers for Medicare

More information

RE: AMIA Comments on Medicare Shared Savings Program: Accountable Care Organizations CMS-1345-P

RE: AMIA Comments on Medicare Shared Savings Program: Accountable Care Organizations CMS-1345-P June 6, 2011 Dr. Donald M. Berwick Administrator Centers for Medicare and Medicaid Services (CMS) Department of Health and Human Services P.O. Box 8013 Baltimore, MD 21244-8013 [Submitted electronically

More information

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions...

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions... TABLE OF CONTENTS SECTION PAGE NUMBER Background... 2 Policy... 2 535.1 Member Eligibility and Enrollment... 2 535.2 Health Home Required Functions... 3 535.3 Health Home Coordination Role... 4 535.4 Health

More information

June 16, Dear Mr. Slavitt:

June 16, Dear Mr. Slavitt: Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W., Room 445-G Washington, DC 20201 RE: CMS-1622-P, Medicare Program;

More information

Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P)

Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Date 2015-04-17 Title Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and

More information

Title 40. Labor and Employment. Part 1. Workers' Compensation Administration

Title 40. Labor and Employment. Part 1. Workers' Compensation Administration Title 40 Labor and Employment Part 1. Workers' Compensation Administration Chapter 3. Electronic Billing 301. Purpose The purpose of this Rule is to provide a legal framework for electronic billing, processing,

More information

RE: CMS-3310-P Electronic Health Record (EHR) Incentive Programs Stage 3

RE: CMS-3310-P Electronic Health Record (EHR) Incentive Programs Stage 3 May 29, 2015 Andy Slavitt Acting Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services Hubert H. Humphrey Building, Room 445 G 200 Independence Avenue, SW

More information

Notice of Imposition of Civil Money Penalty for Medicare Advantage-Prescription Drug Contract Number: H5985

Notice of Imposition of Civil Money Penalty for Medicare Advantage-Prescription Drug Contract Number: H5985 DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 MEDICARE PARTS C AND D OVERSIGHT AND ENFORCEMENT GROUP November 6,

More information

June 28, 2013. Re: Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment. Dear Ms.

June 28, 2013. Re: Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment. Dear Ms. June 28, 2013 Ms. Marilyn Tavenner, Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-6045-P PO Box 8013 Baltimore, MD 21244-8013 Re: Medicare

More information

Key Points about Star Ratings from the CMS 2015 Draft Call Letter

Key Points about Star Ratings from the CMS 2015 Draft Call Letter News From February 24, 2014 Key Points about Star Ratings from the CMS 2015 Draft Call Letter On February 21, 2014 CMS released the 2015 Draft Advance Notice and Call Letter for Medicare Advantage plans.

More information

Request for Information: Advancing Interoperability and Health Information Exchange

Request for Information: Advancing Interoperability and Health Information Exchange April 22, 2013 Ms. Marilyn Tavenner Acting Administrator, Chief Operating Officer Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services Farzad Mostashari, MD, ScM National

More information

Update: Medical Necessity Documentation. Kerry Dunning, MHA, MSH, CPAR, RAC-CT GPS HEALTHCARE CONSULTANTS November 2013

Update: Medical Necessity Documentation. Kerry Dunning, MHA, MSH, CPAR, RAC-CT GPS HEALTHCARE CONSULTANTS November 2013 Update: Medical Necessity Documentation Kerry Dunning, MHA, MSH, CPAR, RAC-CT GPS HEALTHCARE CONSULTANTS November 2013 REMINDER Many claim denials occur because the providers or suppliers do not submit

More information

Compliance Tip Sheet CMS FY 2010 TOP TEN HOSPICE SURVEY DEFICIENCIES COMPLIANCE RECOMMENDATIONS CMS TOP TEN HOSPICE SURVEY DEFICIENCIES

Compliance Tip Sheet CMS FY 2010 TOP TEN HOSPICE SURVEY DEFICIENCIES COMPLIANCE RECOMMENDATIONS CMS TOP TEN HOSPICE SURVEY DEFICIENCIES Compliance Tip Sheet National Hospice and Palliative Care Organization www.nhpco.org/regulatory CMS FY 2010 TOP TEN HOSPICE SURVEY DEFICIENCIES COMPLIANCE RECOMMENDATIONS INTRODUCTION The Centers for Medicare

More information

Medicare doesn t have to be complicated. This guide is provided to help you better understand Medicare and how a Medicare Advantage plan may offer

Medicare doesn t have to be complicated. This guide is provided to help you better understand Medicare and how a Medicare Advantage plan may offer clarity YOUR GUIDE TO MEDicare AdvantaGE Medicare doesn t have to be complicated. This guide is provided to help you better understand Medicare and how a Medicare Advantage plan may offer the coverage

More information

Chapter 4 Health Care Management Unit 1: Care Management

Chapter 4 Health Care Management Unit 1: Care Management Chapter 4 Health Care Unit 1: Care In This Unit Topic See Page Unit 1: Care Care 2 6 Emergency 7 4.1 Care Healthcare Healthcare (HMS), Highmark Blue Shield s medical management division, is responsible

More information

Section 6. Medical Management Program

Section 6. Medical Management Program Section 6. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.

More information

April 3, 2015. Dear Dr. DeSalvo:

April 3, 2015. Dear Dr. DeSalvo: April 3, 2015 Karen DeSalvo, MD, MPH, MSc National Coordinator for Health Information Technology Office of the National Coordinator for Health Information Technology U.S. Department of Health and Human

More information

*The Medicare Hospice Conditions of Participation (2008) (CoPs) contain the federal regulations that govern all Medicare-certified hospice programs.

*The Medicare Hospice Conditions of Participation (2008) (CoPs) contain the federal regulations that govern all Medicare-certified hospice programs. Compliance Tip Sheet National Hospice and Palliative Care Organization www.nhpco.org/regulatory CMS TOP TEN HOSPICE SURVEY DEFICIENCIES COMPLIANCE RECOMMENDATIONS INTRODUCTION The Centers for Medicare

More information

May 28, 2015. Dear Mr. Slavitt:

May 28, 2015. Dear Mr. Slavitt: May 28, 2015 The Honorable Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Ave,

More information

Home Health Face-to-Face Encounter Question & Answers

Home Health Face-to-Face Encounter Question & Answers Home Health Face-to-Face Encounter Question & Answers Question 1: Will requirements be met if a community physician certifies a patient and completes a plan of care when a face-to-face encounter was conducted

More information

CMS 1590-P: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2013

CMS 1590-P: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2013 August 31, 2012 Marilyn Tavenner Acting Administrator and Chief Operating Officer Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1590-P P.O. Box 8013

More information

CMS-1600-P 201. As we discussed in the CY 2013 PFS final rule with comment period, we are

CMS-1600-P 201. As we discussed in the CY 2013 PFS final rule with comment period, we are CMS-1600-P 201 I. Complex Chronic Care Management Services As we discussed in the CY 2013 PFS final rule with comment period, we are committed to primary care and we have increasingly recognized care management

More information

NO. 160. AN ACT RELATING TO THE COORDINATION, FINANCING AND DISTRIBUTION OF LONG-TERM CARE SERVICES. (H.782)

NO. 160. AN ACT RELATING TO THE COORDINATION, FINANCING AND DISTRIBUTION OF LONG-TERM CARE SERVICES. (H.782) NO. 160. AN ACT RELATING TO THE COORDINATION, FINANCING AND DISTRIBUTION OF LONG-TERM CARE SERVICES. (H.782) It is hereby enacted by the General Assembly of the State of Vermont: Sec. 1. DEFINITIONS For

More information

December 3, 2010. Dear Dr. Berwick:

December 3, 2010. Dear Dr. Berwick: December 3, 2010 Donald Berwick, MD Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Avenue, SW

More information