This week, our In Focus section reviews two Medicare fee-for-service (FFS) proposed rules recently issued by the Centers for Medicare & Medicaid Services (CMS). On August 3, 2020, CMS released a proposed rule that includes updates to services furnished under the Medicare Physician Fee Schedule (PFS). On August 4, CMS released the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. These proposed regulations include payment rate and policy changes for the upcoming calendar year. Key features in this year鈥檚 PFS proposed rule include: policies to retain, extend, or end certain telehealth flexibilities implemented in response to the novel COVID-19 public health emergency (PHE), changes to enable certain health care professionals to practice at the top of their licenses, modifications to opioid treatment programs (OTPs), and updates to the Medicare Shared Savings Program (MSSP). View additional information on the PFS Proposed Rule. Among the most notable policy changes in the OPPS and ASC proposed rule are: 1) transitioning services to lower cost settings by eliminating the inpatient-only list to enable more services to be provided in the outpatient settings and increasing the scope of procedures that can be provided in ASCs, 2) further reducing payments for the 340B drug program, and 3) modifying the formula for calculating Hospital Star Ratings, and expand the use of prior authorization for outpatient services. Find additional information about these proposals.
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量子资源网 examines current state of Medicare-Medicaid integration programs
The experts at 量子资源网 (量子资源网) have released the Medicare-Medicaid Integration: Reflecting on Progress to Date and Charting the Path to Making Integrated Programs Available to all Dually Eligible Individuals issue brief and companion bibliography appendix, the second in a series of issue briefs examining Medicare-Medicaid integrated programs.
Based on 量子资源网’s review of the literature and available public information, this brief summarizes the elements for success and barriers encountered by integrated programs. It concludes with essential questions and next steps to move forward with federal and state public policies and care delivery options centered around, informed by, and available to, more dually eligible individuals.
量子资源网 colleagues Sarah Barth, Jon Blum, Elaine Henry, Narda Ipakchi and Sharon Silow-Carroll contributed to the research and final brief.
For the next phase of research, 量子资源网 will convene and interview individuals, their families and other caregivers, providers, payers, community-based organizations, state government, and other stakeholders in select regions across the country.
The project was funded by a grant from , a philanthropy dedicated to tackling some of the most pressing problems in the United States.聽聽
Regulatory changes to Medicare in response to COVID-19
This week, our In Focus section examines how the federal government implemented changes to the Medicare program in response to COVID-19.聽 As the COVID-19 pandemic began in the United States, Congress and the Administration responded with a series of legislative, regulatory, and sub-regulatory changes to the Medicare program that were designed to provide relief from certain Medicare rules to assist health care providers, Medicare Advantage organizations, and Part D plans in responding to the pandemic. Some of these changes waived conditions of Medicare participation to enable patients to be treated in alternative care settings. Others permitted physicians and other providers to receive Medicare reimbursements for telemedicine services.
量子资源网 Information Services adds Medicare Advantage competitive data and state profiles
量子资源网 Information Services (量子资源网IS) is pleased to announce the expansion of its industry-leading healthcare information website to include information and state-by-state profiles of the market for Medicare Advantage and Special Needs Plans (SNPs).
量子资源网 releases COVID-19 Medicare regulation tracking tool
The Medicare program has rapidly transformed how it pays for healthcare providers in response to the COVID-19 pandemic. In an effort to capture these changes, 量子资源网, commissioned by 听补苍诲听, tracked, categorized, and analyzed the 212 Medicare policy modifications made in response to the public health emergency.
量子资源网 Senior Consultant聽Jennifer Podulka聽and Managing Principal聽Jon Blum聽led efforts to analyze and synthesize COVID-19-related legislative, regulatory, and subregulatory changes to existing Medicare regulations issued beginning January 1, 2020. The resulting issue brief聽Regulatory Changes to Medicare in Response to COVID-19聽and companion Policy Tracker use nine categories to organize the data and will be periodically updated to include new information.
The issue brief outlines key COVID-19-related changes including providing telehealth reimbursement for more types of services and providers, and waived conditions of Medicare participation permitting patients to be treated in alternative care settings including community facilities, temporary facilities, homes and in some cases, out of state services on a temporary basis.
Congress and the Trump administration waived or changed regulations to allow flexibility to help healthcare providers, Medicare Advantage plans and Part D plans. The policy tracker catalogs and categorizes these regulatory changes based on characteristics, including types of providers and plans affected, effective date, and expected duration.
These changes have affected virtually all healthcare providers and health plans that participate in the Medicare program, and the issue brief examines several questions surrounding the changes moving forward including risk to beneficiary protections and Medicare spending controls established in the original legislation and rules.
Data collection and analysis for the policy tracker was conducted by 量子资源网 colleagues聽Jennifer Podulka,听Narda Ipakchi,听Zach Gaumer,听Yamini Narayan, and聽Elaine Henry. This project was supported by grants from聽聽 and聽.
Hawaii Releases Quest Integration Reprocurement RFI
This week, our In Focus section reviews the Hawaii request for information (RFI) regarding reprocurement of the state鈥檚 QUEST Integration (QI) Medicaid managed care program, released on July 21, 2020. QI covers approximately 360,000 individuals, including pregnant women, children, parents/caretakers, adults, and individuals who are aged, blind, or disabled (ABD). The state had awarded contracts earlier this year, however, the contracts were rescinded as the state focused on their response to COVID-19.
Webinar Replay: Exploring Medicare Advantage Plans as a New Business Strategy
This webinar was held on August 6, 2020.
The COVID-19 pandemic shined a spotlight on funding pressures on providers and systems that rely largely on fee-for-service payment. This, along with additional stressors brought on by the pandemic, has led many health systems and providers to consider revenue diversification and service expansion strategies. During this webinar, 量子资源网 Medicare Advantage experts addressed the option of using Medicare Advantage as a strategy to better manage care of patients and provide a steady stream of predictable revenues.
Learning Objectives:
- Evaluate the benefits and risks of exploring a Medicare Advantage business strategy.
- Understand the evolving national Medicare Advantage policy landscapes and competitive marketplace.
- Assess various Medicaid Advantage plan options and strategic business considerations.
- Find out about the unique market opportunities of Medicare Advantage Special Needs Plans.
- Learn what needs to be done for a successful Medicare Advantage launch or expansion in 2022.
量子资源网 Speakers
Jon Blum, Managing Principal, Washington, DC
Mary Hsieh, Managing Principal, Atlanta, GA
Webinar Replay: Leveraging the Primary Care Team鈥檚 Strengths During Reopening: Part 3 – Payment and Documentation
This webinar was held on July 29, 2020.
In this webinar, 量子资源网 primary care experts discussed current payment flexibilities that allow physician practices to maintain revenues while operating in a virtual environment. Given the likelihood that many patients will continue to receive care virtually even after the pandemic, 量子资源网 experts explored mechanisms for alternative payment models that support virtual care and allow for efficient use of the care team. Speakers also shared necessary considerations for documentation to assure data capture and appropriate billing.
Learning Objectives
- Discuss current relaxation of regulations related to the National Emergency Declaration and CMS flexibility.
- Understand the use of alternative payment models to enhance revenue opportunities for practices providing virtual care.
- Understand the need for new templates and order sets to support virtual care.
- Discuss EHR optimization to improve care processes and capture data.
Speakers
Helen Duplessis, MD, Principal, Los Angeles, CA
Lisa Harrison, MS, MHS, PA-C, Senior Consultant, Denver, CO
Roxane Townsend, MD, Managing Principal, Raleigh, NC