Health Insurance Exchange

June 20, 2018  By Seema Verma, Administrator, Centers for Medicare & Medicaid Services Working Together for Value Over the past year, the Centers for Medicare & Medicaid Services (CMS) has engaged with the provider community in a discussion about regulatory burden issues. This included publishing a Request for Information (RFI) soliciting comments about areas of high regulatory burden. One of the top areas of burden identified in the over 2,600 comments received was compliance with the physician self-referral law (often called the “Stark Law”) and its accompanying regulations.  In response to these concerns, CMS undertook a review of the existing regulations to determine where the... Read more »

June 11, 2018 CMS Opioids Roadmap Although some progress has been made in efforts to combat the opioid epidemic, the latest data from the Centers for Disease Control and Prevention indicate the crisis is not slowing down. However, it is important for our beneficiaries across the country to know that the Centers for Medicare & Medicaid Services (CMS) is exploring all of our options to address this national crisis. As evidence of our commitment to the health and well-being of patients, CMS is publishing a roadmap outlining our efforts to address this issue of national concern. In this roadmap, we detail our... Read more »

By: Administrator, Seema Verma, Centers for Medicare & Medicaid Services In his first 500 days in office, President Donald J. Trump has achieved results both at home and abroad for the American people, working to ensure government is more accountable to the American people. One of the many promises the Trump Administration has made and kept is improving accountability and transparency in Medicaid. Medicaid provides healthcare for more than 75 million Americans, including many of our most vulnerable citizens, at an annual cost of over $558 billion. It has grown significantly over the years, consuming an every greater share of our public... Read more »

By: Administrator, Seema Verma, Centers for Medicare & Medicaid Services Quality Payment Program Exceeds Year 1 Participation Goal  I’m pleased to announce that 91 percent of all clinicians eligible for the Merit-based Incentive Payment System (MIPS) participated in the first year of the Quality Payment Program (QPP) – exceeding our goal of 90 percent participation. Remarkably, the submission rates for Accountable Care Organizations and clinicians in rural practices were at 98 percent and 94 percent, respectively. What makes these numbers most exciting is the concerted efforts by clinicians, professional associations, and many others to ensure high quality care and improved outcomes... Read more »

By CMS Administrator Seema Verma Nationally expanded performance-based payment model now enrolling service suppliers The Centers for Medicare & Medicaid Services (CMS) in April expanded the Medicare Diabetes Prevention Program (MDPP), a national performance-based payment model offering a new approach to type 2 diabetes prevention in eligible Medicare beneficiaries with an indication of pre-diabetes. For the first time, both traditional healthcare providers and community-based organizations can enroll as Medicare suppliers of health behavior change services. This innovative model promotes patient-centered care and continues to test market-driven reforms to drive quality of care and improve outcomes for America’s seniors, more than a... Read more »

CMS Blog https://blog.cms.gov/2018/03/02/medicare-access-and-chip-reauthorization-act-of-2015-macra-funding-opportunity March 2, 2018 By Kate Goodrich, MD Director, CMS Center for Clinical Standards and Quality & CMS Chief Medical Officer   Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity:Measure Development for the Quality Payment Program CMS is pleased to announce a new funding opportunity for the development, improvement, updating, and expansion of quality measures for use in the Quality Payment Program. CMS will be partnering directly with clinicians, patients, and other stakeholders to provide up to $30 million of funding and technical assistance in development of quality measures over three years. Cooperative agreements provide a unique opportunity for CMS to partner with... Read more »

By: Kate Goodrich, M.D., M.H.S., Director, Center for Clinical Standards & Quality, CMS Chief Medical Officer Medicare and other payers are rapidly moving toward a healthcare system that rewards high quality care while spending more wisely. Foundational to the success of these efforts is having quality measures that are meaningful to patients, consumers, and providers alike.  CMS recently announced the “Meaningful Measures” initiative to identify the most impactful areas for quality measurement and improvement and reflect core issues that are most vital to high quality care and better individual outcomes. Each year, CMS publishes a list of quality and cost measures... Read more »

By Kate Goodrich, MD Director, CMS Center for Clinical Standards and Quality & CMS Chief Medical Officer CMS is actively working to move the needle on improving quality in healthcare without additional burden to those providers on the frontlines. CMS recently launched a new initiative, ‘Meaningful Measures,’ which will streamline current measure sets – so providers can focus on the measures that are most impactful – and will move from process measures to outcome measures where possible. A great deal of attention has also been focused on alignment of quality measures within CMS and with commercial payers, and we are committed to... Read more »

November 16, 2017 By: Seema Verma, CMS Administrator @SeemaCMS  Today, CMS is celebrating National Rural Health Day by commemorating our partners who provide quality care to the nearly one in five Americans who reside in rural communities. CMS recognizes the unique challenges facing rural America, and we are taking action to improve access and quality for healthcare providers serving rural patients. This fall, I have been visiting communities throughout the country to learn more about issues critical to improving access to rural healthcare. I travelled to Kansas City and visited the headquarters of the National Rural Health Association to talk with key leadership... Read more »

 CMS Blog https://blog.cms.gov/2017/11/15/cmss-2017-medicare-fee-for-service-improper-payment-rate-is-below-10-percent November 15, 2017 By Kimberly Brandt, Principal Deputy Administrator for Operations (@cms.hhs.gov) The Centers for Medicare & Medicaid Services (CMS) is committed to reducing improper payments in all of its programs, as evidenced by improper payment reduction efforts contained in the Fiscal Year 2018 President’s Budget. CMS’s new leadership is re-examining existing corrective actions and exploring new and innovative approaches to reducing improper payments, while minimizing burden for its partners. Due to the successes of actions we’ve put into place to reduce improper payments, the Medicare Fee-For-Service (FFS) improper payment rate decreased from 11.0 percent in 2016 to 9.5 percent in... Read more »