CMS
CMS Launches GUIDE Model to Improve Dementia Care
July 15, 2024On July 1, the Centers for Medicare and Medicaid Services (CMS) launched the Guiding an Improved Dementia Experience (GUIDE) Model. This eight-year, voluntary nationwide initiative aims to support individuals with dementia…
Last week, the Centers for Medicare & Medicaid Services (CMS) released a summary report from the Standing Technical Expert Panel (TEP) convened on December 15, 2023, to develop, evaluate, and maintain Post-Acute…
On July 3, the Centers for Medicare & Medicaid Services (CMS) notified hospices of non-compliance with Hospice Quality Reporting Program (HQRP) requirements for calendar year (CY) 2023, impacting their fiscal…
The HCBS CAHPS survey measures participant experiences in areas such as access to services, communication with providers, choice of services, and personal safety. The insights gathered help home care providers…
The Centers for Medicare and Medicaid Services (CMS) released the CY 2025 Home Health proposed rule, signaling that more significant cuts could be on the way for providers. The proposed…
New Edition of HHVBP Newsletter Focuses on Annual Performance Reports, Future Reporting Schedule
July 1, 2024The latest edition of the Expanded Home Health Value-Based Purchasing (HHVBP) Model newsletter is now available. CMS has announced that the preview CY 2024 Annual Performance Report (APR) will be…
CMS Releases New HQRP Quarterly Update
July 1, 2024The latest quarterly Hospice Quality Reporting Program (HQRP) Update has been released via email, featuring crucial annual payment reminders and details on the FY 2025 reconsideration period. CMS has also…
The Center for Medicare & Medicaid Services (CMS) will host a virtual conference on August 7 and 8 from 12 – 4 p.m. for anyone who processes Medicare Part A…
Section 2718 of the Public Health Services Act, titled “Bringing Down the Cost of Health Care Coverage,” requires each hospital operating within the United States (U.S.) for each year to…
The Centers for Medicare & Medicaid Services (CMS) announced the end of the Change Healthcare/Optum Payment Disruption (CHOPD) Program on July 12, 2024. Launched in March, CHOPD provided financial support…
The Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary has released projections of National Health Expenditures (NHE) and health insurance enrollment for the years 2023-2032. The Office…
The Centers for Medicare & Medicaid Services (CMS) has issued the Final April 2024 Interim Performance Reports (IPRs). These reports, which reflect updates to claims-based measure scores, are now available…
CMS Releases Updated Health Equity Fact Sheet
June 10, 2024On May 24, 2024, the Centers for Medicare and Medicaid Services (CMS) released an updated Health Equity Fact Sheet. Based on this fact sheet, home health, home care, and hospice providers…
CMS Revises Hospice Certifying Physician Enrollment Requirement Implementation Guidance
June 10, 2024On June 6, 2024, in response to concerns raised by the provider community, the Centers for Medicare & Medicaid Services (CMS) retracted its guidance indicating that any individual who elects…
Providers can now access the latest Provider Preview Reports via the Certification and Survey Provider Enhanced Reports (CASPER) application. Once released in CASPER, providers will have 30 days during which…
Medicare Provider Compliance Tips
June 3, 2024Looking for information on The Centers for Medicare & Medicaid Services (CMS) Provider Compliance Tips program? Plus, the new CMS tool provides high level guidance on how to prevent claim denials…
PHA Comments: CMS-1810-P Proposed Rule on FY 2025 Hospice Wage Index and Payment Rate Update
June 3, 2024PHA submitted comments to the Centers for Medicare & Medicaid Services on the recently proposed rule by CMS, titled “Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update,…
New Edition: HQRP Quarterly Q&As Now Available
June 3, 2024The HQRP Quarterly Q&A for Q1 2024 is now available. This Q&A includes selected questions received by the Hospice Quality Help Desk during the first quarter of 2024 (January 1…
CMS Open Door Forum
June 3, 2024CMS held a Home Health, Hospice, and DME Open Door Forum (ODF) on Wednesday, May 22 to provide updates on the Hospice Quality Reporting Program. Members are encouraged to sign…
On May 3, 2024, The Centers for Medicare & Medicaid Services (CMS) released the following revisions to the State Operations Manual (SOM): These revisions are effective immediately; however, state survey agency…
GAO Releases Medicare Hospice Report Recommending CMS to Implement Statutory Provisions and Prioritize Certain Overdue Surveys
May 13, 2024On May 8, the Government Accountability Office (GAO) released its anticipated report, Medicare Hospice: CMS Needs to Fully Implement Statutory Provisions and Prioritize Certain Overdue Surveys. This report found that CMS…
On April 30, the U.S. House Energy and Commerce Subcommittee on Health held a hearing titled “Legislative Proposals to Increase Medicaid Access and Improve Program Integrity” that included discussions regarding…
The Home and Community Based Services (HCBS) Quality Dataset was first implemented in 2022 with the intent establishing a national quality framework that allows for standardization of quality measurement and improvement activities…
The Preliminary April 2024 Interim Performance Reports (IPRs) for the expanded HHVBP Model have been published on the Internet Quality Improvement and Evaluation System (iQIES). The quarterly IPRs provide HHAs…
Medicaid Access and Accountability 80/20 Rule Released
April 29, 2024The CMS final rule entitled, “Ensuring Access to Medicaid Services,” proposed to address key issues in Medicaid services, was issued this week. PHA issued a statement and is working diligently to review…
CMS Issued Updates to Home Health Claims Processing
April 29, 2024The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 14543, addressing critical aspects of home health care reporting, including county codes, notice of admission exceptions, telehealth service reporting,…
Important Change: The May 1 go-live date for the Medicare hospice certifying physician enrollment requirement is delayed until June 3. The hospice physician enrollment requirement was originally set to begin on…
Care Compare Quarterly Refresh – April 2024
April 29, 2024The April 2024 quarterly refresh for the Home Health Quality Reporting Program is now available on Care Compare. For this refresh, Home Health (HH) Outcome and Assessment Information Set (OASIS) will…
REMINDER: The Medicare Credit Balance Report for the quarter ending March 31 is due by April 30, 2024. CGS Administrators, LLC (CGS) will suspend all claim payments at 100% if a completed…
There is a new location for accessing the Patient Assessment Change Request Forms effective immediately. The Change Request Forms for MDS, OASIS, IRF, LTCH, and Hospice can be found at…
Beginning May 1, 2024, physicians must be enrolled in or validly opted out of Medicare to certify a patient’s terminal illness under the Medicare hospice benefit. CMS has indicated hospices…
Hospice Item Set (HIS) Manual V3.02 Now Available
April 22, 2024An updated HIS Manual V3.02 is now available. The updates include an extension of the documents expiration date and several minor edits and date corrections. Updated documents include the HIS…
As reported in last week’s Connections, the fiscal year (FY) 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements proposed rule has been…
HHAs: Preview Reports, Star Rating Preview Reports for July Refresh Now Available in iQIES
April 8, 2024Home health providers can now access their Preview Reports and Star Rating Preview Reports for the July 2024 refresh in iQIES. For this refresh Home Health (HH) Outcome and Assessment…
This blog introduces the Quality Pathway, a new initiative focusing on enhancing quality in healthcare. Authored by Dr. Susannah Bernheim, Chief Quality Officer at the CMS Innovation Center, and titled…
The U.S. Department of Health and Human Services (HHS), under the Centers for Medicare & Medicaid Services (CMS), has finalized a rule aimed at enhancing access to care and safeguarding…
The Next Generation Accountable Care Organization (NGACO) Model’s final report has been released, detailing lessons learned from its implementation between 2016 and 2021. This model aimed to improve value and…
On March 27, CMS issued a release regarding the Biden-Harris Administration’s final rule aimed at enhancing the enrollment process and maintaining health coverage for millions of Americans under Medicaid, the Children’s Health…
CMS Proposes 2.6% Pay Raise for Hospices in 2025
April 1, 2024The Centers for Medicare & Medicaid Services (CMS) have proposed a 2.6% pay raise for hospices in the fiscal year 2025. This increase amounts to $705 million compared to FY…
In a post-acute care outreach email, CMS included that a new page has been added to help hospice providers with correcting demographic data. The page, “How to Update Hospice Demographic Data,”…
There will be a temporary pause in distributing CBRs and PEPPERs as CMS works to improve and update the program and reporting system, effective through the fall of 2024. For…
CMS Releases Tool to Help Health Care Providers and Organizations Check Whether or Not They Are Considered HIPAA Covered Entities
March 25, 2024The Centers for Medicare and Medicaid Services has released a new tool to help providers, clearinghouses, and health plans determine if an organization or individual is covered under the Administrative…
CMS Issues Revised Interpretive Guidelines for the Home Health Conditions of Participation (CoPs)
March 25, 2024The Centers for Medicare & Medicaid Services (CMS) has updated Appendix B of the State Operations Manual (SOM) to provide guidance for surveyors in assessing home health agencies (HHAs). These updates reflect…
2024 HCBS CAHPS Report: Participants Satisfied with Quality of Care, Workforce Issues Still Impacting Access
March 18, 2024Individuals receiving Medicaid home and community-based services are overwhelmingly satisfied with the care they receive, yet ongoing workforce issues continue to impact access to care, according to the2024 Home and Community-Based…
Claims Processing Issue: Claims Returning to Provider in Error Due to NOA Offline (Reason Code 19963)
March 18, 2024CGS continues to receive questions from home health providers regarding claims that were returned in error because the corresponding NOA is offline (reason code 19963). If you identify claims that…
New HHVBP Newsletter Highlights Quality Measures + PHA HHVBP Webinar Track Kicks Off March 25!
March 18, 2024Home health providers can access the March Home Health Value-Based Purchasing (HHVBP) Newsletter. This month’s edition includes information on interim performance reports, a look ahead in 2024, a review of the…
CMS Issued Revised Hospice Model Statement
March 18, 2024The Centers for Medicare and Medicaid Services (CMS) has released an updated Hospice Model Election Statement, dated March 2024. Hospices utilizing the CMS Model Election Statement or incorporating its language into…
Last month, the CMS MLN Connects newsletter clarified “that hospice and skilled nursing facility medical directors and administrators are always considered managing employees for Medicare provider enrollment purposes. You must report all current…
The Centers for Medicare and Medicaid Services (CMS) has updated its enrollment FAQs for marriage and family therapists and mental health counselors. This update includes new resources and provides clarification on supervision…
On March 1, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 13449 to establish and implement a new “stay of enrollment” status for Medicare-enrolled providers in an effort to…