Tag Archives: CMS

Backpedaling from Better Quality Measurement?

Melissa Smith

Few would argue Star Ratings is overdue for evolution. With almost 50 Star Ratings measures, many having been in the program for years, and Secretary Price and Administrator Verma both positioned to make their mark on Medicare, change is imminent. But change is also difficult, a fact acknowledged by the Centers for Medicare & Medicaid Services (CMS) when it reversed course in the 2018 Call Letter on several proposals included in the Advance Notice.

Read more

Leave a comment | Share | |

Adjusting Star Ratings for Audits and Enforcement Actions

Regan Pennypacker

Within the Draft Calendar Year 2018 Call Letter, the Centers for Medicare & Medicaid Services (CMS) acknowledged the valuable comments received from the industry related to the use of audit findings and enforcement actions in the Star Ratings Program. As a result of those comments, CMS proposes a revision of the Beneficiary Access and Performance Problems (BAPP) measure.

Read more

Leave a comment | Share | |

CMS Releases Widely Anticipated Proposed ACA regulation, the New Administration’s First Attempt at Market Stabilization

Olga Walther

On February 15, 2017, the Centers for Medicare & Medicaid Services (CMS) released its widely anticipated proposed rule introducing new market health insurance market reforms. CMS is proposing changes for stricter Special Enrollment Period (SEP) verification, exceptions to guaranteed availability, updated network adequacy requirements, and a shorter Open Enrollment Period.

Read more

Leave a comment | Share | |

A Vendor’s Oversight is Never Done

Regan Pennypacker

There are many industry voices adding their perspectives about the new administration and changes to come. However,  the Compliance Officers I know do not have the luxury of stopping and truly considering the potential impact as they are managing the continuous pressures of their daily directives. Today I address a group of very industrious Compliance professionals not often addressed, and those are the staff responsible for Compliance Programs at first tier, downstream and related entities, or “FDRs.” Under Medicare regulations, plan sponsors may enter into contracts with FDRs to provide administrative or healthcare service functions on their behalf.

Read more

Leave a comment | Share | |

Whither Medicaid, CHIP, and the Mega-Reg?

John Gorman

Most attention in health policy since the election has been on the looming repeal of the Affordable Care Act’s Exchanges and subsidies, but the far bigger story is what the incoming Trump Administration and the Republican Congressional majority are about to do to Medicaid, the Children’s Health Insurance Program (CHIP), and the Medicaid “mega-reg.” Literally 50 years of the social safety net could be shredded in the first weeks of 2017.

Read more

Leave a comment | Share | |

Reflections on the Basics of Delegation Oversight

Regan Pennypacker

Imagine entering University and enrolling into Advanced French Language and Literature, a 300-level class, with no previous knowledge or study of the French language. As your professor welcomes you into class with bonjour, bienvenue, ça va, you have no idea how to reply. Now imagine sticking with that course for the full semester, trying to understand complex language and reading concepts without the foundation or basics. It would be quite an overwhelming few months for anyone.

Read more

Leave a comment | Share | |

Meeting CMS Halfway: The 2016 Audit and Enforcement Conference

Regan Pennypacker

On June 16, the Centers for Medicare & Medicaid Services (CMS) held their third annual Medicare Advantage & Prescription Drug Audit and Enforcement Conference and Webcast. At the heart of this conference is the CMS Program Audit. Agency experts as well as Sponsor participants presented to an in-person and webcast audience on expectations, process enhancements, upcoming developments, and more.

Read more

Leave a comment | Share | |