Monday Morning Rounds with CMS

ICYMI, here is recent communication from CMS.

Upcoming Deadlines Not To Miss

Reminder: Participate in Field Testing of Cost Measures Now through February 29
As a reminder, CMS and its contractor, Acumen, LLC, are conducting field testing of 2 episode-based cost measures until February 29, 2024. The following episode-based cost measures are currently being field tested before consideration of their potential use in the cost performance category of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program (QPP):

  1. Movement Disorders: Parkinson’s and Related Conditions, Multiple Sclerosis (MS), and Amyotrophic Lateral Sclerosis (ALS)
  2. Non-Pressure Ulcers

Clinicians and clinician groups who meet the attribution requirements for at least one of the measures will receive a Field Test Report. All members of the public are invited to provide feedback on the draft measure specifications through the online survey, which closes on February 29, 2024, at 11:59 p.m. ET. Participation is voluntary.

Reminder: MIPS 2023 Data Submission is Open
CMS opened data submission for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2023 performance year of the Quality Payment Program (QPP). Data can be submitted and updated until 8:00 p.m. ET on April 1, 2024.

How to Submit and Review Your 2023 MIPS Data

Follow the steps outlined below to submit data:

  1. Go to the Quality Payment Program sign in page.
  2. Sign in using your QPP access credentials.
  3. Submit your MIPS data for the 2023 performance year or review the data reported on your behalf by a third party. (You can’t correct errors with your data after the submission period, so it’s important to make sure the data submitted on your behalf is accurate.)

Events This Week

THIS Wednesday
CMS Hosts Transforming Maternal Health (TMaH) Model Overview
When: Wednesday, February 28, 2024 1:00 – 2:30 pm ET
Register for this event.

CMS will host an overview webinar on the newly announced Transforming Maternal Health (TMaH) Model. This webinar is open to all interested parties, and will provide details about TMaH’s structure, care delivery transformations, and resources available to interested participants. TMaH’s goal is to improve maternal health care by offering targeted technical support to eligible state Medicaid agencies to develop a whole-person approach to pregnancy, childbirth, and postpartum care. Under TMaH, states will implement strategies that address physical and mental health, as well as any social related needs mothers and their babies can experience during pregnancy.

You may submit questions in advance using the registration link. The webinar will be recorded and available on the model website.

Innovation in Behavioral Health (IBH) Model Overview Webinar
When: Thursday, February 29, 2024 2:00 – 3:30pm ET
Register for this event.

During this webinar, the IBH Team will discuss the model’s goals, eligibility, participant types, care delivery framework, and payment structure. The team will also provide additional details on the application process, timeline, and resources.

The IBH Model’s goal is to improve the quality of care and health outcomes for people with moderate to severe behavioral health conditions, including mental health conditions and/or substance use disorders. The model will test a value-based payment approach that enables community-based behavioral health practices to integrate behavioral health care with physical health needs and health-related social needs. Please feel free to submit questions in advance via the registration link.

Upcoming Events

2024 Physician Cost Measures and Patient Relationship Codes (PCMP) Technical Expert Panel (TEP) Webinar
When: Wednesday, March 13, 2024 11:00am – 3:00pm ET
Register for this event.

CMS has contracted with Acumen, LLC to develop episode-based cost measures to meet the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requirements. Acumen is convening the Physician Cost Measures and Patient Relationship Codes (PCMP) Technical Expert Panel (TEP) for a virtual meeting to continue cost measure development and re-evaluation activities. This meeting will be open to the public with a listen-only option, and observers are invited to listen in on the TEP’s discussion. Please share this message with anyone you believe may be interested. During this meeting, Acumen will seek input from TEP members on various topics under the PCMP project covering the comprehensive re-evaluation of the Total Per Capita Cost (TPCC) and Medicare Spending Per Beneficiary (MSPB) Hospital measures, aligning cost and mortality measurement, and identifying actionable refinement areas for publicly reporting cost performance data.

CMS Interoperability and Prior Authorization Final Rule Information Session
When: Tuesday, March 26, 2024 1:00pm ET
Register for this event.

On January 17, 2024, CMS released a final rule to enhance access to health information and streamline prior authorization processes for medical items and services. CMS’s Office of Burden Reduction & Health Informatics will host a virtual education session on the CMS Interoperability and Prior Authorization final rule. Questions can be submitted beforehand via the registration form. Registration will remain open through March 25; however, please register by March 19 to ensure consideration of any submitted questions.


Now Available: Updated 2023 CMS QRDA III Sample Files and Schematron and 2024 CMS QRDA III Sample Files for Eligible Clinician Programs
CMS has released an update to the 2023 CMS Quality Reporting Document Architecture (QRDA) Category III Sample Files and Schematron and 2024 CMS QRDA III Sample Files for Eligible Clinician Programs. The 2023 and 2024 CMS QRDA III Implementation Guides outlines requirements for eligible clinicians to report eCQMs for the calendar year 2023 and 2024 performance periods respectively, for these programs: Quality Payment Program: Traditional Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs), APM Performance Pathway (APP), and MIPS Value Pathways (MVPs); Primary Care First (PCF).

CMS Releases Vaccine Toolkit of Vaccine Coverage and Administration for Medicaid and Children’s Health Insurance Program Individuals
CMS released a vaccine toolkit to equip states with the tools necessary to meet the needs of people with Medicaid and the Children’s Health Insurance Program (CHIP) coverage. The kit helps states understand coverage, cost-sharing, and payment for vaccines, including vaccines administered as part of the Inflation Reduction Act (IRA) under Medicaid, CHIP, and the Basic Health Program (BHP). Vaccinations have long served as a critical tool for the prevention of disease, as a deterrent for outbreaks, and, over the past few years, as a response to public health emergencies (PHE), such as for COVID-19 and Mpox. Acknowledging that states are navigating vaccination coverage requirements after the expiration of the COVID-19 public health emergency, this toolkit also includes guidance regarding the commercialization of COVID-19 vaccines and the end of the American Rescue Plan Act (ARP) COVID-19 vaccination coverage period, which extends through September 30, 2024.

Medicare Physician Fee Schedule Database: April Update
See the attachment in the instruction to your Medicare Administrative Contractor (PDF) to learn about the April quarterly changes to the Medicare Physician Fee Schedule Database:

  • New codes
  • Procedure status changes
  • Code descriptor revisions


Administrative Simplification

CMS Innovation Center