Monday Morning Rounds with CMS

ICYMI, here is recent communication from CMS.

MLN Matters® Special Edition Article for physicians, providers and suppliers who bill Medicare Fee-For-Service (FFS). The HHS declared a public health emergency (PHE) in the entire United States on January 31, 2020. On March 13, 2020 Secretary Azar authorized waivers and modifications under Section 1135 of the Social Security Act (the Act), retroactive to March 1, 2020. CMS is issuing blanket waivers consistent with those issued for past PHE declarations. These waivers prevent gaps in access to care for beneficiaries impacted by the emergency. You do not need to apply for an individual waiver if a blanket waiver is issued.

CMS released the 2018 Quality Payment Program (QPP) Experience Report to provide insights into participation during the 2018 performance year. This report builds on the 2018 participation results shared in this CMS blog post by Administrator Seema Verma in January 2020.

Proposed rule for Medicaid (CMS-2482-P) that builds on current policies to help ensure that opioid prescribing is appropriate, medically necessary, and avoids adverse medical events. The proposal would address a requirement in the SUPPORT for Patients and Communities Act (the SUPPORT Act) that states have systems in place to identify or limit inappropriate prescribing of opioids under certain conditions, such as if a beneficiary is already receiving medication assisted treatment for substance use disorder (SUD). We’re also seeking input from Medicaid stakeholders on proposals for future rulemaking that would require additional review of opioid prescribing, medication assisted treatment, and naloxone prescribing. Read the blog post.

The Physician Compare preview period is open through August 20 at 8 pm ET. Preview your 2018 Quality Payment Program performance information before it appears on the Physician Compare website profile pages and in the Downloadable Database. Access the secured preview through the Quality Payment Program website. Learn more with the Physician Compare Preview Period User Guide.

CMS has published the Quality Reporting Document Architecture (QRDA) Category III Implementation Guide (IG), Schematron, and Sample Files for Eligible Clinicians and Eligible Professionals Programs. The 2021 CMS QRDA III IG outlines requirements for eligible clinicians and eligible professionals to report electronic clinical quality measures (eCQMs), improvement activities (IA), and promoting interoperability (PI) measures for the calendar year 2021 performance period for these programs:

  • Quality Payment Program: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models
  • Comprehensive Primary Care Plus (CPC+)
  • Primary Care First (PCF)
  • Medicaid Promoting Interoperability Program

On July 20, CMS updated its Quality Payment Program Participation Status Tool based on the first snapshot of data from Alternative Payment Model (APM) entities. The first snapshot includes data from Medicare Part B claims with dates of service between January 1, 2020 and March 31, 2020. The tool includes 2020 Qualifying APM Participant (QP) and Merit-based Incentive Payment System (MIPS) APM participation status.

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