By Johanna Legaspi – Hierarchical Condition Categories were mandated in 1997 by CMS and have been the basis for reimbursement for Medicare Advantage plans since 2004. HCCs use data to prospectively estimate predicted costs for enrolled members during the next year of coverage.
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By Phil Galewitz – She didn’t want to spend the rest of her days seeing doctors, the 91-year-old woman confessed to Dr. Kevin Newfield as he treated a deep wound on her arm. “You don’t have to, but you have to tell me what you do want,” Newfield replied. “I’m not afraid of dying. I’m afraid of being 106,” she told the surgeon and her daughter, who was in the room with them.
By Julie Appleby – Medicare plans to test new ways to pay for prescription medications given in doctors’ offices and hospital outpatient centers — moves likely to win praise from some policy experts, but opposition from facilities and practitioners.
The Centers for Medicare & Medicaid Services (CMS) released proposed changes for the Medicare Advantage and Part D Prescription Drug Programs in 2017 that will, if finalized, provide stable and fair payments to plans, and makes unprecedented improvements to the program for plans that provide high quality care to the most vulnerable enrollees.
By Shefali Luthra – A growing number of primary care doctors, spurred by the federal health law and frustrations with insurance requirements, are bringing a service that generally has been considered “health care for billionaires” to middle-income, Medicaid and Medicare populations.
By Andy Slavitt & Niall Brennan – Just over a month ago, HHS convened a forum that brought together consumers, providers, employers, manufacturers, health insurance companies, representatives from state and federal government, and other stakeholders to discuss ideas on how our country can meet the dual imperatives of encouraging drug development and innovation, while ensuring access and affordability.
By Donald Moulds PhD – Six years ago, as a new president was taking office and the prospect of significant health care reform was moving from pipe dream to possibility, the city of McAllen, Texas, was thrust into the national spotlight.
By Dr. Patrick Conway – Almost a year ago, the Administration announced a vision for the future of the Medicare program, including clear goals and a timeline for shifting Medicare payments from volume to value. CMS is continually working to turn this vision into reality through annual rulemaking and the CMS Innovation Center, building on bipartisan ideas, initiatives and legislation from both Congress and the states.
CMS released the Calendar Year 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System policy changes, quality provisions, and payment rates final rule with comment period on October 30, 2015.