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Spotlight on ACOs

March 20, 2017 |

The House Rules Committee cleared for a House vote on Tuesday legislation promoting association health plans and repealing the anti-trust exemption for the health insurance industry.

December 20, 2016 | Daily News

CMS published Tuesday (Dec. 20) regulations on mandatory bundled pay demonstrations for cardiac and joint-replacement services, even though the incoming Republican administration opposes requiring providers to participate in demonstrations that test changes to Medicare reimbursement, and the agency finished writing policy for the accountable care organization Track 1 +, which aims to get more physicians to accept the risk of penalties for poor performance.

December 16, 2016 | Daily News

CMS announced Thursday (Dec. 15) a demonstration that pays bonuses to accountable care organizations for reducing Medicaid spending on beneficiaries enrolled in both Medicare and Medicaid, often referred to as dual eligibles, and the federal government for the first time is letting states share in Medicare savings.

November 11, 2016 | Daily News

Republicans will likely spare accountable care organizations and other demonstrations that the Affordable Care Act created, health care lobbyists and analysts say, and the CMS innovation center that runs the demos is expected to survive as well, although possibly under a different name and with restrictions such as prohibiting mandatory demos and requiring provider involvement in demo designs.

October 27, 2016 | Daily News

The Senate Finance Committee released wide-ranging, bipartisan draft chronic care legislation Thursday (Oct. 27) that among other reforms would extend by two years the Independence at Home demonstration, let kidney-failure patients enroll in Medicare Advantage, ease telehealth restrictions, and change how beneficiaries could be assigned to accountable care organizations.

October 26, 2016 | Daily News

CMS will unveil additional state Medicaid delivery and payment reforms before the Obama administration leaves office, and some of those reforms will help doctors receive Medicare bonuses in two years, CMS Deputy Administrator and Medicaid Director Victoria Wachino said Wednesday (Oct. 29).

October 25, 2016 | Daily News

CMS expects to give doctors more opportunities to qualify for alternative pay model bonuses in the new physician pay system by re-opening applications for 2018 participation in the Comprehensive Primary Care Plus and the Next Generation accountable care organization demonstrations and by starting two-sided risk in the Oncology Care Model in 2017, earlier than planned.

October 18, 2016 | Daily News

CMS says it's unclear what effect the recently announced pilot to reduce contractor audits of doctors participating in pay models with two-sided risk will have on Medicare's improper payment rate, though the agency has also said it believes the pilot will continue to protect Medicare program integrity.

October 17, 2016 | Daily News

CMS reduced the number of electronic health record requirements and shortened the reporting period to 90 days in the physician-pay system regulation published Friday (Oct. 14).

October 14, 2016 | Daily News

CMS says doctors participating in pay models that include penalties will be low priorities for reviews by Recovery Auditors and other contractors in a pilot scheduled to start in January.

October 06, 2016 | Daily News

As providers lose hope for an administrative solution, CAPG is asking for legislation that lets CMS count Medicare Advantage pay toward the revenue thresholds that determine whether providers qualify as participating in alternative pay models under the physician-pay system that CMS is developing.

October 03, 2016 | Daily News

Six Part D plans that provide benefits to about 1.6 million beneficiaries will participate in the enhanced Medication Therapy Management demonstration starting in January, CMS announced Monday (Oct. 3).

September 15, 2016 | Daily News

CMS on Wednesday (Sept. 14) sent the final rule for the highly anticipated MACRA physician pay system to the White House Office of Management and Budget for review.

September 08, 2016 | Daily News

If providers submit at least some data, including information dating after Jan. 1 of next year, to the Quality Payment Program, they'll avoid pay cuts under the new pay system under development by CMS, Acting Commissioner Andy Slavitt announced in a blog post.

September 08, 2016 | Daily News

CMS says it is too early to tell if the first round of State Innovation Model awards changed provider behavior or improved care coordination, quality and population health while reducing costs, but credits the initiative for making “notable progress” in accelerating health care change in Vermont, Arkansas, Massachusetts, Maine, Minnesota, Oregon and Vermont.

August 25, 2016 | Daily News

Medicare spent $217 million more in bonuses to accountable care organizations than the ACO program saved, according to CMS figures released Thursday (Aug. 25).

August 23, 2016 | Daily News

A recent HHS report suggests delivery system reform initiatives could increase the use of telehealth, and the agency says it is looking at reimbursement in Medicaid and Medicare and ways to address licensure, access and affordability for such services.

August 11, 2016 | Daily News

CMS proposes waiving some geographic telehealth restrictions in its cardiac care pay bundle, but a telehealth lobbyist said other restrictions would remain, which could discourage providers from using telehealth services.

August 08, 2016 | Daily News

Medicare pay bundles could hurt accountable care organizations' performance by driving up volume while not crediting ACOs for savings that might come from the bundles, according to representatives for ACOs, hospitals and health plans.

August 01, 2016 | Daily News

CMS estimates that up to 5,000 primary care practices will participate in the agency's new Comprehensive Primary Care Plus model across 14 different areas of the country, but the agency on Monday (Aug. 1) projected far fewer patients would participate than earlier anticipated.

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