Friday, July 31, 2015

CMS issues final rules outlining 2016 Medicare payment policies and rates


FACT SHEET


 

FOR IMMEDIATE RELEASE

July 31, 2015                                                                                                                          

 

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

 

 

CMS issues final rules outlining 2016 Medicare payment policies and rates

 

On July 31, 2015 the Centers for Medicare & Medicaid Services (CMS) issued a final rules to update fiscal year (FY) 2016 Medicare payment policies and rates.

 

The provisions implemented for FY 2016 are summarized below.



The publication date is 08/05/15. The Effective date is 10/01/2015.

 



The publication date is 08/06/15. The Effective date is 10/01/2015.

 



The publication date is 08/06/15. The Effective date is 10/01/2015.

 

 


The publish date is 08/17/15. The comments are due 09/29/15. The Effective date is 10/01/

CMS announces new initiative to promote value-based home health care


CMS NEWS


 

FOR IMMEDIATE RELEASE

July 6, 2015                                                                                                                          

 

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

 

CMS announces new initiative to promote value-based home health care

Proposed initiative ties Medicare home health payments to quality performance

 

The Centers for Medicare & Medicaid Services (CMS) today announced a proposal to launch a new model designed to support greater quality of care among Medicare beneficiaries. The model is included in the CY 2016 Home Health Prospective Payment System proposed rule, which updates payments and requirements for home health agencies under the Medicare program.

 

As proposed, the Home Health Value-Based Purchasing model would test whether incentives for better care can improve outcomes in the delivery of home health services. The model is part of the Department of Health and Human Service’s commitment to build a health care delivery system that’s better, smarter, and healthier – one that delivers better care, spends health care dollars more wisely, and results in healthier people and communities.

 

“People want to be taken care of in their homes and communities whenever possible, and CMS aims to make sure that care in the home is supported by a value-based care delivery model that is consistent with the rest of the system. The goal is that no matter where the care is delivered, it is supported by a payment system that rewards providers who deliver the highest quality outcomes,” said Acting CMS Administrator Andy Slavitt. 

 

Authorized under the Affordable Care Act, the model leverages the successes of and lessons learned from other value-based purchasing programs and demonstrations – including the Hospital Value-Based Purchasing Program and the Home Health Pay-for-Performance and Nursing Home Value-Based Purchasing Demonstrations. The model would apply a payment reduction or increase to current Medicare-certified home health agency payments, depending on quality performance, for all agencies delivering services within nine randomly-selected states. Payment adjustments would be applied on an annual basis, beginning at five percent and increasing to eight percent in later years of the initiative.

 

The proposed model is designed so there is no selection bias, participants are representative of home health agencies nationally, and there is sufficient participation to generate meaningful results among all Medicare-certified home health agencies nationally.

 

CMS will solicit comments until September 4, 2015. Instructions on ways to submit comments are found in the proposed rule. For more information, please visit: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-16790.pdf

On 07/10/2015 and available online at: http://federalregister.gov/a/2015-16790

Covered California proposed rates to increase by only 4 percent in 2016


CMS NEWS


FOR IMMEDIATE RELEASE

July 27, 2015                                                                                                                          

 

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

 

Covered California proposed rates to increase by only 4 percent in 2016

Today, Covered California announced a modest proposed 4 percent statewide weighted average rate increase for plans offered in 2016 on their Health Insurance Marketplace, which is lower than last year’s increase of 4.2 percent. This is the second year in a row that Covered California has achieved single-digit rate increases. As of earlier this year, Covered California accounted for more than one out of every eight Marketplace enrollees who paid for coverage nationwide.

“We are encouraged by Covered California’s proposed rates for the 2016 plan year and pleased that consumers in California will continue to have access to quality, affordable health coverage,” said Kevin Counihan, CEO of the Health Insurance Marketplaces. “Today’s announcement demonstrates that the Affordable Care Act is working as intended to spur competition and transparency in the Marketplaces, keeping premium increases low and leading to affordable new choices for consumers. We are committed to working closely with other states as they review rate proposals and finalize rates for the 2016 plan year.”

Covered California credited an enrollment mix that includes many young and healthy enrollees, as well as premium stabilization programs created by the Affordable Care Act, for helping to hold the line on rate increases. These are two of the factors that CMS encouraged state insurance commissioners to consider when finalizing rates in a recent letter.

The Affordable Care Act’s rate review program helps to keep premiums affordable by requiring insurance companies to document and submit for review increases of 10 percent or more, as well as publicly justify unreasonable rate increases. This program is designed to provide consumers with greater transparency and input into the review process. 

Final rates for all states will be published no later than Nov. 1, 2015.

 

To view information about health insurance rates filings in a state, visit: https://ratereview.healthcare.gov.

 

For more information on how to comment on proposed rate increases subject to review, consumers should visit https://ratereview.healthcare.gov or their state insurance department websites.

 

On its 50th anniversary, more than 55 million Americans covered by Medicare


CMS NEWS


FOR IMMEDIATE RELEASE

July 28, 2015

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

On its 50th anniversary, more than 55 million Americans covered by Medicare

New Medicare state-by-state enrollment numbers

 

As Medicare and Medicaid celebrate their 50th anniversary protecting the health and well-being of millions of seniors, people with disabilities and low-income individuals, the Centers for Medicare & Medicaid Services (CMS) today released updated Medicare state-by-state enrollment numbers, showing that more than 55 million Americans are covered by Medicare.

 

In 1966, approximately 19.1 million Americans were covered by Medicare. In 2012, there were nearly 52 million beneficiaries covered by Medicare. Today’s enrollment numbers represent a three million person increase during the last three years as the Baby Boom generation has started to retire. Medicare beneficiaries depend on the program to provide critical health services such as preventive services, including flu shots and diabetes screenings, hospital stays, lab tests and critical supplies like wheelchairs and prescription drugs.

 

"Over the last 50 years, Medicare has become part of the fabric of our communities, protecting the well-being and financial security of millions of American families as they age or if they become disabled. In doing so, Medicare has kept up with dramatic demographic changes and led the charge toward improving health care delivery," said Andy Slavitt, CMS acting administrator. "As we preserve and advance Medicare for future generations, we are focused on helping build a better system with smarter spending that keeps people healthier."

 

CMS also releases state-by-state Medicaid enrollments on a monthly basis. As of May 2015, over 71.6 million individuals were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) with 12.8 million more gaining coverage since 2013. More information is available on Medicaid.gov.

 

The chart below outlines enrollment as of May 2015 in Original Medicare, Medicare Advantage and Part D (prescription drug plans):

 

 
Original Medicare and
Medicare Advantage
Part D
State
Medicare Parts A and/or B
Medicare Advantage1
Total
Stand-Alone Prescription Drug Plan
Medicare Advantage with Prescription Drug Coverage
Total
Alabama
714,475
246,373
960,848
452,298
229,424
681,722
Alaska
82,292
665
82,957
32,649
465
33,114
Arizona
685,835
433,055
1,118,890
383,601
414,757
798,358
Arkansas
469,450
121,903
591,353
298,282
105,044
403,326
California
3,246,443
2,354,920
5,601,363
2,067,831
2,227,601
4,295,432
Colorado
486,962
290,466
777,428
278,220
270,140
548,360
Connecticut
465,754
161,781
627,535
317,170
151,704
468,874
Delaware
163,003
15,077
178,080
115,989
12,163
128,152
District of Columbia
76,076
11,735
87,811
38,777
11,033
49,810
Florida
2,367,608
1,601,277
3,968,885
1,401,435
1,518,812
2,920,247
Georgia
1,023,363
480,178
1,503,541
611,803
456,095
1,067,898
Hawaii
130,226
112,326
242,552
61,779
108,148
169,927
Idaho
186,352
91,711
278,063
104,739
81,022
185,761
Illinois
1,585,563
472,008
2,057,571
1,051,092
385,676
1,436,768
Indiana
867,439
274,477
1,141,916
597,766
225,331
823,097
Iowa
482,104
86,749
568,853
358,169
71,192
429,361
Kansas
416,622
67,545
484,167
277,987
58,803
336,790
Kentucky
631,252
226,064
857,316
456,903
173,808
630,711
Louisiana
547,162
239,874
787,036
339,349
230,597
569,946
Maine
234,647
69,616
304,263
149,639
63,669
213,308
Maryland
842,226
81,163
923,389
475,626
68,903
544,529
Massachusetts
948,839
261,433
1,210,272
578,654
238,763
817,417
Michigan
1,263,405
622,116
1,885,521
1,086,223
365,255
1,451,478
Minnesota
416,680
489,099
905,779
391,006
286,560
677,566
Mississippi
472,274
84,720
556,994
316,868
75,485
392,353
Missouri
804,245
324,780
1,129,025
527,833
299,985
827,818
Montana
162,736
36,852
199,588
91,322
34,763
126,085
Nebraska
271,448
39,218
310,666
185,386
31,687
217,073
Nevada
296,171
149,826
445,997
150,293
144,634
294,927
New Hampshire
244,219
20,067
264,286
148,826
14,996
163,822
New Jersey
1,252,414
233,355
1,485,769
876,915
183,598
1,060,513
New Mexico
251,323
117,883
369,206
143,187
112,227
255,414
New York
2,077,589
1,251,906
3,329,495
1,384,028
1,151,552
2,535,580
North Carolina
1,221,482
529,303
1,750,785
786,481
483,175
1,269,656
North Dakota
98,440
19,871
118,311
78,232
5,068
83,300
Ohio
1,241,692
898,626
2,140,318
1,035,905
598,792
1,634,697
Oklahoma
557,128
116,649
673,777
342,071
100,146
442,217
Oregon
414,968
330,468
745,436
243,883
295,092
538,975
Pennsylvania
1,501,476
1,018,209
2,519,685
1,035,656
842,655
1,878,311
Rhode Island
130,451
71,751
202,202
81,821
68,980
150,801
South Carolina
708,740
219,934
928,674
452,710
201,873
654,583
South Dakota
125,660
29,233
154,893
93,950
10,875
104,825
Tennessee
797,583
426,921
1,224,504
504,231
399,407
903,638
Texas
2,436,297
1,159,610
3,595,907
1,552,590
919,046
2,471,636
Utah
224,070
116,912
340,982
120,665
110,507
231,172
Vermont
120,557
10,024
130,581
86,007
8,494
94,501
Virginia
1,082,620
255,307
1,337,927
613,006
214,850
827,856
Washington
819,681
356,870
1,176,551
427,326
308,397
735,723
West Virginia
301,883
113,220
415,103
199,348
89,221
288,569
Wisconsin
645,149
397,405
1,042,554
421,147
301,225
722,372
Wyoming
90,820
3,678
94,498
56,075
2,304
58,379
American Samoa
4,174
238
4,412
351
225
576
Guam
14,764
63
14,827
3,026
54
3,080
Northern Mariana Islands
*
*
2,063
*
*
480
Puerto Rico
195,888
561,658
757,546
14,994
557,169
572,163
Virgin Islands
19,074
236
19,310
11,090
202
11,292
Pending State Designation
*
*
3,046
*
*
923
Foreign and Other Outlying Areas
422,200
4,014
426,214
7,589
3,445
11,034
Total
37,345,712
17,710,809
55,056,521
23,920,896
15,325,400
39,246,296

 

1 The following organization types are included in the Medicare Advantage column: Local and Regional Coordinated Care Plans, Program of All-Inclusive Care for the Elderly (PACE) plans, Medical Savings Account (MSA) plans, Section 1876 Cost Contract plans, Section 1833 Health Care Prepayment (HCPP) plans, Chronic Care Plans, and Medicare-Medicaid Demonstration Plans.

 

* CMS is obligated by the federal Privacy Act, 5 U.S.C. Section. 552a and the HIPAA Privacy Rule, 45 C.F.R Parts 160 and 164, to protect the privacy of individual beneficiaries and other persons. All direct identifiers have been removed from this data file. In addition, information is suppressed that is based upon fewer than eleven (11) beneficiaries in the population.