Sunday, July 31, 2016

8 Digital Health Jobs of the Future to Watch


1. Healthcare Navigator – Guides patients through the complex medical system of the future

 

2. Life Extension Specialist – Helps people live longer, healthier lives

 

3. Bioinformatician – Analyzes data from a wide range of biological fields

 

4. Organ Implant Designer – Designs and prints organs with patient cells

 

5. Medical Roboticist – Designs robots to assist medical professionals

 

6. Cryopreservation Specialist – Freezes humans or organs to preserve them for the future

 

7. Health Specialties Professor – Trains future medical professionals

 

8. Medical Scribe – Handles patients’ medical information

 

 

Source: HIT Consultant  

 

According to a recent survey, 95.5% of respondents ...

... had received a medical bill from a doctor, hospital, or health care provider in the past 12 months. Of those, 60.5% rated their medical bills as confusing or very confusing. Their frustrations included the following:

  • The relationship between bills from provider and the statements from insurance company: 50.6%
  • Not sure if the total owed was correct: 49.4%
  • The amount owed was a surprise: 48.8%
  • Unexpected expenses that were thought to be covered by insurance: 46.1%
  • Not sure if the insurance company had paid yet: 43.2%
  • The bill arrived a long time after the date of service: 42.3%
  • The relationship between the bill and insurance deductible: 35.1%
  • Didn't understand the language on the bill: 23.5%
  • Wasn't sure if everything listed on the bill really happened: 22.0%

Both deductible and out-of-pocket maximum costs for consumers rose ...

... 13% between 2014 and 2015; in 2015 the average deductible was $1,278 and out-of-pocket costs averaged $3,470 per patient.

Source: "Patient Payment Responsibility up 13% in One Year," TransUnion Press Release, June 28, 2016, http://newsroom.transunion.com/patient-payment-responsibility-up-13-in-one-year/  

According to a recent survey given to surgeons ...

... to assess how they disclosed adverse events to their patients, here are some of the results:

  • 92% explained why the event happened
  • 87% expressed regret for what happened
  • 95% expressed concern for the patient's welfare
  • 97% disclosed the event within 24 hours
  • 98% discussed steps taken to treat any subsequent problems
  • 55% apologized to patients
  • 55% discussed whether the event was preventable
  • 32% discussed whether recurrences could be prevented
Source: "Surgeons’ Disclosures of Clinical Adverse Events," JAMA Surgery, abstract only, July 20, 2016, http://archsurg.jamanetwork.com/article.aspx?articleid=2534133

CMS is pleased to announce that plan year 2017 registration and training will open on Monday, August 1.


Agents and brokers will be able to log in to their CMS Enterprise Portal user accounts and access the Marketplace Learning Management System (MLMS) to start the registration steps on August 1.  

Remember: Even if you successfully completed plan year 2016 registration, you can only assist consumers until October 31, 2016 when your plan year 2016 Federally-facilitated Marketplace (FFM) Agreement(s) for the Individual Marketplace and/or Small Business Health Options Program (SHOP) Marketplace expire. You must complete plan year 2017 registration and training to help consumers with 2016 coverage during November and December 2016, or to help them enroll for the first time or re-enroll in coverage for plan year 2017.  

To learn more about the agent and broker FFM registration and training requirements for plan year 2017, please register at www.REGTAP.info for one of webinars described below. You are welcome to attend any one of the sessions, but CMS asks that you only register for one session.  

Two sessions remain of the “Plan Year 2017 FFM Registration and Refresher Training for Agents and Brokers Returning to the FFMs” webinar for returning agents and brokers. The webinar will provide an abbreviated review of the registration steps, and describe the new, condensed Refresher Training option available to you if you completed registration for the Individual Marketplace in plan year 2016.

  • Wednesday, August 3 from 1:00 PM – 2:30 PM ET
  • Wednesday, August 10 from 1:00 PM – 2:30 PM ET 

 

CMS will also hold one more session of the “Plan Year 2017 FFM Registration and Training for Agents and Brokers New to the FFMs” webinar for new agents and brokers on Thursday, August 4 from 11:00 AM – 12:30 PM ET. This webinar will provide a detailed discussion of registration steps and training requirements to assure you have the information you need to complete all the registration steps, including some steps that returning agents and brokers need not perform. 
Registration for these webinars closes 24 hours prior to each event. If you have questions on the webinar registration process, visit the “Agent and Broker Webinars” section of the Agents and Brokers Resources webpage for more information. If you require assistance with registration or logistics, you may contact the REGTAP registrar at 800-257-9520, 9:00 AM – 5:00 PM ET, Monday through Friday or email registrar@REGTAP.info. 

Today, in an effort to facilitate greater access to Marketplace data ...

... CMS released a set of state-based Marketplace public use files (SBM PUF). Each file contains data associated with certified qualified health plans (QHPs) and stand-alone dental plans (SADPs) within state-operated Marketplaces.

 

While health plan information including benefits, copayments, premiums, and geographic coverage is publically available on HealthCare.gov, these downloadable files on the other hand, will help researchers and other stakeholders conduct timely benefit and rate analysis.

 

With that, the SBM PUF is comprised of the following 2016 Data Dictionaries:

  • Benefits and Cost Sharing PUF  – Plan-level data on essential health benefits, coverage limits, and cost sharing.
  • Rate PUF  – Plan-level data on individual rates based on an eligible subscriber’s age, tobacco use, and geographic location.
  • Plan Attributes PUF  – Plan-level data on maximum out of pocket payments, deductibles, cost sharing, HSA eligibility, formulary ID, and other plan attributes.
  • Business Rules PUF  – Additional information on how an issuer determines the premiums for a specific application.  For example: the maximum number of dependents used to determine a family rate for single or two parent families, the maximum age for a dependent, whether a domestic or same sex partner may be treated as a spouse, Number of tobacco-free months considered when qualifying for a non-tobacco rate.
  • Service Area PUF  – Issuer-level data on the geographic coverage or service area (i.e., where the plan is offered) including state, county, and zip code.
  • Network – Issuer-level data identifying provider network URLs.

 

Helping Consumers Make Care Choices through Hospital Compare



July 27, 2016
By: Kate Goodrich, MD, MHS, Director of Center for Clinical Standards and Quality

Helping Consumers Make Care Choices through Hospital Compare


 

When individuals and their families need to make important decisions about health care, they seek a reliable way to understand the best choice for themselves or their loved ones. That’s why over the past decade, the Centers for Medicare & Medicaid Services (CMS) has published information about the quality of care across the five different health care settings that most families encounter.[1] These easy-to-understand star ratings are available online and empower people to compare and choose across various types of facilities from nursing homes to home health agencies. Today, we are updating the star ratings on the Hospital Compare website to help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side-by-side, and ask important questions about care quality when visiting a hospital or other health care provider.

Today’s ratings include the Overall Hospital Quality Star Rating that reflects comprehensive quality information about the care provided at our nation’s hospitals. The new Overall Hospital Quality Star Rating methodology takes 64 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars. The rating includes quality measures for routine care that the average individual receives, such as care received when being treated for heart attacks and pneumonia, to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections. Specialized and cutting edge care that certain hospitals provide such as specialized cancer care, are not reflected in these quality ratings.

We have received numerous letters from national patient and consumer advocacy groups supporting the release of these ratings because it improves the transparency and accessibility of hospital quality information. In addition, researchers found that hospitals with more stars on the Hospital Compare website have tended to have lower death and readmission rates.[2],[3] 

Prior to publishing the Overall Hospital Quality Star Rating, we paused to give hospitals additional time to better understand our methodology and data. In response, we delayed the release of the ratings. Since then, we have conducted significant outreach and education to hospitals to understand their concerns and directly answered their questions, including:

  • Hosting two National Provider Calls with over 4,000 hospital representatives. During the calls, we walked through the Overall Hospital Quality Star Rating data and the methodology in detail while responding to questions that the attendees raised.

  • Providing specialized assistance to hospitals. We held numerous meetings with the hospital associations and individual hospitals to explain their data and answer questions.

  • Posting an evaluation of the national distributions of the Overall Hospital Quality Star Rating based on hospital characteristics. The analysis shows that all types of hospitals have both high performing and low performing hospitals.

  • Subjecting the measures used to calculate the Overall Hospital Quality Star Rating to rigorous scientific review and risk adjustment. All of the measures used to calculate the Overall Hospital Quality Star Rating are based on clinical guidelines and have undergone a rigorous scientific review and testing. The vast majority are endorsed by the National Quality Forum. Most of these quality measures are already adjusted for clinical co-morbidities to account for the illness-burden of the population. Some hospitals have raised the question of making additional adjustments to account for the sociodemographic characteristics of the patients they serve. We continue to work closely with the National Quality Forum and the Assistant Secretary for Planning and Evaluation (ASPE), who is required by the IMPACT Act to study the effect of socioeconomic status on quality measures and payment programs based on measures. We will work with ASPE and determine what next steps, if any, should be taken to adjust our measures based on the recommendations in the report.

CMS will continue to analyze the star rating data and consider public feedback to make enhancements to the scoring methodology as needed. The star rating will be updated quarterly, and will incorporate new measures as they are publicly reported on the website as well as remove measures retired from the quality reporting programs.

Today, we are taking a step forward in our commitment to transparency by releasing the Overall Hospital Quality Star Rating. We have been posting star ratings for different for facilities for a decade and have found that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries. We will continue to work closely with hospitals and other stakeholders to enhance the Overall Hospital Quality Star Rating based on feedback and experience.

These star rating programs are part of the Administration’s Open Data Initiative which aims to make government data freely available and useful while ensuring privacy, confidentiality, and security.


### 

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter @CMSgov

 


[2] Wang DE, Tsugawa Y, Figueroa JF, Jha AK. Association Between the Centers for Medicare and Medicaid Services Hospital Star Rating and Patient Outcomes. JAMA Intern Med. 2016;176(6):848-850. doi:10.1001/jamainternmed.2016.0784. http://archinte.jamanetwork.com/article.aspx?articleid=2513630
[3] Trzeciak, S. Gaughan, J. Mazzarelli, A. Association Between Medicare Summary Star Ratings and Clinical Outcomes in US Hospitals. Journal of Patient Experience. 2016 vol. 3 no. 1 2374373516636681 doi: 10.1177/2374373516636681 http://jpx.sagepub.com/content/3/1/2374373516636681.abstract

While you must have a CMS user account to log into the CMS Enterprise Portal and access the Marketplace Learning Management System ...

... to complete plan year 2017 Federally-facilitated Marketplace (FFM) registration and training, it is important that you not create multiple CMS user accounts. 

Having multiple or duplicate accounts can lead to delays, such as not being listed on the Agent and Broker FFM Registration Completion List and/or delays in receiving credit or compensation from issuers for FFM enrollment transactions. 

Get ready to begin plan year 2017 registration by going to your CMS Enterprise Portal user account now and confirming your profile information is current and complete.

·         Not sure if you already have a CMS Enterprise Portal account, or forgot your FFM User ID and/or password? See the Avoiding the Creation of a Duplicate CMS Enterprise Portal Account Quick Reference Guide, which explains how you can use self-service options to find out if you have an account, and how to retrieve you FFM User ID and password, or reset your password.

·         New to the FFMs? You can set up a CMS Enterprise Portal account at https://portal.cms.gov/wps/portal/unauthportal/home/ by selecting the “New User Registration” link. 

To get more information on how you can prepare for plan year 2017 FFM registration, register to participate in one of the remaining plan year 2017 registration and training webinars, which end on August 10, via the “Agent and Broker Webinars” section of the Agents and Brokers Resources webpage. Check the webpage often for up-to-the-minute information about plan year 2017 registration and training and the upcoming Open Enrollment period. 

Contact Us:

  • For information about the FFM agent and broker program, contact the Producer and Assister Help Desk via email at FFMProducer-AssisterHelpDesk@cms.hhs.gov or call the Agent and Broker Call Center at 1-855-267-1515 and select option “1.”
  • Direct questions about a client’s Individual Marketplace plan to the Marketplace Call Center at 1-800-318-2596.
Direct questions about SHOP Marketplace coverage to the SHOP Call Center at 1-800-706-7893. 

CMS has posted the slides from our plan year 2017 Federally-facilitated Marketplace (FFM) registration and training webinars ...

... for both new and returning agents and brokers in the “Agent and Broker Webinars” section of the Agents and Brokers Resources webpage.


To register for one of our remaining webinar sessions for either new or returning agents or brokers, or for more information on the FFM Agents and Brokers Program, please visit the Agents and Brokers Resources webpage.

 

Contact Us:

  • For information about the FFM agent and broker program, contact the Producer and Assister Help Desk via email at FFMProducer-AssisterHelpDesk@cms.hhs.gov or call the Agent and Broker Call Center at 1-855-267-1515 and select option “1.”
  • Direct questions about a client’s Individual Marketplace plan to the Marketplace Call Center at 1-800-318-2596.
  • Direct questions about SHOP Marketplace coverage to the SHOP Call Center at 1-800-706-7893. 
 

CMS is excited to announce the release of two new videos for agents and brokers participating in the Federally-facilitated Marketplaces (FFMs).


CMS is excited to announce the release of two new videos for agents and brokers participating in the Federally-facilitated Marketplaces (FFMs).


For additional information about how you can help consumers enroll in and use health coverage through the Individual Marketplace or Small Business Health Options (SHOP) Marketplace, please visit the Agents and Brokers Resources webpage. 

Contact Us:

  • For information about the FFM agent and broker program, contact the Producer and Assister Help Desk via email at FFMProducer-AssisterHelpDesk@cms.hhs.gov or call the Agent and Broker Call Center at 1-855-267-1515 and select option “1.”
  • Direct questions about a client’s Individual Marketplace plan to the Marketplace Call Center at 1-800-318-2596.
Direct questions about SHOP Marketplace coverage to the SHOP Call Center at 1-800-706-7893. 

Join us for the CMS National Training Program Monthly Partner Update Webinar


Join us for the CMS National Training Program

Monthly Partner Update Webinar

August 2, 2016

2:30 – 3:30 pm ET

 

This webinar will feature presentations on:

  • Pre-claim Review Demo for Home Health Services
  • Medicare Summary Notice (MSN) Production in Audio & Braille

 

Registration is Required to Attend


 

Upon registration, you will receive an email from “messenger@webex” with the dial-in information and webinar link. Follow the instructions in the email to attend.

CMS uses periodic data matching to confirm consumers who are enrolled in Marketplace coverage ...

... coverage and receiving advance payments of the premium tax credit and cost-sharing reductions are not also enrolled in or eligible for minimum essential coverage through Medicaid and/or the Children’s Health Insurance Program (CHIP). Consumers who do not take action to resolve such issues could lose their eligibility for financial help. 

To learn more about how you can help these consumers, register now for the “Summer 2016 Periodic Data Matching (PDM) for Consumers with Medicaid or CHIP Minimum Essential Coverage (MEC): An Overview of for Agents and Brokers” webinar, to be presented on Wednesday, August 5 at 1:00 PM Eastern Time. To register for the webinar, please log in to www.REGTAP.info. Registration closes next Tuesday, August 4, at 1:00 PM ET. 
If you have questions on the webinar registration process, visit the “Agent and Broker Webinars” section of the Agents and Brokers Resources webpage for more information. If you require assistance with registration or logistics, you may contact the REGTAP registrar at 800-257-9520, 9:00 AM – 5:00 PM ET, Monday through Friday or email registrar@REGTAP.info

The percentage of large employers who offered telemedicine benefits in 2015 ...

... was only 48 - that number has increased to 74 percent in 2016. 72 percent of hospitals use a telemedicine program while only 52 percent of physician groups implement them into their operation.
Source: American Telemedicine Program

18.5% of Healthy-Weight Adults Had Pre-Diabetes in 2012


The Annals of Family Medicine recently released a study on the correlation between pre-diabetes and abdominal obesity. Here are some key findings from the report:

·         18.5% of healthy-weight adults had pre-diabetes in 2012.

·         The prevalence of prediabetes among healthy-weight adults was 10.2% in 1988-1994.

·         Among those aged 45+, the prevalence of prediabetes increased from 22.0% in 1994 to 33.1% in 2012.

·         7.6% of adults had an unhealthy waist circumference in 2012, up from 5.6% in 1988-1994.

·         1 in 3 adults had an unhealthy weight-height ratio in 2012, versus 27.2% in 1988-1994.

·         The mean BMI for individuals without prediabetes was 22.2, and 22.6 for those with prediabetes.

Source: Annals of Family Medicine, July 2016

20% Are Not Satisfied With Benefits Offered By Their Employer


The Employee Benefit Research Institute recently released a study on attitudes about workplace benefits. Here are some key findings from the report:

·         3 in 4 workers state that employee benefits is extremely (36%) or very (41%) important in their decision.

·         30% are only somewhat satisfied with the benefits offered by their current employer.

·         1 in 5 workers are not satisfied with the benefits offered by their employer.

·         88% of workers report that employment-based health insurance is extremely or very important.

·         6 in 10 are planning to work longer than they would like to keep their employer-based insurance.

·         22% of workers report they have accepted, quit, or changed jobs because of the benefits.

Source: EBRI, November 2015

Friday, July 29, 2016

Good news! Plan year 2017 registration and training will open on Monday, August 1.


At that time, you will be able to establish or use your existing Federally-facilitated Marketplace (FFM) User ID and password to log in to the CMS Enterprise Portal to start the registration steps. 

The plan year 2016 FFM Agreement(s) for the Individual Marketplace and/or Small Business Health Options Program (SHOP) Marketplace expire on October 31, 2016. This means you must complete plan year 2017 registration to help consumers with 2016 coverage during November and December 2016, and to help them enroll for the first time or re-enroll in coverage for plan year 2017 once the Open Enrollment period begins on November 1. 

To learn more about the agent and broker FFM registration and training requirements for plan year 2017, please register at www.REGTAP.info for one of webinars described below. You are welcome to attend any one of the sessions, but CMS asks that you only register for one session. 

Two sessions remain of the “Plan Year 2017 FFM Registration and Refresher Training for Agents and Brokers Returning to the FFMs” webinar for returning agents and brokers. The webinar will provide an abbreviated review of the registration steps and describe the new, condensed Refresher Training option available to you if you completed registration for the Individual Marketplace in plan year 2016.

  • Wednesday, August 3 from 1:00 PM – 2:30 PM ET
  • Wednesday, August 10 from 1:00 PM – 2:30 PM ET 

CMS will also hold one more session of the “Plan Year 2017 FFM Registration and Training for Agents and Brokers New to the FFMs” webinar for new agents and brokers, on Thursday, August 4 from 11:00 AM – 12:30 PM ET. The webinar will provide a detailed discussion of registration steps and training requirements to assure you have the information you need to complete all the registration steps, including some steps that returning agents and brokers need not perform. 

Registration for these webinars closes 24 hours prior to each event. If you have questions on the webinar registration process, visit the “Agent and Broker Webinars” section of the Agents and Brokers Resources webpage for more information. If you require assistance with registration or logistics, you may contact the REGTAP registrar at 800-257-9520, 9:00 AM – 5:00 PM ET, Monday through Friday or email registrar@REGTAP.info. 

Contact Us:

  • For information about the FFM agent and broker program, contact the Producer and Assister Help Desk via email at FFMProducer-AssisterHelpDesk@cms.hhs.gov or call the Agent and Broker Call Center at 1-855-267-1515 and select option “1.”
  • Direct questions about a client’s Individual Marketplace plan to the Marketplace Call Center at 1-800-318-2596.
  • Direct questions about SHOP Marketplace coverage to the SHOP Call Center at 1-800-706-7893.

Medicare projects relatively stable average prescription drug premiums in 2017


CMS NEWS


FOR IMMEDIATE RELEASE

July 29, 2016

 

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

 

Medicare projects relatively stable average prescription drug premiums in 2017

 

Today, Medicare announced that the average basic premium for a Medicare Part D prescription drug plan in 2017 is projected to remain relatively stable at an estimated $34 per month. This represents an increase of approximately $1.50 over the actual average premium of $32.56 in 2016.

 

“Stable Medicare prescription drug plan premiums help seniors and people with disabilities afford their prescription drugs,” said Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS). “However, I remain increasingly concerned about the rising cost of drugs, especially high-cost specialty drugs, and the impact of these costs on the Medicare program.”

 

The stability in average basic Medicare Part D premiums for enrollees comes despite the fact that Part D costs continue to increase faster than other parts of Medicare, largely driven by high-cost specialty drugs and their effect on spending in the catastrophic benefit phase. Although private prescription drug plans receive capitated payments for portions of the Part D benefit, Medicare is directly responsible for 80 percent of the cost of drugs purchased by beneficiaries while in the catastrophic benefit phase.

 

As the recent 2016 Medicare Trustees report noted, growth in the costs of prescription drugs paid by Medicare continue to exceed growth in other Medicare costs and overall health expenditures. Medicare Part D expenditures per enrollee are estimated to increase by an average of 5.8 percent annually through 2025, higher than the combined per-enrollee growth rate for Medicare Parts A and B (4.0 percent). The report found that these costs are trending higher than previously predicted, particularly for specialty drugs. In addition, a March 2016 Department of Health and Human Services report provided a detailed analysis of high-cost prescription drug spending trends.

 

Today’s projection for the average premium for 2017 is based on bids submitted by drug and health plans for basic drug coverage for the 2017 benefit year and calculated by the independent CMS Office of the Actuary.

 

Seniors and people with disabilities are continuing to see savings on out of pocket drug costs as the Affordable Care Act closes the Medicare Part D “donut hole” over time. Since the enactment of the Affordable Care Act, more than 10.7 million seniors and people with disabilities have received discounts of over $20.8 billion on prescription drugs, an average of $1,945 per beneficiary.

 

The upcoming annual Medicare open enrollment period begins on October 15, 2016, and ends on December 7, 2016. During this time, people with Medicare can choose health and drug plans for 2017 by comparing their current coverage and plan quality ratings to other plan offerings, or choose to remain in Original Medicare. CMS anticipates releasing the premiums and costs for Medicare health and drug plans for the 2017 calendar year in mid-September.

 

To view the Part D Base Beneficiary Premium, the Part D National Average Monthly Bid Amount, the Part D Regional Low-Income Premium Subsidy Amounts, the De Minimis Amount, the Part D Income-Related Monthly Adjustment Amounts, the 2017 Medicare Advantage Employer Group Waiver Plan Regional Payment Rates, and the Medicare Advantage Regional Benchmarks, go to: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Ratebooks-and-Supporting-Data.html, and select “2017.”

 

To learn more about the Medicare Part D prescription drug benefit, go to: http://www.medicare.gov/part-d/.

CMS extends, expands fraud-fighting enrollment moratoria efforts in six states


CMS News


FOR IMMEDIATE RELEASE
July 29, 2016

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
 

CMS extends, expands fraud-fighting enrollment moratoria efforts in six states
New demonstration enhances agency’s enrollment and investigative options


Today, the Centers for Medicare & Medicaid Services (CMS) announced an extension and statewide expansion of fraud-fighting temporary provider enrollment moratoria efforts in six states, along with a new related demonstration project to allow for certain exceptions to the moratoria and heightened screening requirements for new providers.  CMS also announced it is immediately lifting the current temporary moratoria on all Medicare Part B, Medicaid, and Children’s Health Insurance Program (CHIP) emergency ground ambulance suppliers. 

“CMS is continuing its efforts to tackle fraud, waste, abuse and protect benefits and services for those eligible for federal health care programs through expanding the existing temporary moratoria,” said Shantanu Agrawal, M.D., deputy administrator for program integrity, CMS. “CMS is also increasing its oversight efforts through the use of heightened screening and investigative tools for new providers in the moratoria areas.”

CMS announced it is extending for six months and expanding statewide the temporary provider enrollment moratoria on new Medicare Part B non‑emergency ground ambulance suppliers in New Jersey, Pennsylvania, and Texas and home health agencies (HHAs) in Florida, Texas, Illinois, and Michigan.  Additionally, the statewide expansion also applies to Medicaid and CHIP.  CMS also announced the Provider Enrollment Moratoria Access Waiver Demonstration (PEWD), which gives CMS the ability to allow for provider and supplier enrollment exceptions in the moratoria areas if access to care issues are identified and for the development and improvement of methods of investigating and prosecuting fraud in Medicare, Medicaid, and CHIP.

The statewide expansion of the temporary moratoria coupled with the PEWD will allow CMS to continue to target fraud within these services while granting individual enrollment waivers.  These changes will address access to care issues and allow providers and suppliers who are subject to the moratoria to enroll in Medicare, Medicaid, and CHIP after passing heightened screening requirements.  The agency will also immediately lift the current temporary moratoria on all Medicare Part B, Medicaid and CHIP emergency ground ambulance suppliers.  These changes are effective on July 29, 2016.

For more information on the extension and statewide expansion of the temporary moratoria, the lifting of temporary moratoria on Part B, Medicaid, and CHIP emergency ground ambulance suppliers, and the PEWD, please visit:  https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/ProviderEnrollmentMoratorium.html.

CMS’ key responsibilities is to protect the Trust Funds and other public resources against losses from fraud, waste, abuse, and other improper payments and to improve the integrity of the federal health care system.  CMS’s program integrity strategy is moving beyond the reactive “pay and chase” method toward a more effective, proactive strategy that identifies potential improper payments before they are made, keeps unscrupulous providers and suppliers out of Medicare and Medicaid at the outset, quickly removes wrongdoers from the programs once they are detected, and corrects improper payments as quickly as possible.

Moratoria and related investigations are a portion of CMS’ comprehensive strategy, the results of which are demonstrated our recently published activities in FY 2013 and FY 2014.  CMS estimates that program integrity activities saved Medicare $21.1 billion in FY 2013 and $18.1 billion in FY 2014, for a two-year return on investment of $12.4 to 1.

This weekly email summarizes the content of emails distributed by CMS ...

... to agents and brokers during the preceding week to keep you up-to-date on the Federally-facilitated Marketplaces (FFMs).

 

As these sent emails are not posted publicly, to retrieve the complete email messages, use these email subject lines, dates of receipt (noted in parentheses), or keywords derived from the summaries to search for them in your email account. You can also refer to the additional resources noted as hyperlinks in the summaries to learn more.

 

Plan year 2017 registration and training opens on Monday, August 1! (July 26)

CMS is pleased to announce that plan year 2017 registration and training will open on Monday, August 1. Agents and brokers will be able to log in to their CMS Enterprise Portal user accounts and access the Marketplace Learning Management System (MLMS) for the CMS-developed training or to be redirected to a CMS-approved vendor’s training.

 

Remember: Even if you successfully completed plan year 2016 registration, you can only assist consumers until October 31, 2016 when your plan year 2016 FFM Agreement(s) for the Individual Marketplace and/or Small Business Health Options Program (SHOP) Marketplace expire. You must complete plan year 2017 registration and training to help consumers with 2016 coverage during November and December 2016, or to help them enroll for the first time or re-enroll in coverage for plan year 2017 when Open Enrollment begins on November 1.

 

2016 State-Based Marketplace (SBM) Public Use Files (July 26)

To facilitate greater access to Marketplace data, CMS released a set of SBM public use files, which contain data associated with certified qualified health plans (QHPs) and stand-alone dental plans within state-operated Marketplaces. To download the files, visit: www.cms.gov/CCIIO/Resources/Data-Resources/sbm-puf.html

 

Avoid compensation delays by confirming you have a single CMS Enterprise Portal account (July 27)

See the Avoiding the Creation of a Duplicate CMS Enterprise Portal Account Quick Reference Guide to learn about self-service options you can use to find out if you have a CMS Enterprise Portal account, and how to retrieve your FFM User ID and password, or reset your password. If you are new to the FFMs, you can set up a CMS Enterprise Portal account at https://portal.cms.gov/wps/portal/unauthportal/home/ by selecting the “New User Registration” link. 

 

Slides from plan year 2017 registration & training webinars (July 27)

CMS has posted the slides from the plan year 2017 FFM registration and training webinars for both new and returning agents and brokers in the “Agent and Broker Webinars” section of the Agents and Brokers Resources webpage. You can also register for one of the remaining webinar sessions by selecting one of the webinar dates in that section of the webpage.

 

CMS releases new videos for agents and brokers (July 28)

CMS has released two new videos for agents and brokers participating in the FFMs:


Learn how to help consumers who could lose eligibility for financial help because they are dually enrolled/eligible for Marketplace coverage and Medicaid or the Children’s Health Insurance Program (CHIP) (July 28)

CMS uses periodic data matching (PDM) to confirm consumers who are enrolled in Marketplace coverage and receiving advance payments of the premium tax credit and cost-sharing reductions are not also enrolled in or eligible for minimum essential coverage through Medicaid or CHIP. To learn more about how you can help these consumers, log in to www.REGTAP.info to register for the “Summer 2016 PDM for Consumers with Medicaid or CHIP Minimum Essential Coverage ” webinar on August 5 at 1:00 PM Eastern Time.

 

Contact Us

  • For information about the FFM agent and broker program, contact the Producer and Assister Help Desk via email at FFMProducer-AssisterHelpDesk@cms.hhs.gov or call the Agent and Broker Call Center at 1-855-267-1515 and select option “1.”

  • Direct questions about a client’s Individual Marketplace plan to the Marketplace Call Center at 1-800-318-2596.
Direct questions about SHOP Marketplace coverage to the SHOP Call Center at 1-800-706-7893.