IHA Daily Briefing Jan. 11

Thursday, January 11, 2018

CMS: Guidance for Testing Medicaid Requirements
New Info on Medicare Appeals Settlement
New Medicare Bundled Payment Model Announced
DOI Video Reviews Mental Health Parity
Briefly Noted

CMS: Guidance for Testing Medicaid Requirements
The Centers for Medicare & Medicaid Services (CMS) today announced new policy guidance aimed at supporting state efforts to incentivize community engagement among able-bodied, working-age Medicaid beneficiaries. CMS indicates that the policy—implemented by CMS Administrator Seema Verma when she designed Indiana’s Medicaid expansion waiver—responds to numerous state requests to test programs through Medicaid demonstration projects under which work or participation in other community engagement activities—including skills training, education, job search, volunteering, or caregiving—would be a condition for Medicaid eligibility for able-bodied, working-age adults. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women.

According to CMS, the new policy guidance sent to states is intended to help them if they decide to design demonstration projects that incorporate work or participation in other community engagement activities.

“Medicaid needs to be more flexible so that states can best address the needs of this population. Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction,” said Verma.

To date, CMS has received demonstration project proposals from 10 states that include employment and community engagement initiatives: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin. For more information, see CMS’ press release.

IHA opposes barriers to access to care, such as work requirements for Medicaid beneficiaries.


New Info on Medicare Appeals Settlement
On Jan. 4, the Centers for Medicare & Medicaid Services (CMS) published additional information, including forms, agreements and questions and answers, on its latest Medicare appeals settlement offer. Beginning Feb. 5, CMS will accept “Expressions of Interest” from providers interested in its recent offer to settle 62 percent of the allowable amount of low-volume appealed claims.

To be eligible for the settlement offer, the provider must have no more than 500 appeals pending across all of its system National Provider Identifiers and the total billed amount of the individual claim cannot exceed $9,000.


New Medicare Bundled Payment Model Announced
On Jan. 9, the Centers for Medicare & Medicaid Services (CMS) announced the implementation of a new, voluntary Medicare bundled payment model, the Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under this model, participants can earn Medicare payment bonuses if their costs of providing services to beneficiaries are within established cost targets.

In BPCI Advanced, participants are expected to redesign healthcare delivery to keep Medicare costs under control, while maintaining or improving performance on specific quality of care measures. BPCI Advanced participants can receive payments for up to 32 different clinical episodes, and the model qualifies as an Advanced Alternative Payment Model, as defined by the Medicare Access and CHIP Reauthorization Act of 2015’s Quality Payment Program.

BPCI Advanced begins on Oct. 1, 2018 and ends on Dec. 31, 2023. Applications must be submitted to CMS by March 12. Additional information is available on CMS’ website. To help interested providers learn more about this model, CMS’ Innovation Center will conduct a Questions and Answers Forum from 11 a.m. to 12 p.m. CT on Tuesday, Jan. 30. Register here.


DOI Video Reviews Mental Health Parity
The Illinois Dept. of Insurance (DOI) this week released a public service announcement aimed at answering questions about mental health and addiction coverage parity. The video addresses parity, substance use disorder treatment and how consumers can request assistance if they believe their insurance company has unfairly denied them coverage. For more details, see DOI’s press release.

To learn more about mental health and addiction parity, see IHA’s member guide, which helps simplify insurance parity laws for mental health and substance use disorder benefits.


Briefly Noted
President Trump yesterday issued an executive order aimed at improving access to broadband internet service in rural areas. The order directs executive branch departments and agencies to reduce barriers to capital investment, remove obstacles to broadband services and more efficiently employ government resources in order to accelerate the deployment and adoption of affordable, reliable, modern high-speed broadband connectivity in rural America, including at healthcare facilities.