This week in Medicare updates—9/5/18
First Annual Report: Next Generation Accountable Care Organization (ACO) Model Evaluation
On August 27, CMS published a Report on the first performance year of the Innovation Center’s Next Generation ACO Model. The report showed that the Next Generation ACO Model generated $62 million in savings to Medicare while maintaining quality of care for beneficiaries.
CMS published a Press Release and a “Findings at a Glance” document on the same date.
Merit-Based Incentive Payment System 2018 Assignment Methodology Specifications for the CMS Web Interface and CAHPS for MIPS Survey
On August 28, CMS published a Report to describe the process for assigning beneficiaries to a group or a virtual group participating in the MIPS program. The assigned beneficiaries will be used for CMS web interface reporting, the CAHPS for MIPS survey, and in cost measure calculations.
Review of Opioid Use During The Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV)
On August 28, CMS published Special Edition MLN Matters 18004 regarding the existing policy for eligible healthcare professionals who furnish the AWV to Medicare beneficiaries. The article reviews Medicare coverage policies for the IPPE and AWV, and it includes notes throughout about times during visits when Medicare would like to include reviews of opioid use.
Effective date: N/A
Implementation date: N/A
Next Generation Accountable Care Organization (ACO) Model 2019 Benefit Enhancement
On August 28, CMS published Demonstrations Transmittal 205, which rescinds and replaces Transmittal 203, dated August 10, 2018, to replace the word “three” with “four” in the Summary of Changes.
CMS published a revised MLN Matters 10824 on August 29 to accompany the transmittal.
Effective date: January 1, 2019
Implementation date: January 7, 2019
Indication-Based Formulary Design Beginning in Contract Year (CY) 2020
On August 29, CMS published a Memorandum to all Part D sponsors regarding additional flexibilities in the Medicare Part D program to allow for innovative formulary design in an attempt to expand drug choices and address the rising costs of drugs. Beginning in 2020, CMS will allow Medicare Part D plan sponsors to implement indication-based formulary design, a formulary management tool that allows health plans to tailor on-formulary coverage of drugs for specific indications.
CMS published a Fact Sheet and Press Release regarding the policy on the same date.
Updated Corporate Integrity Agreement Documents
On August 29, the OIG published information on a new Corporate Integrity Agreement with Post Acute Medical, LLC, of Enola, PA.
Meeting of the Advisory Panel on Outreach and Education (APOE), September 26, 2018
On August 31, CMS published a Notice in the Federal Register to announce the next meeting of the APOE will be held on Wednesday, September 26, 2018 from 8:30 a.m. to 4 p.m. ET.
October 2018 Update of the Ambulatory Surgical Center (ASC) Payment System
On August 31, CMS published Medicare Claims Processing Transmittal 4125 regarding changes to and billing instructions for various payment policies implemented in the October 2018 ASC payment system update.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Influenza Vaccine Payment Allowances - Annual Update for 2018-2019 Season
On August 31, CMS published Medicare Claims Processing Transmittal 4124 regarding payment allowances for the listed seasonal influenza virus vaccines included in the transmittal.
Effective date: August 1, 2018
Implementation date: Not later than October 1, 2018; November 1, 2018 - Business Requirement 10914.5