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LeadingAge Advocates for CMMI Models to Align Financial Incentives
The Feb 20 proposed rule, if finalized, will extend the CJR Model through December 31, 2023 for certain participating hospitals and proposes to expand the eligible procedures to include certain outpatient hip and knee replacement procedures. The CJR model is currently scheduled to end December 31, 2020. The rule also seeks to ...
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CMS Adds New Coverage Requirements to MA Plans Under COVID-19
Specifically, for tests or services on or after March 18 through the national emergency period, MAOs are required to cover the following without cost sharing to the plan enrollee: Clinical laboratory tests for the detection and diagnosis of the virus strain that causes COVID-19 and ...
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Summary of Health Plan Waivers and Policies in COVID-19 Era
While CMS has been making changes to Medicare fee-for-services policies such as waiving 3-day stay requirements for SNF stay and extending some SNF stays beyond the 100 days, managed care plans, such as Medicare Advantage and Special Needs Plans, are not required to adopt these same ...
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COVID-19 Creates New MA Plan Obligations and Flexibilities
These plan obligations and flexibilities occur under any of the following triggering events: a presidential declaration of disaster or emergency, a secretarial declaration of a public health emergency, or a declaration by the Governor of a State or Protectorate. They end when the source of the declaration says the disaster or ...
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The "Hospice Carve In" Demo Explained
Who can apply? Medicare Advantage Organizations (MAOs) can elect to participate in the hospice benefit component and in other components offered by the VBID model or to only participate the hospice benefit component of VBID (while meeting a few core criteria of the VBID model). MAOs are ...