Tag Archives: CMS

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

2018 Social Security and Medicare trustees’ reports released
The Social Security and Medicare Boards of Trustees issued their annual financial review of the programs. The projections indicate that income is sufficient to pay full scheduled benefits until 2026 for Medicare’s Hospital Insurance program, 2032 for Social Security’s Disability Insurance program, and until 2034 for Social Security’s Old Age and Survivors Insurance program. The Supplementary Medical Insurance (SMI) Trust Fund remains adequately financed throughout the projection period, but only because SMI has unlimited access to general revenues.

For more information, click here.

The CMS’ RDS Center changes its location for retiree and cost report files
The Centers for Medicare and Medicaid Services’ (CMS) Retiree Drug Subsidy (RDS) Center is changing the location where retiree and cost report files are sent via Connect:Direct. By the end of 2018, all files that are currently sent to the RDS Center via Connect:Direct must be sent to the new location. This change only impacts vendors that submit data to the RDS Center via Connect:Direct and does not affect vendors that submit data using the RDS secure website.

For more information, click here.

Medicare ACO assignment methodology change may have unintended consequences

A number of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) experienced significant, unanticipated changes in their 2017 performance year historical benchmarks and performance expenditures. These changes were not consistent in direction or magnitude. The exclusion of some nursing facility visits from MSSP assignment, effective in 2017, is the likely cause of the unanticipated changes.

The Centers for Medicare and Medicaid Services (CMS) now excludes nursing facility provider evaluation and management visit codes with place of service (POS) 31 as a qualifying claim type for beneficiary assignment. This assignment methodology change is referred to as the POS 31 exclusion. It started with the 2017 performance year and is also applied to the corresponding baseline years for all MSSP tracks.

Some ACOs likely lost and some likely gained costly nursing facility beneficiaries due to the new exclusion in both the baseline and performance years. The POS 31 exclusion only works as intended if POS codes correctly differentiate between Part A skilled nursing facilities and other nursing facility patient services. Unfortunately, our analysis across the Medicare 5% sample indicates that POS codes for nursing facility-based claims may not always be reliable.

To read more about the possible impact of these changes, read this article by Tia Sawhney, Kate Fitch, and Cory Gusland.

An overview of the Bundled Payments for Care Improvement Advanced Model

In January, the Centers for Medicare and Medicaid Services announced a new voluntary bundled payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced). This model starts on October 1, 2018, and creates a replacement for the current BPCI initiative. This paper by Milliman consultants Samuel Bennett and Pamela Pelizzari outlines the major provisions of the newly announced BPCI Advanced model.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

2019 Medicare Part D benefit parameters published
The Centers for Medicare and Medicaid Services (CMS) released the Medicare Part D standard benefit parameters and the cost thresholds and limits for qualified retiree prescription drug plans for 2019.

For more information, click here.

CMS’s RDS Center now accepting Medicare Beneficiary Identifier (MBI) in retirees files
Effective as of April 1, 2018, CMS’s Retiree Drug Subsidy (RDS) Center is accepting Medicare Beneficiary Identifier (MBI) in retiree files. Plan sponsors and vendors should note that the use of MBI is not mandatory within the RDS program and that RDS will continue to accept Social Security number (SSN) and/or health insurance claim number (HICN) or Railroad Retirement Board (RRB) indefinitely. For information on the use of MBI in RDS retiree file formats please reference the following pages in the RDS User Guide:

• Retiree File Layouts
• Retiree Response File Layouts
• Weekly Notification File Layouts
• Covered Retiree List File Layout and Format
• RDS Reason Codes

For more information, contact CMS’s RDS Center.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

ACA Information Returns Submission (AIR) guide updated
The Internal Revenue Service (IRS) has released its “ACA Information Returns (AIR) Submission Composition and Reference Guide.” The guide was updated as of March 16, 2018. The purpose of this document is to provide guidance to all types of external transmitters about composing and successfully transmitting compliant submissions to IRS.

To download the guide, click here.

RDS to start accepting Medicare Beneficiary Identifier files
The Retiree Drug Subsidy (RDS) Center of the Centers for Medicare and Medicaid Services (CMS) will begin accepting the Medicare Beneficiary Identifier (MBI) in retiree files in accordance with CMS’s new Medicare Card Project, beginning April 1, 2018. Healthcare plan sponsors should review the RDS program website’s “New Medicare Card Project” page for helpful guidance on this initiative and how it impacts the RDS program.

For more information, click here.

Comprehensive Care for Joint Replacement Performance Year 1 results: Key considerations

The Comprehensive Care for Joint Replacement (CJR) model is a bundled payment model in which 799 participating hospitals from 67 metropolitan statistical areas are required to participate. The first CJR reconciliation for Payment Year 1 (PY1) was completed in spring 2017. This paper by Milliman’s Pamela Pelizzari, Jocelyn Lau, and Harsha Mirchandani combines data from the report of PY1 results and other publicly available sources to compare hospitals that received payments in CJR PY1 to those that did not.