ACA Now

Implementation Status

CMMI has launched a variety of pilot and demonstration programs. Visit the agency’s website for full details. In December 2012, CMMI submitted its most recent annual Report to Congress describing its various activities. In total, through the end of 2012, CMMI had launched 41 different payment reform initiatives, which can be viewed here.

2012

On December 17, 2012, GAO issued a Report recommending that CMMI improve its coordination with other CMS offices to prevent overlap and duplication of efforts.

2013

On February 4, 2013, CMMI posted a notice announcing the agency’s request for applications from organizations to participate in the testing of the Comprehensive End-Stage Renal Disease (ESRD) Care Model,  authorized beginning in 2013 and ending in 2016, with a possible extension into subsequent years (also see a fact sheet here). CMS will partner with groups of providers and suppliers – ESRD Seamless Care Organizations (ESCOs) – to test and evaluate a new model of payment and care delivery specific to Medicare beneficiaries with ESRD. CMS held two Open Door Forums (on February 5 and February 26) to elaborate on the model.  Non-binding letters of intent to participate were due to CMS by March 15.  Applications were due by May 1.

On February 15, 2013, CMS announced the 27 recipients of the Strong Start for Mothers and Newborns initiative under which awardees will test enhanced prenatal care initiatives aimed at reducing pre-term births among high-risk women in Medicaid and CHIP.

On February 21, 2013, CMS announced the recipients of the $275 million State Innovation Models (SIM) initiative.  For more on the SIM awards, please see here.

In February 28, 2013 testimony before a Senate Finance Committee hearing, Jonathan Blum, CMS’s Acting Principal Deputy Administrator and Director of the Center of Medicare, shared early results, particularly in reducing readmissions among beneficiaries, from CMS’s efforts to implement ACA delivery system reform, such as accountable care organizations (ACOs).

CMS held on March 5, 2013 a webinar to discuss a number of topics, including the Strong Start Program.

On April 5, 2013, the Medicare Payment Advisory Commission (MedPAC) received an update on CMS’s current ACO initiatives. Commissioners discussed these models’ designs, as well as ACOs’ strengths, weaknesses and geographic distribution relative to Medicare Advantage plans.

On April 12, 2013, CMMI released a document relating to the Comprehensive End-Stage Renal Disease (ESRD) Care Initiative enumerating the total Medicare FFS ESRD beneficiaries not aligned to Medicare ACOs by State.

In April 2013, CMS announced that the date by which eligible states – i.e., those that have already received a design contract and signed a MOU with CMS – must apply under Round 3 of the Demonstration to Integrate Care for Dual Eligible Individuals is 3pm EST on May 29 (per the recent grants.gov modification).  Details are available here and here.

Also please see here for an article published in the April 2013 edition of Health Affairs by a CMS official that provides insights into the CMMI’s blueprint for rapid-cycle evaluation of new care and payment models.

On May 3, the Center for Medicare and Medicaid Innovation (CMMI) announced that it is reducing the minimum beneficiary threshold for participants in the Comprehensive End Stage Renal Disease Care Initiative from 500 to 350. As noted on the initiative’s website, to maintain a statistically sound methodology, this requires CMMI to increase the minimum savings rate for non-Large Dialysis Organizations participants from 4% to 4.75%. The deadline for Letters of Intent from participants is May 15 and the application deadline is currently July 1.

On May 15, CMS announced the availability of funding for Round 2 of the Health Innovation Awards. To view the underlying FOA on grants.gov, see here.  For more information specifically on the latest Round 2 of this initiative, see here and here.  A letter of intent (LOI) is due by 3 p.m. EDT on June 28  (note that CMS will begin accepting them as early as June 1) and applications are due by 3 p.m. EDT on August 15 (note that CMS will begin accepting applications as early as June 14).

On May 16, CMS announced an open period for additional organizations to be considered for participation in Model 1 of the Bundled Payments for Care Improvement initiative under which acute care IPPS hospitals and organizations that wish to convene acute care hospitals in a facilitator convener role are eligible to participate.

On May 17, CMMI published a Federal Register Notice announcing an “open period” for additional organizations interested in participating in Model 1 of the Bundled Payments for Care Improvement initiative. The deadline for submitting a “Model 1 Open Period Information Intake form” is July 31, 2013. Additional information is available on the CMMI’s Model 1 homepage.

In June, CMMI held several webinars on Health Care Innovation Awards (HCIA) Round 2, including an overview of categories 1 and 2 (“rapidly reduce Medicare, Medicaid and/or Children’s Health Insurance Program costs in outpatient and/or post-acute settings” and “improve care for populations with specialized needs,” respectively; see slides), as well as categories 3 and 4 (“transform the financial and clinical models of specific types of providers and suppliers” and “improve health of populations through better prevention efforts,” respectively; see slides). CMMI also held a webinar on HCIAs’ potential to lower costs through improvement, which also covered elements of the application’s required financial plan (see slides). Other HCIA webinars are planned. HCIA deadlines: June 28, 2013 3pm EDT (Letter of Intent); August 15, 2013 3pm EDT (Application). On June 21, CMMI released supplemental materials to assist stakeholders in submitting applications for the HCIA. These and previously posted materials are available here.

On June 13, Sen. Ron Wyden (D-OR) delivered a keynote address at a National ACO Summit in which he discussed ACO reforms, noting, for instance, “the attribution rule needs to be changed to allow providers to specialize in chronic care.”

On June 20, CMMI announced that it is reopening and effectively extending the deadline for Letters of Intent (LOIs) and applications for the Comprehensive ESRD Care initiative due to “the high level of stakeholder interest and feedback from the community on the need for additional time to prepare applications.”  LOIs, which are required prior to completing an application and were previously due to CMS by May 15, are now due by July 19.  Applications, which were previously due by July 1, are now due August 1.  See here for more information.

On July 8, 2013, CMS released its CY14 Medicare Physician Fee Schedule (MPFS) proposed regulation, which delineates proposed payment changes to physician payments, in addition to effectuating ACA-authorized requirements consistent with these statutory provisions of the law.  Comments on the underlying proposed regulation are due by September 6. A CMS press release is available here.

On July 16, CMMI announced year-1 results for the Pioneer ACO demonstration, noting that 13 out of 32 participating ACOs shared in savings with the agency. CMMI also noted that 7 Pioneer ACOs that did not generate shared savings are applying to the separate Medicare Shared Savings Program, which does not include the same degree of risk sharing as CMMI’s Pioneer model.  Two Pioneer ACOs told CMS they are leaving the model.

On July 26, CMMI released a revised Request for Applications for the Comprehensive End Stage Renal Disease Care Model, along with an updated fact sheet. The agency amended the payment track for large dialysis organizations (LDOs) with more than 200 dialysis facilities by initiating the phase-in of discounts in the second performance year and clarified the rebasing methodology for all payment tracks. Recently extended deadlines remain as previously noted (per an extension announced on July 19): non-binding letters of intent and applications are due on August 30, 2013.

Throughout July, leading up to the August 15, 2013 (3 p.m. EDT) application deadline, CMMI hosted webinars on applying for Health Care Innovation Awards Round 2 awards, under which up to $1B of which is potentially available for projects testing new payment and delivery approaches for Medicare, Medicaid and CHIP beneficiaries. See materials for: July 11 (Developing Payment Models); July 18 (Application Road Map); July 24 (Submitting an Application/Technical Assistance).

On July 26, CMS posted a revised article in the Medicare Learning Network Series to reflect a recent change order – as noted preceding the article – that is designed for providers participating in the Bundled Payments for Care Improvements Model 4 demonstration and submitting claims to Medicare contractors. The article addresses issues ranging from readmissions to claims submission.

On July 8, CMS released the CY 2014 Physician Fee Schedule proposed rule, part of which, among other ACO-related issues, addresses ACO quality benchmarking issues. On this note, “CMS proposes to includ[e] data submitted by the Shared Savings Program and Pioneer ACOs to set the benchmark for the 2014 performance period.” Also see the accompanying quality-focused fact sheet. Comments are due on September 6, 2013.

On August 1, CMS held an Open Door Forum on the revised Request for Applications (RFA) under the Comprehensive ESRD Care Initiative, and on August 9, CMS published a notice formalizing the agency’s announced extension of the LOI and application period for the Comprehensive ESRD Care Initiative to August 30, 2013.

On August 2, 2013, CMS issued its FY 2014 Medicare Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS final rule under which gross hospital payments will be $1.2 billion higher in FY 2014 than they were in FY 2013 – much higher than the $27 million increase initially proposed.  The final rule addresses a number of IPPS and LTCH payment and quality-related provisions authorized or amended by the ACA.

On August 6, 2013, CMS posted updated information on grants.gov pertaining to the next cycle of funding to support state Demonstration Ombudsman Program services to individuals who participate in the Financial Alignment model.  The second round of applications are due by 3pm EST on October 3, with the third round  due by 3pm EST on January 14, 2014.  Also, note that on August 26, CMS and the state of New York formally announced their partnership to move forward with the implementation of the state’s Fully Integrated Duals Advantage (FIDA) demonstration under CMS’ broader Financial Alignment initiative.  A webinar on the initiative was held on August 29.

On September 23, 2013, CMMI posted a final report on Medication Therapy Management in Chronically Ill Populations.  On September 25, CMS released a revised MLN Matters article detailing the ACA and the Model 4 Bundled Payments for Care Improvement (BPCI) initiative.

On October 1, CMS’ Innovation Center announced that the Phase 2 risk-bearing phase began under the Bundled Payments for Care Improvement initiative for 9 awardees under Model 2 (details here); 6 awardees under Model 3 (details here); and 1 awardee under Model 4 (details here).  On October 4, CMS submitted an information collection regarding the existing Medicare Current Beneficiary Survey, which the agency indicates in this notice will help to inform new policy initiatives underway at CMMI or generally.  On October 25, CMS announced it will reopen the Request for Applications (RFA) process for the Comprehensive ESRD Care Initiative “this winter.”

On October 25, CMS approved South Carolina’s duals demonstration project known as “Healthy Connections Prime” under the agency’s Financial Alignment initiative.  Additional information on implementation of the South Carolina demonstration is available here.

On Nov. 14,  2013, CMS posted here information pertaining to the recent issuance of the Contract Year (CY) 2015 Notice of Intent to Apply (NOIA) and related information under its Financial Alignment Initiative (“Duals Demonstration”).  On Nov. 19, CMS posted the responses from the State of South Carolina given to several clarifying questions posed by CMS in order to determine whether the state’s ‘Duals Demo’ proposal meets the standards and conditions for the program.  On Nov. 25, CMS and Washington State formalized a MOU for the state to proceed with a capitated model (via a three-way contract with Medicare-Medicaid Integration Plans) under the Financial Alignment initiative to improve care for dual-eligibles.  The latest model is intended to complement the state’s managed FFS demonstration, which is already underway. CMS also recently updated its Financial Alignment Demonstration webpage to include: (1) Final CY 2014 Marketing Guidance for Ohio Medicare-Medicaid Plans; (2) Final CY 2014  Marketing Guidance for Illinois Medicare-Medicaid Plans; (3) Chapters of the Member Handbook for Virginia (see here to download the Pharmacy Provider Directory; here to download the Member Handbook; here to download the Summary of Benefits; and here to download the List of Covered Drugs); and (4) Translations of the Pharmacy Provider Directory, Summary of Benefits and List of Covered Drugs for Illinois (see here to download the Pharmacy Provider Directory).  On Nov. 26, CMS posted the final contract for plans participating in the capitated model under Illinois’ Medicare-Medicaid Financial Alignment initiative.

In late December 2013, CMS issued Draft Medicare-Medicaid Plan (MMP) Marketing Guidance for the New York Capitated Financial Alignment Demonstration (here) as well as posted Chapter 8 of the Virginia MMP Evidence of Coverage (EOC)/Member Handbook model for CY 2014 & model member ID card for CY 2014 (here). Also, on a related note, on December 18, 2013, MedPAC and MACPAC released a data book entitled, Beneficiaries Dually Eligible for Medicare and Medicaid. In January 2014, CMS issued the 2015 MMP Annual Requirements and 2015 Capitated Financial Alignment Application, along with 2015 new applicant guidance (see here). Also in January 2014, CMS posted Appendix 5: State-Specific Enrollment Guidance for California and Illinois (here and here, respectively); Massachusetts’ evaluation design report here; contracts for plans participating in the California demonstration here and in the Virginia demonstration here; as well as Readiness Review tools for South Carolina (here) and Washington State (here).

On December 20, 2013, CMS announced the Pioneer ACO Model RFI (see here). In early January 2014, CMS posted archive slide deck information from a November 2013 open door forum (ODF) convened on the Medicare Intravenous Immune Globulin (IVIG) Demonstration (see here). On January 10, 2014, CMS and Maryland formalized its partnership for the state to move forward in its All-Payer Model, the details of which are available here. On January 24, CMS issued a transmittal delineating recurring file updates for models 2 and 4 of the Bundled Payments for Care Improvement Initiative (BPCI), effective in April. On January 28, CMS convened an eHealth provider webinar to provide information on ACOs, with a more extensive discussion of the various ACO models (Pioneer, Advance Payment, Comprehensive ESRD Initiative; and MSSP). See here. On January 30, CMS released interim findings on a number of delivery system reforms underway – including the MSSP and Pioneer ACOs (first-year evaluation report here), as well as (the pre-ACA) Physician Group Practice (PGP) demonstration (see here) and the BPCI initiative (fact sheet on ongoing BPCI efforts here). A CMS blog post and a press release on these findings are available here and here, respectively.

2014

In February 2014, CMS posted the following information: (1) Illinois – a revised version of the Illinois Medicare-Medicaid Plan (MMP) Enrollment and Disenrollment Guidance Exhibit 5a: MMP Welcome Letter; and the Integrated Denial Notice; (2) California – the California MMP Enrollment and Disenrollment Guidance [Exhibit 5a: MMP Welcome Letter for County Organized Health System (COHS) and Non-COHS plans]; the California Spanish-language MMP Member Handbook (Chapters 6,7,8 and 11); the MMP Member Handbook (Chapters 1 and 9), Spanish-language MMP Member Handbook (Chapters 1,2,3 and 5) and Spanish-language Pharmacy Provider Directory; (3) Virginia – Appendix 5: Additional State-Specific Enrollment Guidance Requirements for Virginia MMPs; and the Virginia MMP Enrollment and Disenrollment Guidance (Exhibit 5a: MMP Welcome Letter for Passively Enrolled Individuals and Exhibit 29: Model Notice for Enrollment Status Update); (4) Ohio – three-way template contact. Details here; and (5) Massachusetts – updated version of the Capitated Model Reporting Requirements for Massachusetts. On February 26, CMS posted an updated version of the Capitated Model Reporting Requirements here.

A webinar to discuss budget neutrality regarding the Frontier Community Health Integration Project Demonstration, which was announced on January 31, 2014, is planned for March 3. Details here. A previous webinar was held on February 12; details here

On February 13, CMS issued a notice announcing a winter 2014 opening for additional organizations to apply to participate in Models 2, 3, and 4 of the ongoing Bundled Payments for Care Improvement (BPCI) initiative. Interested organizations must submit their intake forms by April 18, 2014. For more information, please see here. Also, on February 11, CMS issued a Request for Information (RFI) soliciting input from stakeholders regarding two potential innovative models of payment and specialty care, namely: a procedural episode-based payment model; and a complex and chronic disease management episode-based payment model. Comments were extended through April 10, 2014; please see here. On January 30, 2014, CMS released interim findings on a number of delivery system reforms underway, including those related to Medicare ACOs, including Pioneer ACOs, as well as (the pre-ACA) Physician Group Practice (PGP) demonstration and the Bundled Payments for Care Improvement (BPCI) initiative. For more information, see here (CMS fact sheet); here (CMS blog post); and here (Pioneer ACO interim evaluation).

On February 21, 2014, CMS issued the CY15 Advanced Call Letter, which would produce a 6-7% cut from CY14. But the Agency adjusted the “normalization factor,” which could soften the blow by over 3%. But some analysts have suggested that, if CMS’ analysis is correct, then enrollee risk scores will dip in the coming years, negating the benefit of this change. Most other components of MA reimbursement are driven by statute, and CMS took no steps to alleviate those. While the combined growth factor is -1.9%, additional rate cuts from the ACA, the expiration of the 3-star bonus demonstration, and other changes further reduce MA plan comp. Comments are due March 7 at 6pm EST. The final rates will be released April 7.

On March 5, 2014, CMS issued a RFI soliciting input from stakeholders on a number of questions posed by the agency regarding the large scale transformation of clinician practices – including through, for example: quality improvement efforts; team-based models; patient-centered care; and so forth. Comments are due by April 8, 2014. On March 7, CMS announced that the public comment period to submit input on the draft quality measures of the Comprehensive ESRD Care Initiative was extended to March 31, 2014. Details here. Also in early March, CMS posted slides used during the March 3 webinar regarding budget neutrality and savings examples under the Frontier Community Health Integration Project Demonstration; updated FAQs on the demonstration were posted on March 28.

On March 18, CMS issued a RFA announcing an opportunity to apply for the Medicare Care Choices Model, testing “whether Medicare beneficiaries who meet Medicare hospice eligibility requirements would elect hospice if they could continue to seek curative services.” CMMI says it anticipates selecting at least 30 Medicare-certified and enrolled hospices via a competitive process; the performance period would be 3 years. Additional details on the model are available on the CMMI website. Applications are due by June 19, 2014.

In March, CMS posted updated MMP Member Handbook information for Ohio (see here); revisions to the CY14 Marketing Guidance for California MMPs as well as other updates (see here); and information pertaining to Illinois Appeal Decision Notices (see here). More broadly speaking, CMS issued MMP Monthly Enrollment Payment Data Guidance (available here) and Guidance and Training Resources for the 2015 Formulary Submission Process with respect to the integrated drug benefit (see here).

In April, CMS posted updated Financial Alignment demonstration information pertaining to: (1) The Enrollment Data Validation (EDV) process for States and Medicare-Medicaid Plans (MMPs) (see here); (2) a webinar series for providers working with individuals with developmental disabilities (see varying dates here); and (3) 2015 Plan Benefit Package (PBP) Training (available here). Regarding state-specific developments, CMS posted: (1) Illinois – Reporting Requirements and FAQs (available here); (2) Ohio – the Spanish-language MMP Member Handbook Chapters 1-3, 5-8, and 11 available here; Spanish-language MMP templates for the Provider and Pharmacy Directory and List of Covered Drugs here; and Ombudsman Technical Assistance Program award here; and (3) California – revised version of the California Integrated Denial Notice available here.

On April 9, CMMI posted the final evaluation report for the Senior Risk Reduction Demonstration (SRRD). On April 15, CMMI issued a notice reopening the application period for the Comprehensive ESRD Care Initiative; see updated RFA.  ESCOs that include a dialysis facility from a large dialysis organization (LDO) must submit a non-binding letter of intent on or before June 23, 2014; the submission deadline for the LDO application also is June 23, 2014.  ESCOs that include a non-LDO facility must submit a non-binding letter of intent on or before September 15, 2014, with that same date being the due-date for the non-LDO application. A CMS ODF was held on April 24. Additional details about the Comprehensive ESRD Care Initiative is available here. Also, CMMI hosted an ODF on April 16 regarding the Medicare Care Choices Model for which presentation slides are available here. Also in April, CMMI posted a report titled, “Priority Measures for Monitoring and Evaluation Document,” which serves as a compilation of internally and externally-endorsed measures to evaluate CMMI models.

In May, CMS posted the following updates: (1) California – Revised versions of the Spanish-language California Medicare-Medicaid Plan (MMP) Member Handbook Chapters 2, 9, and 12 were issued. Spanish-language Chapters 8 and 10 for Los Angeles plans posted on the Information and Guidance for Plans page; (2) Washington – The Evaluation Design Plan is available here; and the Ombudsman Technical Assistance Program award is available here; (3) New York – Guidance for New York FIDA Plans regarding new marketing codes and model marketing materials is available here and here, respectively; (4) Massachusetts – Updated reporting templates for plans is available here; (5) Illinois – Updated reporting templates for plans is available here; and the state’s evaluation design plan is available here; (6) Virginia – the state’s evaluation design plan is available here; and (7) Texas – for details regarding the partnership/MOU between CMS and Texas, see here.

On May 1, CMS issued a proposed rule updating FY 2015 Medicare payment policies and rates for inpatient stays at general acute care and LTCHs. Under the proposed rule, hospitals that participate in the Hospital Inpatient Quality Reporting (IQR) Program and are ‘meaningful users’ of EHRs would receive a 1.3% payment update. However, the 1.3% rate increase, when coupled with the payment policy reductions – including those under the Hospital Readmissions Reduction Program, the Hospital Acquired Condition (HAC) Reduction Program, Medicare DSH changes as well as “the expiration of certain statutory provisions that provided special temporary increases in payments to hospitals and other proposed changes” – would ultimately decrease IPPS operating payments by approximately 0.8% or $241 million over FY 2015 payment levels. Also of note, gross LTCH payments under the proposed rule would increase by 0.8% or $44 million over FY 2014 payments, with a delay (pursuant to the statutory mandate) in the full application of the 25% Rule patient threshold, among other key LTCH policy changes denoted further below. Comments are due by June 30, 2014. CMS fact sheets are available here and here. A CMS press release is available here.

On May 6, CMS posted a video pertaining to the Comprehensive ESRD Care Initiative, titled “Making the ACO Business Case.” A subsequent webinar regarding ESCO partnerships was posted here.

On May 8, CMS issued a revised fact sheet, exploring “what providers need to know” about ACOs. The agency also updated its fact sheets on the MSSP final rule (here); MSSP engagement for rural providers (here); CMMI’s Advance Payment Model demo (here); and the methodology for determining shared savings and losses (here).

On May 20, CMS posted updated FAQs pertaining to the Medicare Care Choices Model (see here for model and application details). The FAQs – which address questions raised by stakeholders about the recent solicitation, including definitional considerations regarding in-home respite vs. inpatient respite; eligible beneficiaries; and criteria for hospital stays – are accessible here.

On May 22, CMS issued a press release announcing the “first batch of awardees” under the Health Care Innovation Awards Round Two (“Innovation Awards Round Two”) funding opportunity. Under the Innovation Awards Round Two award, HHS extended $110 million to 12 selected recipients – each receiving between $2 million-$18 million over a 3-year award period – to test new ideas to improve the quality and cost of care delivered to Medicare, Medicaid, and CHIP. For more information about the awardees, see here. In addition to the Innovation Awards Round Two announcement, CMS released a $730 million competitive State Innovation Model (SIM) initiative FOA, which is intended to “help states design and test improvements to their public and private health care payment and delivery systems.” HHS noted that under this latest SIM funding opportunity, “[u]p to 12 states will be chosen for state-sponsored Model Testing awards ($700 million available) and up to 15 states will be chosen for state-sponsored Model Design work ($30 million available).” Letters of intent are due by June 6; applications by July 21.

On May 7, HHS issued a report, delineating a number of Department-led quality improvement initiatives aimed at reducing hospital readmissions, adverse drug events (ADEs), and other forms of patient harm – including falls and hospital acquired conditions (HACs). HHS estimates that these efforts have prevented an estimated 15,000 deaths and saved roughly $4.1 billion in costs over the 2011-12 period. In particular, the report touts these achievements in the broader context of the ongoing Partnership for Patients initiative (Partnership), as well as measures under the ACA that seek to improve patient safety.

Key updates in June included: (1) New York – posting of the Chapter 8 Explanation of Benefits and Handbook here; the Summary and List of Covered Drugs here; and the Spanish-language Member Handbook for select chapters (1, 6, and 11) here; (2) Virginia – posting of the Reporting Appendix here; (3) Washington – posting of the Capitated Evaluation Design Plan here; (4) Ohio – posting of the Reporting Appendix and Templates here; and certain guidance documents available in Spanish here; and (5) Texas – posting of the addendum to the state’s MOU here. Finally, generally speaking, CMS published the Financial Alignment Demonstration Year 1 Quality Withhold Methodology and Core Technical Notes here.

On May 30, CMS posted additional FAQs on the Medicare Care Choices Model.

On June 2, CMS issued an information collection pertaining to the application for participation in the IVIG Demonstration.

On June 5, CMS posted ESRD Seamless Care Organization (ESCO) Needs Assessment guidance under the Comprehensive ESRD Care Initiative.

Key updates for July include: (1) New York – the Integrated Explanation of Benefits (EOB) Models for CY 2015 were posted here; the Spanish-language New York MMP Member Handbook Chapter 8 was posted here; and both MMP Member Handbook Chapters 2, 5, and 7, in addition to the Spanish-language New York MMP Summary of Benefits and List of Covered Drugs were posted here; (2) Ohio – the Integrated Explanation of Benefits (EOB) Models for CY 2015 were posted here; and the MMP 2015 Member Handbook, Marketing Guidance, Member ID Card, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, Integrated Denial Notices, Delegated Notices and Annual Notice of Change was posted here; (3) Illinois – the MMP 2015 Member Handbook, Marketing Guidance, Member ID Card, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, Integrated Denial Notices, Delegated Notices (5a, 16, 27, 29, 30) and Annual Notice of Change were posted here; (4) Massachusetts – the MMP 2015 Member Handbook, Marketing Guidance, Member ID Card, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, Integrated Denial Notices, Delegated Notices (5a & 5b) and Annual Notice of Change was posted here; (5) Virginia – the MMP 2015 Member Handbook, Member ID Card, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, Integrated Denial Notices and Annual Notice of Change was posted here; and (6) Colorado – the final demonstration agreement was posted here. Also, in mid-July, CMS issued modifications to its ongoing funding opportunity to support states in the deployment of demonstration ombudsman programs serving Financial Alignment demonstration beneficiaries. Applications under this fifth funding round are due by 3pm ET on October 1, 2014.

On July 2, CMS issued its CY15 Medicare Physician Fee Schedule (MPFS) proposed rule delineating a number of payment policies impacting over one million physicians and other practitioners paid under the MPFS each year. The proposed rule also sets payment policies for the Clinical Laboratory Fee Schedule (CLFS) and other Part B payments for the upcoming year. These key ACA provisions are addressed in the underlying rule. See also: CMS’ accompanying facts sheets on the rule (here and here). Comments are due by September 2, 2014.

On July 2, CMS convened webinars to discuss the respective application processes under the Model Design and Model Testing components of the $730 million competitive State Innovation Model (SIM) initiative. Archived details are available here (Model Design) and here (Model Testing).

On July 9, CMMI announced the second and remaining installment of preliminary awardees under the Health Care Innovation Awards (HCIA) Round Two program. With these latest HCIA awards, CMS noted that total HCIA program funding has now reached nearly $360 million – with federal support now extended to 39 recipients over 27 states plus DC. A full list of the awardees by state can be found here. A comprehensive listing of the combined set of HCIA Round 2 awardee project profiles is available here. The preliminary awards – which CMS reiterates are “not yet final” – are expected to range anywhere between $2 million and $23.8 million over the three-year award period, and that such prospective awardees should receive final confirmation of the notice of their award “later this summer.” Additional details are also available here.

On July 14, CMS – building on the work of the National Governor’s Association’s (NGA) Health Care Sustainability Task Force (see here) and the National Association of Medicaid Directors (NAMD) – announced a new $100 million technical assistance initiative – the Medicaid Innovation Accelerator Program (IAP) (letter to states; fact sheet; FAQs; CMS blog post) – under which the agency intends to collaborate with states to deploy innovative delivery and payment system reforms to improve the quality and reduce the cost of care provided to Medicaid beneficiaries. As far as next steps, CMS indicates that it “will be consulting with states, experts, consumers, providers and health plans on program priorities to which IAP resources will be applied and how best to deploy these new technical resources. To that end, CMS is exploring holding several meetings across the country in late summer to brief stakeholders and get input.”

On July 25, CMS issued a MLN Matters article regarding Change Request 8792 that provides further guidance regarding the “use of a demonstration code when utilizing a waiver of the 3-day hospital stay requirement for SNF claims” pursuant to the ongoing implementation of Model 2 of the Bundled Payments for Care Improvement (BPCI) initiative.

On July 31, CMS issued a BPCI fact sheet detailing key components of the bundled payments initiative.

On July 2, CMS released its CY15 ESRD PPS proposed rule which, following an advance notice of proposed rule-making on the topic, also embeds separate proposals on implementing the ACA-mandated adjustments to DME to reflect competitively bid rates. CMS estimates that overall, ESRD facilities will experience a 0.3% increase in 2015 for an increase of about $30M in Medicare payments, which derive from updates to the outlier threshold amounts. CMS notes for CY15, under the proposal, hospital-based ESRD facilities have an estimated 0.5% increase in payments coed with freestanding facilities seeing an estimated 0.3% increase. CMS also “projects that urban ESRD facilities will receive an estimated increase in payments of 0.4% while rural facilities will receive a decrease of 0.5%.” Also, the proposed rule also contains proposals on establishing a methodology for adjusting DMEPOS payment amounts using information from the Medicare DMEPOS Competitive Bidding Program and adopting a phase-in of “special payment rules” for certain DME and enteral nutrition in certain areas. These key ACA provisions are addressed in the proposed rule. An agency fact sheet on the proposed rule, including the DME components, is available here. Comments on the proposed rule are due by September 2, 2014.

On July 31, CMS issued an updated Bundled Payments for Care Improvement Initiative fact sheet.

Key updates in August include a general update of reporting requirement templates here(zipped file). Of note on the state-specific front: (1) Massachusetts – updates to the Spanish-language MMP 2015 Member Handbook, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, and Annual Notice of Change here; (2) Ohio – updates to the Spanish-language MMP 2015 Member Handbook, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, and Annual Notice of Change, as well as the MMP 2015 Final EOB and Delegated Notice (5a), posted here; (3) New York – MMP Member Handbook (Chapters 10 & 12), Part D Model Excluded Provider Letter and Part D Model Prescription Transfer Letter posted here; (4) Virginia – MMP Delegated Notices (5a, 29), MMP Reporting Requirement Templates (ongoing data collection tool), and MMP 2015 Marketing Guidance posted here; (5) Illinois – MMP 2015 Delegated Notice (4) posted here; and (6) California – MMP 2015 Member Handbook, Member ID Card, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, Integrated Denial Notices, Delegated Notices (5a, 5b) and Annual Notice of Change posted here.

On August 4, CMS issued a final rule updating FY 2015 Medicare payment policies and rates for inpatient stays at general acute care and LTCHs. The final rule also codifies “two interim final rules with comment period relating to criteria for disproportionate share hospital [DSH] uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.”

Under the final rule, hospitals that participate in the Hospital Inpatient Quality Reporting Program and are ‘meaningful users’ of EHRs would receive a 1.4% payment update – up slightly from the agency’s 1.3% proposed increased. However, the 1.4% rate increase, when coupled with payment policy reductions enumerated further below – including reductions under the Hospital Readmissions Reduction Program, changes to Medicare DSH payments, and so forth – are projected to decrease IPPS operating payments by approximately 0.6%” (compared to the net decrease of 0.8% under the proposed rule) – or by roughly $756 million in FY 2015.

CMS also finalized its proposal to continue its slow phase-in of the ATRA’s coding intensity adjustment, leaving ~$8 billion to be recouped in FYs ‘15 and ‘16.

Gross LTCH payments under the final rule would increase by 1.1%  – up from the 0.8% CMS put forward in its proposed rule, with a delay (pursuant to the statutory mandate) in the full application of the 25% Rule patient threshold, among other key LTCH policy changes denoted further below.

CMS fact sheets are available here and here.  An agency press release is available here.

On August 5, CMMI announced the launch of the three-year Medicare Intravenous Immune Globulin (IVIG) Demonstration, which aims to assess “the benefits of providing payment for items and services needed for the in-home administration of intravenous immune globulin for the treatment of primary immune deficiency disease” (details).

On August 6, CMMI posted here a compilation (two ‘batches’) of public comments provided on the agency’s below-referencedRFIon the “Evolution of Accountable Care Organization (ACO) Initiatives.”

On August 11, CMMI announced revisions to market participants under the agency’s Comprehensive Primary Care Initiative (details).

On August 19, CMMI issued a RFI soliciting stakeholder feedback on potential models to enhance Medicare/Medicaid/CHIP beneficiary engagement. Comments are due by September 15, 2014. Details here.

On Sept. 17, CMMI extended the deadline from September 15 to September 22 under which responses to the Beneficiary Engagement, Incentives, and Behavioral Insights RFI were due.

On Sept.18, CMMI announced that, while “the initial [IVIG Demonstration] enrollment period concluded September 15…the number of eligible applicants did not exceed the statutory limits.” As such, CMS intends to accept new applications under the IVIG Demonstration [updated fact sheet as of Aug. 2014] “on a rolling basis until the demonstration reaches or is projected to reach the statutory limit on funding and/or enrollment.” A MLN Matters article on IVIG Demonstration implementation was also released as were updated FAQs for beneficiaries (as of Aug. 21) and suppliers (as of Aug. 28).

On Sept. 26, CMS issued a transmittal that delineates a recurring update of the participating hospital files, episodes, and prospective bundled payment amounts associated with Models 2 and 4 of the BPCI.

Also in September, CMS posted Version 2.1 of the MMP technical manual for submitting enrollment-related transactions to CMS. Regarding state-specific developments: (1) California – MMP 2015 Reporting Requirement Appendix and CY 2015 Marketing Guidance, as well as various other document and CY 2015 formulary updates (including an Ombudsman Technical Assistance Program award here), are posted here; (2) Colorado – The state’s Ombudsman Technical Assistance Program award is posted here; (3) Illinois – A revised CY 2015 formulary list and updates to the state’s MMP 2015 Member Handbook, among other documents, are posted here; (4) Massachusetts – A revised CY 2015 formulary update and MMP Integrated Denial Notice are posted here; (5) Minnesota – A Summary of Benefits, Low Income Subsidy (LIS) Rider and Annual Notice of Change are posted here; (6) Ohio – A revised CY 2015 formulary list is posted here; (6) Texas – The Texas Readiness Review Tool is posted here; (7) New York – The CY 2015 Marketing Guidance for New York FIDA plans is posted here; and (8) Virginia – A revised CY 2015 formulary list is posted here.

In October, CMS posted here updated information for: (1) Illinois (Provider FAQs); (2) Michigan (CY15 Marketing Guidance; 2015 Member Handbook and other key documents); (3) New York (Spanish-language 2015 Member Handbook; 2015 Member Handbook updates and other key documents, including Part D Model Transition Letter); (4) South Carolina (three-way contract; 2015 Member Handbook updates and other key documents); (5) Texas (2015 Member Handbook and other key documents); and (6) Virginia (Continuity of Care Provisions). In addition, broadly speaking, in late Oct., CMS provided updated information for Medicare-Medicaid Capitated Financial Alignment Model plans regarding CY 2014 Model Core Reporting Requirements.

On October 2, CMS released a RFI (available here; response form) on testing health plan innovations under its ACA authority to conduct demonstrations to improve quality and reduce costs in Medicare, Medicaid and CHIP. Comments are due by Nov. 3.

On October 8, CMS announced that in 2012, the first Medicare Pioneer ACOs performance year, Pioneer ACOs reduced expenditures for assigned Medicare beneficiaries by as much as 7.1%. Others exceeded cost benchmarks by up to 5.2%. The following year, those remaining in the program posted a similar range of between 7.0% savings and 5.6% losses relative to their benchmark. Also: year 1 and year 2 quality results.

On October 15, CMS announced (fact sheet; FAQs; online application) the availability of up to $114 million in ACA funding to support roughly 75 ACOs participating in the MSSP. This funding – made available in the form of upfront investments (or pre-paid shared savings) under the newly-launched ACO Investment Model (AIM) – builds on theAdvance Payment Model and is intended to support providers who might otherwise lack the capital to make requisite infrastructure changes to form ACOs and to spur current MSSP ACOs “to transition to arrangements with greater financial risk.” CMS clarifies that “[t]he application deadline for organizations that started in the [MSSP] in 2012 or 2013 will be December 1, 2014. Applications will be available in the summer of 2015 for ACOs that started in the [MSSP] in 2014 or will start in 2016.”

On October 23, CMS announced (fact sheet; FAQs) a new $840 million, four-year collaborative, peer-based learning initiative – the Transforming Clinical Practice Initiative (TCPI) – to “support 150,000 clinicians in sharing, adapting and further developing comprehensive quality improvement strategies.” Under this particular funding opportunity, CMS intends to award cooperative agreements to two network systems: (1) Practice Transformation Networks (FOA); and (2) Support and Alignment Networks (FOA). For both initiatives, non-binding Letters of Intent (LOI) are “highly encouraged” and should be submitted by Nov. 20, 2014. Applications under both funding opportunities are due by January 6, 2014. Awards are intended to be made by April 10, 2015 (per the two respective FOAs). Informational webinars are planned for Nov. 6 and Nov. 20; seehere.

On October 24, CMS posted the updated benchmark methodology report applicable to performance years 4-5 of the Pioneer ACO model. Additional details here.

On October 28, CMS announced its plans to convene a webinar on Nov. 10 from 10:30am-11:30am ET to provide an update on the CMS Innovation Center’s work and the models being tested; details and registration here.

On Oct. 31, CMS posted the CY 15 Medicare Physician Fee Schedule (MPFS) final rule with comment (fact sheet) addressing a number of ACA provisions related to physician payment and quality. Citing the April 1 doc fix, the Protecting Access to Medicare Act (PAMA) of 2014, CMS notes that a 0.0% update applies between Jan. 1, 2015, and March 31, 2015, for a conversion factor (CF) of $35.8013 during that period (after budget neutrality adjustments). The SGR calculation applies thereafter (April 1, 2015-Dec. 31, 2015), with the final rule conveying a 21.2% payment reduction for this period relative to the CY14 CF, with a CF of $28.2239.

On Oct. 31, CMS issued  its CY 15 ESRD final rule that also incorporates separate provisions finalizing a methodology – driven by the ACA – to adjust DMEPOS fee schedule payments based on competitively bid rates. The final regulation addresses the ACA productivity adjustment (at sec. 3401) as well as special payment rules for DME and enteral nutrition via sec. 3021 authority. Under the rule, CMS estimates that compared with CY14, ESRD facilities will see a 0.3% net increase in estimated CY15 Medicare payments – the same as estimated under the proposed rule. A fact sheet on the rule is available here.

On Nov. 10, RAND posted its final evaluation of the Medicare Imaging Demonstration. Additional details available here.

On Nov. 10, CMS convened a webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer. The webinar highlighted the work underway at the Innovation Center. Archive materials are available here.

On Nov. 12, CMS posted updated FAQs regarding the Medicare IVIG Demonstration.

On Nov. 17, CMS posted slides from its Nov. 2014 webinars (details) addressing application assistance for the ACO Investment Model.

On Nov. 19, CMS posted updated FAQs regarding the Transforming Clinical Practices Initiative. Details regarding the Nov. 2014 webinars on this initiative are available here.

On Nov. 21, CMS announced the launch of a three-year Medicare prior authorization model for non-emergency hyperbaric oxygen therapy. The model is set to begin on Mar. 1, 2015 in three states, MI, NJ, and IL.

On Nov. 24, CMS released a report to Congress evaluating the Medicare Frontier Extended Stay Clinic (FESC) Demonstration.

On Nov. 24, CMS posted the Medicare Coordinated Care Demonstration report to Congress.

On Dec. 5,  CMMI released a final report titled, “Evaluation of the Medicare Physician Hospital Collaboration Demonstration”.

On Dec. 15, 22, and 29, CMMI updated FAQs for Transforming Clinical Practice Initiative.

On Dec. 16, HHS announced the award of $665 million in ACA funding to support a subsequent round (Round 2) of awardees under the ongoing State Innovation Models (SIM) initiative.

On Dec. 19, CMS conveyed its intention to announce the Medicare Choices Model (MCCM) awards for concurrent hospice and curative care in early 2015.

On Dec. 30, CMMI submitted its annual report (see here) to Congress focusing on CMMI activities between November 1, 2012 and September 30, 2014.

2015

On Jan. 14, 2015, CMMI announced the availability of a waiver for the 3-Day Hospital Stay Requirement for SNF Payment for Awardees testing the episode payment model for an episode length that ranges from 30 to 90 days.

On Jan. 16, CMMI updated the list of providers participating in its Comprehensive Primary Care Initiative (CPCI). For a full list of participating providers see here.

On Jan. 23, CMS announced first year findings from two CMMI initiatives, the Primary Care Practice (PCP) initiative (findings here) and the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration (findings here). For the PCP initiative, CMS noted a 3% reduction in hospital admissions and a 2% reduction in ED admissions. For the MAPCP demonstration, CMS said the demonstration saved the program $4.2M.

On Jan. 26, CMS announced new measurable goals intended to move the Medicare program further toward value driven health care. HHS sets out to have 85% of Medicare fee-for-service payments tied to quality or value by 2016 and 90% by 2018. See a press release here.

On Jan. 28, CMMI announced the release of a report (see here) on patient satisfaction and experience for Medicare beneficiaries with End-Stage Renal Disease (ESRD). The report considers the impact of the ESRD Quality Incentive Program.

On Feb. 12, CMS released “Data Navigator” updates highlighting, among several other data sets, the availability of the most recent data release for Shared Savings Program Accountable Care Organizations (SSP ACOs).

On Feb. 12, CMS issued a request for proposals (RFP) for Hospital Engagement Network (HEN) contracts (HEN 2.0) via the ongoing Partnership for Patients initiative, a public-private partnership under which 26 state, regional, and hospital system organizations currently serve as HENs to “help identify solutions already working to reduce hospital-acquired conditions, and work to spread them to other hospitals and health care providers.” More about the existing HENs is available here.

On Feb. 12, CMS announced a new multi-payer payment and care delivery model, the Oncology Care Model.

On Feb. 13, CMMI issued an RFI (available here) to inform its development of Advanced Primary Care Initiatives. The agency is particularly interested in input “on mechanisms to encourage more comprehensiveness in primary care delivery; to improve the care of complex patients; to facilitate robust connections to the medical neighborhood and community-based services; and to move reimbursement from encounter-based towards value-driven, population-based care.” Comments are due Mar. 16, 2015.

On Feb. 24, CMS posted slides from a Feb. 19 webinar on the Oncology Care Model.

On Feb. 25, CMS announced the posting of a practice spotlight for its Comprehensive Primary Care Initiative. The Spotlight focuses on Primary Care Partners, a practice in Grand Junction, CO.

On Feb. 27, HHS announced the launch of the Health Care Payment and Learning Action Network (details), followed by a formal kick-off event and list of partners with organization-specific goals on Mar. 25 (press release; fact sheet; and partners)

On Feb. 27, CMS released the first evaluation report for the Bundled Payments for Care Initiative (BPCI) Models two, three and four.

On Mar. 6, CMS posted its first evaluation report from the three-year Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) Demonstration, which concluded on October 31, 2014.

On Mar. 10, CMS announced a Request for Applications for providers to participate in a Next-Generation Accountable Care Organization (ACO) Model through which they would coordinate fee-for-service Medicare beneficiaries’ care in return for higher levels of shared risk and potential shared savings than is available through the Medicare Shared Savings Program (MSSP) or Pioneer ACO Model. Note also the addition of slidesfrom the Mar. 17 Open Door Forum (ODF) on the Next Generation ACO Model, as well the posting of slidesfrom the Mar. 24 Open Door Forum webinar on the Next Generation ACO Model.

On Mar. 24, CMS posted slides from a Mar. 23 webinar on the Oncology Care Model.

On Apr. 1, CMS updated its three-day hospital stay waiver for Model 2 participants.

On Apr. 3, CMS posted slides from a Mar. 31 webinar on Finances for the Next generation ACO model.

On Apr. 8, CMS posted a document summarizing its Mar. 25 Health Care Payment Learning and Action Network kickoff event.

On Apr. 9, CMS posted slides from an Apr. 7 webinar on Beneficiary Engagement for the Next generation ACO model.

On Apr. 10, CMS posted seven evaluation reports from its round one awards. See reports here.

On Apr. 16, CMS posted slides from an Apr. 14 webinar on Letter of Intent and Applications for the Next generation ACO model.

On Apr. 17, as part of a proposed rule updating FY 2016 Medicare payment policies and rates for inpatient stays at general acute care and LTCHs, CMS noted that it would continue to use data from hospitals participating in BPCI models 1, 2, and 4 in its IPPS payment modeling and rate-setting calculations.

On Apr. 20, CMS released a report titled “Evaluation of the Medicare Advantage Quality Bonus Payment Demonstration.”

On Apr. 22, the Oncology Care Model (OCM) team hosted a webinar on OCM FAQs and application considerations. See slides here.

On Apr. 22, CMS released a practice spotlight for its Comprehensive Primary Care Initiative (CPCI). See here.

On May 4, HHS released a report finding more than $384 million in savings from the Pioneer ACO Model.

On May 4, CMS announced the release of an evaluation report for performance years 1-2 of the Pioneer ACO Model.

On May 5, CMS released a transmittal, “Affordable Care Act Bundled Payments for Care Improvement Initiative – Recurring File Updates Models 2 and 4 July 2015 Updates.”

On May 5, CMS released a transmittal titled “Updates to the Model 4 Bundled Payments for Care Improvement (BPCI) Initiative to Clarify the Payment Calculation to Include New Technology Add-On Payments, Validate Only Claims with Medicare as Primary Payer, Allowing Medical Necessity Denial Claims to Process Effectively, and Correct Processing of Claims Submitted as Model 4 for Beneficiaries Determined to be Ineligible.”

On May 5, the first evaluation report was posted for CMS’ Strong Start for Mothers and Newborns Initiative.

On May 5, CMS updated its FAQs for the recently announced Oncology Care Model.

On May 7, the final evaluation report for CMS’ State Innovation Models Initiative: Model Pre-Test Awards was posted.

On May 7, CMS released the first annual report for its State Innovation Models Initiative: Model Test Awards Round One.

On May 14, CMS posted the practices that have submitted a letter of intent to participate in the Oncology Care Model.

On May 21, HHS’ Health Care Payment Learning and Action Network released a document called “Guiding Committee Membership.”

On May 22, GAO released a report on the results from the first two years of the Pioneer ACO model.

On May 28, CMMI released a request for applications (here) to participate in a new project (Federal Register announcement; fact sheet) called the “Million Hearts: Cardiovascular Disease Risk Reduction Model” (homepage). The goal of the project is to reduce the prevalence of heart attacks and strokes among Medicare patients.

On June 2, CMS announced the availability of a preview version of the application for a July 1 acceptance period.

On June 6, CMS updated its request for applications for its Oncology Care Model.

On June 9, CMS extended the application period for providers seeking to participate in its Oncology Care Model until June 30, 2015.

On June 10, CMS held a webinar for the Health Care Payment Learning and Action Network for interested stakeholders.

On June 18, CMS released the year one performance results for the Independence at Home Demonstration.

On June 19, CMS posted updated FAQs for its Oncology Care Model.

On June 25, CMS updated its eligibility criteria for its ACO Investment Model to allow for large rural Shared Savings Program ACOs and ACOs that have just recently started.
On June 26, CMS announced a July 1 webinar to help with the application process for the Million Hearts Cardiovascular Disease Risk Reduction Model.

On June 26 CMS announced an information collection for its Health Care Payment Learning and Action Network to allow the Innovation Center “to potentially inform the design, selection, testing, modification, and expansion of innovative payment and service delivery models.”

On June 29, CMS released a practice spotlight for its Comprehensive Primary Care Initiative for the Capital Care Medical Group in the Capital District of New York.

On July 1, CMS released an evaluation report for its Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents

On July 8, CMMI posted updated webinar materials for its Million Hearts: Cardiovascular Disease Risk Reduction Model.

On July 8, CMS posted the CY 16 Medicare Physician Fee Schedule (MPFS) proposed rule, which delineates payment policies impacting over one million physicians and other practitioners paid under the MPFS each year (see fact sheet here). Citing the latest doc fix (P.L. 114-10), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS effectuates the statutory 0.5% increase. The proposed rule addressed this provision of the ACA. Comments are due Sept. 8.

On July 9, CMMI announced a new model to test a new bundled payment and quality measurement for an episode of care associated with hip and knee replacements

On July 13, CMS posted the second evaluation report for its Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) Demonstration.

On July 20, CMS announced a new Model, the Medicare Care Choices Model, which will allow Medicare beneficiaries to receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers.

On July 28, CMS posted a practice spotlight for its Comprehensive Primary Care Initiative (CPCI).

On Sep. 1, CMS announced its Medicare Advantage Value-Based Insurance Design model, and a webinar was convened on Sept. 24 to provide an overview of the model.

On Sep. 9, CMS announced that it will issue “a single-source, cooperative agreement award to three grantees to test a data aggregation model that combines data from insurance companies and Medicare in support of an innovative payment and service delivery initiative.”

On Sep. 10, CMS extended the date by which applications and letter of intents (LOIs) are due under the Million Hearts Cardiovascular Disease Risk Reduction model (now due: Oct. 8).

On Sep. 24, CMS held a Q&A session regarding its Million Hearts Cardiovascular Disease Risk Reduction model.

On Sep. 25, CMS announced round two Hospital Engagement Network awards under its Partnership for Patients initiative.

On Sep. 28, CMS announced a new model, the Part D Enhanced Medication Therapy Management (MTM) model

On Sep. 28 CMS announced $685 million in awards under its Transforming Clinical Practices Initiative (TPCI), a project to promote physician collaboration on quality improvement strategies.

On Dec. 4, CMS held a webinar on the Part D Enhanced Medication Therapy Management Model.

On Dec. 8, CMS held an open door forum on its Home Health Value-Based Purchasing (VBP) Model.

On Dec. 15, CMS released a fact sheet providing a mid-year update on its Comprehensive Primary Care Initiative (CPCI). CMS also posted updated guidance regarding Per Beneficiary per Month Payment (PBPM) implementation under the Medicare Care Choices Model (MCCM).

On Dec. 16, CMS posted ICD-9 and ICD-10 hip fracture diagnosis codes and hospital list spreadsheets for its Comprehensive Care for Joint Replacement Model.

On Dec. 21, CMS made publically available a set of responses to stakeholder inquiries regarding its Medicare Advantage Value-Based Insurance Design Model.

On Dec. 21, CMS announced that the BPCI Model 1: Retrospective Acute Care Hospital Stay Only model would conclude at the end of the third performance period.

On Dec. 29, CMS posted a set of FAQs for its Home Health VBP Model.

On Dec. 30, CMS released a Model episode exclusion list for its Retrospective Post-Acute Care Only model (BPCI Model 3).

On Dec. 30, CMS posted a Model episode exclusion list for BPCI Model 4: Prospective Acute Care Hospital Stay Only.

On Dec. 31, CMS released the actual certification form for its Part D Enhanced Medication Therapy Management Model.

On Dec. 31, CMS posted recurring file updates for BPCI Models 2 and 4.

2016

On Jan. 4, 2016, CMS posted a hospital list for its Comprehensive Care for Joint Replacement (CJR) Model.

On Jan. 4, CMS posted the Skilled Nursing Facility three-day hospital stay waiver document for its Retrospective Acute & Post-Acute Care Episode BPCI Model (Model 2).

On Jan. 5, CMS announced the Accountable Health Communities (AHC) Model. Webinars were convened on Jan. 21 and Jan. 27 (details). Non-binding LOIs are due by Feb. 8. Applications are due by Mar. 31. FAQs are being updated and posted here.

On Feb. 3, CMS posted the final evaluation report for its Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.

On Feb. 5, CMS released – and then rescinded – a transmittal instructing MACs to prepare for a new Part B payment model.

On Feb. 9, CMS posted FAQs for its newly announced Accountable Health Communities (AHC) Model.

On Feb. 10, CMS updated the hospital list for its Comprehensive Care for Joint Replacement Model.

On Feb. 10, CMS held a webinar to discuss the state agency’s role in the AHC Model.

On Feb. 11, CMS released a Change Request to implement systems’ changes for its Monthly Enhanced Oncology Services (MEOS) Payments for the Oncology Care Model.

On Feb. 19, CMS released an MLN Matters article providing provider education for its Comprehensive Care for Joint Replacement Model (CJR).

On Feb. 19, CMS issued a Change Request implementing Per Beneficiary per Month Payment (PBPM) for its Medicare Care Choices Model (MCCM).

On Feb. 24, CMS released an information collection on proposed changes to its Medicare Current Beneficiary Survey, which is administered by CMMI.

On Feb. 25, CMS submitted to OMB for review a proposed rule outlining an alternate payment Model for Part B drugs.

On Apr. 4, CMS announced that LOIs and applications are being accepted until April 15, 2016 for its Million Hearts: Cardiovascular Disease Risk Reduction Model.

On Apr. 11, CMS announced a new five-year multi-payer payment model called the Comprehensive Primary Care Plus (CPC+) model. The CPC+ model will begin in 2017, and CMS notes that it is the “largest-ever multi-payer initiative to improve primary care in America.” CMS says the model will expand on a previous primary care payment reform initiative called the Comprehensive Primary Care (CPC) initiative.

On Apr. 14, CMMI released a RFI (see here) on the use of global budgets, a payment scheme that “prospectively establishes an annual budget for the health care services delivered to patients by each participating provider.” Global payments are currently employed under the Maryland All-Payer Model, and CMS is seeking input on the feasibility of similar approaches for other geographical areas, which could include areas smaller than a state.

On Apr. 18, CMS offered BPCI Models 2, 3 and 4 awardees the opportunity to extend their participation in the pilot through Sept. 30, 2018. Specifically, per the announcement, awardees must “choose to sign an amendment extending their period of performance for all clinical episodes for up to 2 years.”

On Apr. 19, CMS released the FY 2017 inpatient prospective payment system (IPPS) and long-term care hospital PPS and policy proposed rule that, once, finalized, will apply to discharges beginning on or after Oct. 1, 2016. Under the rule, CMS estimates a net average payment increase of 0.7% (a roughly $539 million increase in spending, including capital) in FY 2017 for the IPPS. For LTCH’s, and stemming largely from the application of statutory site-neutrality provisions in the Pathway for SGR Reform Act, CMS estimates that FY 2017 payments will decrease by an estimated $355 million or -6.9% in FY 2017.

On Apr. 19, CMS released the Payer MOU for the CPC+ Model.

On Apr. 21, CMS extended the deadline for LOIs for its Next Generation ACO Model until May 20, 2016.

On Apr. 27, CMS released the vendor MOU and payer solicitation instruction documents for its CPC+ Model.

On Apr. 27, CMS released a highly-anticipated proposed rule, setting the foundation for the new Merit-based Incentive Payment System (MIPS) and upcoming incentives for participation in Alternative Payment Models (APMs) pursuant to the latest ‘doc fix,’ the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Both MIPS and APMs encompass a broader framework, the Quality Payment Program, envisioned by the MACRA, which aims to better align Medicare payments to cost and quality of patient care through these two payment pathways. The proposed rule also delineates the proposed criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) (details) in making comments and recommendations on physician-focused payment models (PFPMs).

Following a series of letters sent by the Senate Finance Committee, on May 2, House Budget Committee Chairman Tom Price (R-GA), House Energy and Commerce Committee Member John Shimkus (R-IL), and House Ways and Means Committee Member Charles Boustany (R-LA), sent a widely signed letter to CMS Acting Administrator Andy Slavitt urging CMS to withdraw its proposed Part B Drug Payment Model. Some Democrats joined the predominantly Republican letter, with 242 total Member signatures.

On May 6, CMS posted a draft communication guidance document for its Medicare Advantage Value-Based Insurance Design Model.

On May 11, CMS released materials from an open door forum on the Next-Generation ACO Model.

On May 12, CMS announced an evaluation report describing the progress made on projects funded through its Health Care Innovation Awards.

On May 13, CMS released a fact sheet for payers seeking to participate in its Comprehensive Primary Care Plus model.

On May 17, the Energy and Commerce Subcommittee on Health held a hearing about CMS’ proposed demonstration that would reform payment for certain Medicare Part B drugs.

On May 23, HHS released its spring 2016 Regulatory Agenda. CMS’ final rule on the Medicare Part B Drug Payment Model is targeted for March 2019, although the three-year timeframe likely reflects the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)’s three-year deadline for finalizing or re-proposing a pending proposed rule rather than an actual delay in the agency’s anticipated timeframe.

On June 1, CMS updated the FAQs for its Comprehensive Primary Care Plus (CPC+) Model. Updated FAQs include new questions about duals’ participation in CPC+ and MSSP.

On June 10, CMS posted the second evaluation Report to Congress for its Medicaid Incentives for the Prevention of Chronic Diseases Model.

On June 11, CMS announced that up to $10 million will be available over the next three years to fund the second round of the Support and Alignment Networks under the Transforming Clinical Practice Initiative (TCPI).

On June 24, CMS released the calendar year 2017 proposed rule for the end-stage renal disease (ESRD) prospective payment system (PPS), which updates rates for renal dialysis services provided to Medicare beneficiaries on or after Jan. 1, 2017. In the rule, CMS sought comment on strategies to refine innovative payment models related to kidney care. Comments are due by Aug. 23, 2016.

On June 27, CMS released its proposed rule on the calendar year (CY) 2017 home health prospective payment system rate update, which also proposes further policies for implementing a Home Health Value-Based Purchasing (HHVBP) Model beginning in CY 2018. Comments are due by Aug. 26, 2016.

On June 28, the Senate Finance Committee held a hearing to examine the Centers for Medicare and Medicaid Services’ (CMS) proposed Part B demonstration. During the hearing, members from both sides of the aisle questioned the hearing’s sole witness, CMS’ Dr. Patrick Conway, about a number of issues raised by stakeholders about the Model.

On June 29, CMS announced that it has selected nearly 200 physician group practices and 17 insurance companies to participate in its Oncology Care Model. The Medicare component of the Model has more than 3,200 oncologists and will cover approximately 155,000 beneficiaries nationwide. It begins on July 1, 2016, and runs through June 30, 2021.

On June 30, CMS announced that it has selected nearly 200 physician group practices and 17 insurance companies to participate in its Oncology Care Model. The Medicare component of the Model has more than 3,200 oncologists and will cover approximately 155,000 beneficiaries nationwide. It begins on July 1, 2016 and runs through June 30, 2021.

On July 1, CMS updated the list of hospitals participating in the Comprehensive Care for Joint Replacement Model.

On July 1, CMS posted a three-day hospital stay waiver for its BPCI Model 2: Retrospective Acute & Post-Acute Care Episode.

On July 7, CMS released its calendar year (CY) 2017 Medicare Physician Fee Schedule (MPFS) proposed rule delineating wide-ranging Medicare Part B policies that would take effect on Jan. 1, 2017. The proposed rule also would expand the Medicare Diabetes Prevention Program Model, require transparency of certain Medicare Advantage (MA) data, continue the implementation of appropriate use criteria for advanced diagnostic imaging services, and make selected refinements to the Medicare Shared Savings Program, among other policies.

On July 14, CMMI released a request for information (RFI) (see here) on the use of global budgets, a payment scheme that “prospectively establishes an annual budget for the health care services delivered to patients by each participating provider.”

On July 21, CMS announced 516 awardees to reduce risk of heart attack and stroke among Medicare beneficiaries in the Million Hearts: Cardiovascular Disease Risk Reduction Model.

On July 25, CMS posted a proposed rule proposing three new cardiac-focused bundled payment models under CMMI’s broad demonstration authority. The agency also proposes an amplification of the existing Comprehensive Joint Replacement Model (CJR) to include additional procedures and proposes several modifications to the CJR Model. Finally, it takes into account the models’ role in the Medicare Access and CHIP Reauthorization Act’s (MACRA) Advanced Alternative Payment Models (APMs) and makes proposals related to participants’ eligibility as Advanced APMs.

On July 25, in a related development, HRSA’s Bureau of Primary Health Care (BPHC) announced it is awarding funds to health centers transitioning to value-based models of care, improving the use of information in decision making, and increasing engagement in delivery system transformation.

On Aug. 1, CMMI announced the beginning of the application period for practices in 14 selected regions for the CPC+ Model.

On Aug. 1 CMMI updated the hospital list for the Comprehensive Joint Replacement Model.

On Aug. 2, CMS released the FY 2017 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) PPS and policy final rule. The final rule governs FY 2017 payments to approximately 3,330 acute care hospitals and 430 LTCHs through the IPPS and LTCH PPS, respectively, and effectuates key policy changes. Under the rule, net payments to inpatient hospitals will increase by 0.95 percent on average compared with FY 2016. For the IPPS, the rule finalizes the 1.5 percent documentation and coding recoupment cut, as proposed, and delays the proposed incorporation of S-10 data into uncompensated care calculations. LTCH PPS payments will decrease by 7.1 percent under the LTCH PPS amid the ongoing implementation of site neutrality and will increase by 0.7 percent for cases qualifying for the higher standard rate. The aforementioned provisions are addressed in this regulation.

On Aug. 4, CMS announced participant for its Frontier Community Health Integration Project Demonstration.

On Aug. 9, CMS posted the year two performance results from its Independence at Home Demonstration.

On Aug. 11, the Center for Medicare and Medicaid Innovation announced refinements to the design of the second year of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model.

On Aug 18, CMS released guidance intended for providers who are participating in Next Generation Accountable Care Organizations (NGACOs) and submitting claims to Medicare Administrative Contractors (MACs) for certain skilled nursing facility, telehealth, and post-discharge home visit services to Medicare beneficiaries that would not otherwise be covered by Medicare FFS.

On Aug. 19, CMS posted a year one evaluation report for the Health Care Innovation Awards Round Two.

On Aug. 25 CMS released the 2015 performance year (PY) results on Medicare Shared Savings Program (MSSP) and Pioneer Accountable Care Organizations’ (ACOs) financial and quality performance.

On Aug. 29, CMS posted the Health IT vendor list for its Comprehensive Primary Care Plus model.

On Aug. 30, CMS posted the first evaluation report Financial Alignment Initiative for Medicare-Medicaid Enrollees for the state of Washington.

In a Sept. 7 blog post, CMS touted both “progress” and “value” under Round 1 of the State Innovation Model (SIM) initiative Model Test Awards (Round 1 Test Awards).

On Sept. 8, the House Budget Committee held a hearing, “Center for Medicare and Medicaid Innovation (CMMI): Scoring Assumptions and Real-World Implications.” The hearing was scheduled to examine how the CBO’s scoring of CMMI is affecting the ability of Congress to perform its duties.

On Sept. 8, CMS announced a Track 1 funding opportunity and an overview webinar for the Accountable Health Communities (AHC) model. Applications are due by 3pm ET on Nov. 3 (including from applicants that previously applied to Track 1 under the original AHC FOA that must reapply).

On Sept. 9, CMS issued a RFI related to its State Innovation Mode (SIM) initiative.

On Sept. 12, CMS posted for review potential ICD-10 episode exclusion categories and fracture codes for FY 2017 for its Comprehensive Joint Replacement model.

On Sep 13, CMS held a webinar to provide an overview of the new funding opportunity and application requirements specific to Track One of the AHC innovation model.

On Sept. 13, CMS posted the Health IT vendor list for its Comprehensive Primary Care Plus model.

On Sept. 14, CMS posted slides from a webinar explaining how a recent proposed rule impacts the Comprehensive Joint Replacement model’s ability to qualify as an advanced APM under MACRA.

On Sept. 19, CMS released the second annual evaluation report for Models 2-4 of the voluntary Bundled Payments for Care Improvement (BPCI) initiative.

On Sept. 29, CMS today announced the award of $347 million in Hospital Improvement and Innovation Network (HIIN) contracts to continue efforts in reducing hospital-acquired conditions and readmissions in the Medicare program.

On Sept. 29, CMS announced the second round awardees for the Support and Alignment Network under the Transforming Clinical Practice Initiative.

On Oct. 3, CMMI elaborated on its 2018 plans for the MA Value-Based Insurance Design Model (MA VBID), following Aug. 10 guidance to MA insurance plans.

On Oct. 3, CMS announced the six Part D sponsors that will be participating in the Part D Enhanced Medication Therapy Management (MTM) Model (Enhanced MTM Model), which is set to begin next January in five Part D regions.

On Oct. 4, CBO said legislation blocking the proposed Medicare Part B Drug Payment Demonstration would cost $395 million over 10 years.

On Oct. 4, CMS posted the three-day hospital stay waiver for its Bundled Payments for Care Improvement initiative model 2, Retrospective Acute & Post-Acute Care Episode.

On Oct. 14, CMS released its highly anticipated final rulefinalizing requirements for implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the MACRA.

On Oct. 17, CMS announced shared savings and quality results for its Comprehensive Primary Care initiative.

On Oct. 25, CMS posted its 2018 RFA for the MA Value-Based Insurance Design Model.

On Oct. 26 CMS announced the Vermont All-Payer ACO Model.

On Oct. 31, CMS released the CY 2017 final rule for the ESRD PPS. The rule also addresses key policies related to the DMEPOS Competitive Bidding (CB) Program.

On Nov. 4 CMS announced a conference call to discuss expansion of the Medicare Diabetes Prevention Program.

On Nov. 15 CMS updated its payer and region list for its CPC+ model.

On Nov. 22 a pair of top Democratic leaders called on the Obama administration to withhold final regulations on the Medicare Part B Drugs Payment Model, potentially dealing a knockout blow to the administration’s preeminent foray into the drug pricing debate.

On Dec. 8, 2016, CMMI announced two new models that it broadly terms “Beneficiary Engagement and Incentives (BEI) Models.”

On Dec. 15, CMS announced the Medicare-Medicaid ACO Model, a new initiative for beneficiaries who are enrolled in both Medicare and Medicaid.

2017

On Jan. 18, 2017, CMS announced over 359,000 clinicians are confirmed to participate in four of CMS’s Alternative Payment Models (APMs) in 2017: The Medicare Shared Savings Program (Shared Savings Program), Next Generation ACO Model, Comprehensive ESRD Care Model (CEC) and Comprehensive Primary CarePlus (CPC+) Model.

On Feb. 17, CMS announced delay of the effective date of a rule that will implement three new Medicare episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model, and changes to the existing Comprehensive Care for Joint Replacement (CJR) model.

On Feb. 21, CMS opened the application period for payers to participate in Round 2 of the Comprehensive Primary CarePlus (CPC+) model, to begin January 1, 2018.

On Feb. 27, CMS announced a RFI (available here) seeking input on approaches to improve pediatric care. CMS is exploring the development of a new pediatric health care payment and service delivery model.

On Mar. 20, CMS for the second time delayed the start date of its episode payment models. The second delay moves the effective date of the rule from Mar. 21, 2017 until May 20, 2017 and the applicability date (start date) of the models from July 1, 2017 to Oct. 1, 2017.

On Mar. 28, CMS announced an extension of the deadline by which stakeholders are encouraged to provide feedback on the agency’s draft Pediatric Alternative Payment Model (Pediatric APM) concept. Comments on the RFI are due Apr. 7.

On March 31, CMS posted final evaluation report for its Pioneer ACO Model.

On April 27, CMS released its proposal to revise the FY 2018 Medicare IPPS, a rule that includes provisions stemming from section 3021 authority.

On May 5, CMS posted the evaluation for the Strong Start for Mothers and Newborns Initiative.

On May 19, CMS finalized May 20, 2017 as the effective date of the final rule titled, “Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR).”

On June 9, CMS posted the final evaluation report for its Multi-Payer Advanced Primary Care Practice Announced.

On June 21, CMS posted the final evaluation report for the FQHC Advanced Primary Care Practice Demonstration.

On July 13, 2017 CMS proposed to implement Medicare Diabetes Prevention Program expanded model nationwide.

On Aug. 15, CMS proposed to eliminate episode payment models for Acute Myocardial Infarction (AMI) and for Coronary Artery Bypass Graft (CABG). The agency had previously delayed implementation of the models.

On Aug. 15, CMS announced proposed changes to its Comprehensive Joint Replacement Model that would scale back the number of mandatory geographic regions for participation.

On Sept. 20, CMS released an informal Request for Information (RFI) on a “new direction” for the Innovation Center (CMMI). Comments are due by Nov. 20.

2018

Aug 27: CMS released an evaluation report for the first performance year (2016) of the Next Generation ACO model (NGACO) (highlights; technical appendices). For the first year of the model, CMS estimates that Medicare spending was reduced by 1.1 percent, or $62 million, after adjusting for shared savings/loss payments.

Aug. 29: CMS posted the Physician Group Practice (PGP) Episode Initiator (EI) training aid for the BPCI Advanced model. Details.

2019

On Jan. 18, CMMI announced a new demonstration model to test incentives for Medicare Part D plans to encourage drugs with lower list prices and reduce spending in the catastrophic phase of the benefit (fact sheet; press release; summary). Called the Part D Payment Modernization model, the five-year voluntary demonstration seeks to test the “impact of a modernized Part D payment structure that creates new incentives for plans, patients, and providers to choose drugs with lower list prices in order to address rising federal reinsurance subsidy costs in Part D.”

On Jan. 18, CMMI announced four new interventions available for testing under the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model in 2020 (fact sheet). The MA VBID program is a model currently being tested through the CMMI and seeks to reduce Medicare expenditures while improving quality of care by allowing plans greater flexibilities in benefit design that promote high-value services.

In mid-March, CMMI released the slides used during a recent webinar overviewing the Alternative Payment Model (APM) component of the Integrated Care for Kids Model (InCK). CMMI also provided an audio recording of the event itself. Announced earlier this year (WHG summary here), the InCK model will establish new care delivery and payment models in select states designed to provide comprehensive, wrap-around care for children covered under Medicare and CHIP. Applications to participate in the InCK model are due June 10, 2019.

On Mar. 21, CMMI released its third annual report evaluating the progress of the center’s State Innovation Model (SIM) Round 2 Initiative. This model aims to test state-based approaches to implementing multi-payer health care transformation models to achieve a “preponderance of care.” Our summary of the report is available here.

On April 22, CMMI announced a suite of voluntary five-year payment model options, the Primary Cares Initiative, as the next step in the Trump Administration’s value-based transformation initiative. CMS estimates that roughly 25 percent of all Medicare fee-for-service (FFS) beneficiaries – roughly 11 million individuals – will be served under the five payment model options detailed below. Additionally, the model will aim to provide opportunities for dual-eligible individuals to participate, specifically those in Medicaid managed care organizations (Medicaid MCOs) and Medicare FFS.

On April 28, CMMI published its fourth report to Congress, which outlined the agency’s work during the period of October 1, 2016 to September 30, 2018.

On Oct. 24, CMMI released the request for application (RFA) for its Primary Care First (PCF) Model Options, as well as its voluntary kidney care models.