The proposed rules seek to codify or create new operational requirements for the plans including: proposed credits for achieving network adequacy, new care management and model of care requirements for all SNPs, additional appeals process provisions, and a discussion of the impact on plans when providers consolidate.
On March 17, the Centers for Medicare Services (CMS) released guidance for the telehealth waiver, in the form of a Fact Sheet and a Q&A document. Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and include a patient’s places of residence starting March 6, 2020.
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 emergency has ended or 30 days has elapsed and no end date was included in the original declaration.
A Washington Post article today highlighted, in Italy, what we know as providers to be inherently true everywhere: this virus, like other flulike viruses, is “disproportionately risky for the old[er adult].” Countries now battling the Coronavirus are scrambling to find ways to protect their most vulnerable populations, such as the elderly; o
Framed by Chairperson Senator Susan Collins (R-ME) and Ranking Member Senator Bob Casey (D-PA), as a hearing to help older adults receive services and support in their homes and communities several issues and pieces of legislation important to LeadingAge members were discussed.
Much of the proposed changes seek to convert CMS existing and past sub-regulatory guidance and practices into regulation. By doing this, CMS provides a little more certainty to plans and providers that certain positions, approaches and policies of the agency will remain in force until a rule change is made through the prescribed process instead of simply a change in decision by the agency. It also seeks to clarify in regulation how certain issues have been addressed in practice but for which there is no clear law or regulation that supports the practice.
On February 10, the President delivered his fiscal year 2021 (FY21) budget request to Congress. The annual delivery of the Administration’s request for program funding is the start of the process for Congress to determine funding levels for federal programs.
A key focus related to Medicare is to “eliminate excessive spending and distortionary payment incentives” of which several proposals relate to areas of interest for LeadingAge members.
Contact: Lisa Sanders
lsanders@leadingage.org / 202-508-9407
Patient-Driven Groupings Model (PDGM)
Taking into account, the increased complexity of the new payment system, LeadingAge has made three new payment tools available for organizations to help in budgeting and planning for PDGM impacts.
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