Here is a new update from the Centers for Medicare and Medicaid Services:
CMS Launches New Podcast
On February 19, the Centers for Medicare and Medicaid Services (CMS) ) launched “CMS: Beyond the Policy,” a new podcast highlighting updates and changes to policies and programs in an easily accessible and conversational format. The podcast was created as a new method to explain the agency’s policies and programs. The podcast website is available at https://www.cms.gov/podcast.
The inaugural episode focuses on Evaluation and Management Coding (E/M Codes). CMS finalized changes in the Calendar Year 2019 Physician Fee Schedule (PFS) as part of efforts to help create a more accessible, affordable and innovative healthcare system that delivers quality for patients and empowers them to make the best decisions about their healthcare. The podcast can be heard here: https://www.cms.gov/podcast/episode-1-evaluation-and-management-coding.
CMS MOM and InCK Opioid Model Funding Opportunity Announced
The Maternal Opioid Misuse (MOM) model is the next step in the Center for Medicare and Medicaid Innovation’s (Innovation Center) multi-pronged strategy to combat the nation’s opioid crisis. The model addresses fragmentation in the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD) through state-driven transformation of the delivery system surrounding this vulnerable population. By supporting the coordination of clinical care and the integration of other services critical for health, wellbeing, and recovery, the MOM model has the potential to improve quality of care and reduce costs for mothers and infants.
The Integrated Care for Kids (InCK) Model is a child-centered local service delivery and state payment model that aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of behavioral and physical health needs. The model will empower states and local providers to better address these needs and the impact of opioid addiction through care integration across all types of healthcare providers.
The InCK Model Notice of Funding Opportunity was announced on February 8 and the deadline for applications is June 10. The MOM Notice of Funding Opportunity was announced on February 8 and the deadline for application is May 6. Click on the hyperlinked text to see the websites with recordings of webinars about the programs and how to apply for the funding.
HHS Launches Innovative Payment Model for Meeting Emergency Needs
The U.S. Department of Health and Human Services (HHS), Center for Medicare and Medicaid Innovation (Innovation Center), which tests innovative payment and service delivery models to lower costs and improve the quality of care, announced a new payment model for emergency ambulance services that aims to allow Medicare Fee-For-Service (FFS) beneficiaries to receive the most appropriate level of care at the right time and place with the potential for lower out-of-pocket costs.
The new model, the Emergency Triage, Treat and Transport (ET3) model, will make it possible for participating ambulance suppliers and providers to partner with qualified health care practitioners to deliver treatment in place (either on-the-scene or through telehealth) and with alternative destination sites (such as primary care doctors’ offices or urgent-care clinics) to provide care for Medicare beneficiaries following a medical emergency for which they have accessed 911 services. In doing so, the model seeks to engage health care providers across the care continuum to more appropriately and effectively meet beneficiaries’ needs. Additionally, the model will encourage development of medical triage lines for low-acuity 911 calls in regions where participating ambulance suppliers and providers operate. The ET3 model will have a five-year performance period, with an anticipated start date in early 2020.”
Part D Opioid Overutilization Policies Beneficiary Fact Sheet
CMS is introducing new Medicare Part D opioid overutilization policies to prevent and reduce opioid overutilization while preserving medically necessary opioid use. The new policies include improved safety alerts for beneficiaries who are filling their initial opioid prescription or who are receiving high doses of opioids when their prescriptions are being filled at the pharmacy, and drug management programs to better coordinate care for potentially high risk opioid use by patients who receive opioids from multiple prescribers and/or pharmacies. More information, including a fact sheet and Power Point Slides on what this means for beneficiaries can be found here:https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/rxutilization.html.
Health Insurance Marketplace Blogs
CMS has released two blogs to help individuals and families who receive health insurance from the Health Insurance Marketplace. The first blog is for people who are eligible for a Special Enrollment Period. The second blog is for filing taxes when you have a Marketplace plan.
Blog: Need to submit documents for Marketplace Insurance to confirm a life event? If you are eligible for a Special Enrollment Period to enroll in or change plans for 2019, you may be asked to provide documents to confirm the event that makes you eligible.
Do I need to submit documents?
- You’ll learn if you have to provide documents after you submit your application.
- Details and instructions appear on your eligibility results screen and in a notice you can download or get in the mail.
- If your eligibility results don’t say you need to, just pick a plan and enroll.
What document types can I provide?
- The documents depend on your life event. See the documents and deadlines for each kind.
- If you have your documents handy and are ready to upload them, follow these steps
How long do I have to send documents?
- After you pick a plan, you have 30 days to send documents.
- While your coverage start date is based on when you pick a plan, you can’t use your coverage until your eligibility is confirmed and you make your first premium payment.
Blog: 3 things to know about 2018 taxes and Marketplace Insurance. 2018 tax filing season starts January 29, 2019. You must report information about your 2018 health coverage when you file. If you had Marketplace health insurance in 2018, check out these 3 tips:
Keep an eye out for Form 1025-A
- If anyone in your household had a Marketplace plan in 2018, we’ll mail you Form 1095-A, Health Insurance Marketplace Statement, by early February. It’ll also be available online in your HealthCare.gov account. Note: It comes from the Marketplace, not the IRS.
- You’ll use it to “reconcile” your premium tax credit.
Make sure your Form 1095-A is correct.
- If anything about your coverage or household is wrong, contact the Marketplace Call Center.
- Also, make sure the information about the “second lowest cost Silver Plan” (SLCSP) is correct.
- Don’t file your taxes until you have an accurate 1095-A.
Get help, step-by-step instructions and tax forms
- Choose the situation that best applies to you to learn about health coverage and your 2018 federal taxes.
- Find out where to get free volunteer tax help from the IRS.
IMPORTANT: Did not have health insurance in 2018? If you could have afforded insurance in 2018 but chose not to buy it, you may have to pay a fee when you file taxes this year. But starting with the 2019 plan year (for which you’ll file taxes in 2020), the fee no longer applies.
Health and Wellness Webinars
The Association of State and Territorial Health Officials (ASTHO), the Centers for Disease Control and Prevention (CDC), and the CMS Innovation Center (CMMI) are offering a webinar on Adverse Childhood Experiences (ACEs). Exposure to ACEs or trauma in childhood contribute to increased risk of behavioral health diagnoses for children and youth, and correlates with increased morbidity, health care utilization, and premature death. The InCK Model provides an opportunity for states to address ACEs and other health needs through early identification, screening, and integrated care coordination and case management. Registration for the ACEs webinar is available using the following link above.