Tags Posts tagged with "CMS"


CMS Webinar: June 14, 2023
1:30 pm – 3:00 pm ET
Register here

States can use outcome-based payment arrangements as an alternative or supplement to traditional fee-for-service (FFS) payments to incentivize 1915(c) waiver program providers with meeting targeted milestones or achievements. States offering outcome-based payment arrangements establish targeted outcomes that align with participant or program goals. This training will help states by:

  • Providing an overview of outcome-based payments in 1915(c) waiver programs;
  • Highlighting examples of outcome-based payments from 1915(c) waiver programs and outcome-based payments methodologies;
  • Discussing the impact of the COVID-19 Public Health Emergency and state responses using outcome-based payments; and
  • Discussing considerations for states implementing outcome-based payments in 1915(c) waiver programs.

Message from ANCOR:

ANCOR has been working diligently to review the proposed Access Rule, Ensuring Access to Medicaid Services, assess its impact, and propose ways to strengthen access to community-based services. Please join us on Tuesday, June 6, from 1:00 pm – 2:00 pm EDT for our second Members-Only Briefing on the Access Rule.

Please register in advance for Tuesday’s Feedback Forum.

During Tuesday’s Members-Only Briefing, the GR team will review:

  • How the Access Rule proposes to address direct care compensation, standardize systems of reporting, and engage stakeholder input;
  • ANCOR’s strategy to respond to the Access Rule;
  • How you can help us assess the impact and submit comments.

In addition to Tuesday’s briefing, we want to hear from you, in your own words, what impact the proposed rulemaking may have on your organization’s ability to provide services.

Please respond to this 10-question survey by Friday, June 9 at 11:59 pm PDT.

We remain committed to keeping you informed and providing you with the tools you need to offer comments and insight into the proposed rules. Thank you for everything you do each day, and we hope to see you on Tuesday at 1:00 pm EDT.

Shannon McCracken
Vice President of Government Relations

If you have any questions regarding this ANCOR message, please contact Carol Ferenz.

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On Thursday, May 25, the Centers for Medicare and Medicaid Services (CMS) posted updated information to the Inpatient Rehabilitation Facility (IRF) Review Choice Demonstration (RCD) website. Included in this updated information is the Review Choice Demonstration for Rehabilitation Facility Services Operational Guide and the IRF RCD Process Flowchart. The flowchart is also contained as an appendix in the operational guide.

The Operational Guide provides additional detail on the processes for IRFs impacted by the RCD. The IRF RCD is expected to begin in Alabama on August 21, 2023. The next phase of the rollout has not been shared yet; however, Pennsylvania is expected to be one of the next states to be impacted.

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The Centers for Medicare and Medicaid Services (CMS) recently notified the American Medical Rehabilitation Providers Association (AMRPA) that the rollout of the Review Choice Demonstration (RCD) would begin on August 21, 2023, in Alabama. In previous information released about the RCD, Pennsylvania is most likely to be one of the next states in line for this rollout. Under this demonstration, CMS Medicare Administrative Contractors (MACs) will review all Medicare Fee-for-Service (FFS) claims in select states. CMS will utilize a dedicated website to provide updated information and resources to inpatient rehabilitation facility (IRF) stakeholders.

RCPA is working closely with AMRPA staff and will keep members apprised of developments and updates throughout the demonstration. The RCD website confirms that affected IRFs will have the option to elect pre-claim or post-payment review (and must use the same option for all claims).

The Centers for Medicare and Medicaid Services (CMS) released two notices of proposed rulemaking (NPRM): Ensuring Access to Medicaid Services and Managed Care Access, Finance, and Quality.

If adopted as proposed, the rules would establish national standards for access to care regardless of whether that care is provided through managed care plans or directly by states through fee-for-service (FFS). Specifically, they would establish access standards through Medicaid or CHIP managed care plans, as well as transparency for Medicaid payment rates to providers, including hourly rates and compensation for certain home care and other direct care workers. The rules would also establish other access standards for transparency and accountability and empower beneficiary choice.

The proposed rules together include new and updated proposed requirements for states and managed care plans that would establish tangible, consistent access standards and a consistent way to transparently review and assess Medicaid payment rates across states. The rule also proposes standards to allow enrollees to easily compare plans based on quality and access to providers through the state’s website.

Other highlights from the proposed rules include:

  • Establishing national maximum standards for certain appointment wait times for Medicaid or CHIP managed care enrollees, and stronger state monitoring and reporting requirements related to access and network adequacy for Medicaid or CHIP managed care plans, which now cover the majority of Medicaid or CHIP beneficiaries;
  • Requiring states to conduct independent secret shopper surveys of Medicaid or CHIP managed care plans to verify compliance with appointment wait time standards and to identify where provider directories are inaccurate;
  • Creating new payment transparency requirements for states by requiring disclosure of provider payment rates in both fee-for-service and managed care, with the goal of greater insight into how Medicaid payment levels affect access to care;
  • Establishing additional transparency and interested party engagement requirements for setting Medicaid payment rates for home and community-based services (HCBS), as well as a requirement that at least 80 percent of Medicaid payments for personal care, homemaker, and home health aide services be spent on compensation for direct care workers (as opposed to administrative overhead or profit);
  • Creating timeliness-of-access measures for HCBS and strengthening necessary safeguards to ensure beneficiary health and welfare as well as promote health equity;
  • Strengthening how states use state Medical Care Advisory Committees, through which stakeholders provide guidance to state Medicaid agencies about health and medical care services, to ensure all states are using these committees optimally to realize a more effective and efficient Medicaid program that is informed by the experiences of Medicaid beneficiaries, their caretakers, and other interested parties;
  • Requiring states to conduct enrollee experience surveys in Medicaid managed care annually for each managed care plan to gather input directly from enrollees; and
  • Establishing a framework for states to implement a Medicaid or CHIP quality rating system, a “one-stop-shop” for enrollees to compare Medicaid or CHIP managed care plans based on quality of care, access to providers, covered benefits and drugs, cost, and other plan performance indicators.

The proposed rules will be published in the May 5, 2023, Federal Register, and comments will be accepted through July 3, 2023.

Photo by Christina @ wocintechchat.com on Unsplash

The Centers for Medicare and Medicaid Services (CMS) will be hosting an informational National Office Hours call on April 25, 2023, at 3:30 pm. The call will focus on the ending of the COVID-19 Public Health Emergency (PHE) that will take place on May 11, 2023, and will help providers, facilities, and people with Medicare prepare. CMS leaders and expert staff will present an overview of the effects of the PHE’s ending on the current waivers and flexibilities and then answer questions.

In preparation for this webinar, CMS encourages participants to review the following resources to determine what questions remain that will support your efforts after the end of the PHE:


  • CMS Leaders from the Office of the Administrator, Center for Medicare, and Center for Clinical Standards and Quality
  • CMS Subject Matter Experts on Medicare policy and PHE-related waivers and flexibilities

RSVP — Register Here

After registering, a confirmation email will be sent containing information about joining the call. When you select the link to join the call on April 25, you will see a message stating that the host will allow you to join the event momentarily. Please continue to wait at that screen until the CMS team opens the call and admits everyone.