Tag: Final

From: Federal Register CMS-1644-F – 6/10/16

Under the Medicare Shared Savings Program (Shared Savings Program), providers of services and suppliers that participate in an Accountable Care Organization (ACO) continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. This final rule addresses changes to the Shared Savings Program, including: Modifications to the program’s benchmarking methodology, when resetting (rebasing) the ACO’s benchmark for a second or subsequent agreement period, to encourage ACOs’ continued investment in care coordination and quality improvement; an alternative participation option to encourage ACOs to enter performance based risk arrangements earlier in their participation under the program; and policies for reopening of payment determinations to make corrections after financial calculations have been performed and ACO shared savings and shared losses for a performance year have been determined.

Medicare Shared Savings Program; Accountable Care Organizations – Revised Benchmark for Rebasing Methodology, Facilitating Transition to Performance-Based Risk – Final Rule

From: CMS PC Pricer Website – 11/17/15

CMS released an update the IP Rehab PPS Pricer this week.  There is no information on what was changed.

IP Rehab PPS PC Pricer Update – FFY 2016

From: Federal Register – CMS-5516-F – Filed 11/16/15; Publication 11/24/15

SUMMARY: This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

DATES:  These regulations are effective on January 15, 2016, and applicable on April 1, 2016 when the first model performance period begins.

Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services