Tags Posts tagged with "CMS"


The Office of Developmental Programs (ODP) has received approval from the Centers for Medicare & Medicaid Services (CMS) to make one-time payments for workforce recovery efforts. Payments will be calculated at 6% of the fee schedule revenue received for services rendered between July 1, 2023, through December 31, 2023, for the waiver services listed in the announcement. Don’t miss this opportunity for additional funding for your organization!

The intent of these funds is to assist providers in covering costs related to staffing programs and services. Other than the restriction that payments may not be used to increase or supplement compensation for agency executive staff, there are no specific restrictions, timeframes, or reporting due for these funds other than completing the ODP Workforce Recovery Supplemental Payments survey. ODP has indicated that this revenue would be considered similar to any other service revenue and advises providers to keep a record of how funds were used in the event that they are reviewed as part of the normal claim review process.

As of the morning of May 6, 2024, ODP has received requests from 350 providers. If your MPI is on this file, this will serve as confirmation that your agency’s request has been received. ODP will release a similar file next week prior to the deadline. Late requests will not be accepted. Providers must request the subject payments no later than May 15, 2024. See ODP Announcement 24-041 for additional information.

For any questions, contact Carol Ferenz.

The Centers for Medicare and Medicaid Services (CMS) has announced the next Medicare Updates and Education webinar. The webinar, “Medicare & Other Programs for People With Disabilities,” is scheduled for May 9, 2024, from 1:00 pm – 2:30 pm and will include information about:

  • What’s Happening in Medicare – May 2024;
  • NTP Announcements and Resources;
  • Women’s Health Week (May 12 — May 18);
  • National Osteoporosis Prevention Month;
  • World No Tobacco Day (May 31);
  • Older Americans Month;
  • Arthritis Awareness Month;
  • Mental Health Awareness Month; and
  • Coverage to Care.

To participate, please register here.

ADvancing States and the ARPA HCBS TA Collective Announce Release of Report Summarizing State Experiences with ARPA HCBS Initiatives

April 23, 2024
CONTACT: Camille Dobson

ARLINGTON, VA — ADvancing States and our partners in the American Rescue Plan Act (ARPA) home and community-based services (HCBS) Technical Assistance Collective (TA Collective) are proud to release a report sharing findings about states’ experience in implementing their ARPA HCBS initiatives. While the ARPA infusion of federal dollars into HCBS provided an historic opportunity to try bold, new approaches to supporting people in their homes and communities, states were challenged to make systemic improvements given the time-limited nature of the federal funds.

To gather insights into states’ experiences in implementing their ARPA HCBS spending plans, the TA Collective fielded a national survey in early 2024 that aimed to identify successful strategies used by states implementing their ARPA HCBS spending plans, as well as any barriers hindering their success. Based on responses to that survey, this report highlights the challenges and barriers states faced in thoughtfully executing their initiatives in the midst of a public health emergency. The thirty-three states that responded to the survey shared the top barriers to implementing their projects as planned. These barriers include:

  • Delays in obtaining approval from CMS for both their spending plans and the necessary federal authorities to implement those plans;
  • Lack of staff capacity to design and implement complex initiatives;
  • The time it takes to complete state procurement processes to implement projects; and
  • The need to secure legislative approval and/or budget authority before beginning work.

The report also suggests ways to make any future time-limited investments in the HCBS system more effective, including giving states more time to implement, easing the CMS approval process and providing resources to both states and CMS. Moreover, any future investments should be accompanied by a federal evaluation to glean insights into successful interventions that could be replicated across the country.

While this report highlights challenges and lessons learned, it should be noted that, against all odds, states created transformational change with their ARPA spending plan initiatives. Our hope is that this report — and the recommendations contained therein — serves as a roadmap for any future federal investment in the HCBS system.

This report is also informed by the TA Collective’s work supporting states with their ARPA initiative planning, implementation, and evaluation activities and by observations and analysis of state and federal ARPA HCBS activities. It builds upon the TA Collective’s past work including, Efforts to Evaluate the Impact of ARPA HCBS Investments, an issue brief examining state evaluation approaches, and a summary of the work of the HCBS Sustainability Summit, which provided valuable context on sustaining the HCBS commitment fostered by ARPA investments. Both reports can be found here.

We are grateful to The John A. Hartford Foundation, the Care for all with Respect and Equity (CARE) Fund, The SCAN Foundation, and the Milbank Memorial Fund for their support in making the work of the TA Collective possible.

Visit here to read the new report.

The Information Sharing and Advisory (ISAC) Committee for the Office of Developmental Programs (ODP) met on Tuesday, April 23, 2024. Deputy Secretary Ahrens gave an update and reminded members that on Friday, April 19, 2024, ODP published two very important announcements:

  • ODP Announcement 24-038: Open for Public Comment: Proposed Waiver Amendments and Rates for Services Funded Through the Adult Autism Waiver (AAW); and
  • ODP Announcement 24-039: Open for Public Comment: Proposed Implementation of Performance-Based Contracting for Residential Services, Waiver Amendments to the Consolidated, Community Living, and Person/Family Directed Waivers, and Rates.

Public comments are due June 4, 2024, for both of these announcements.

The proposed rates will be dependent on the governor’s budget passing with the proposed increases for ODP services remaining intact. Deputy Secretary Ahrens urged all stakeholders to advocate with legislators to keep this funding in the budget. Governor Shapiro has been visiting programs and sharing publicity about the importance of these services.

The Deputy Secretary also reviewed the current plans for Performance-Based Contracting for Residential Services with ISAC members. ODP has shared provider preparedness tools with the Residential Strategic Thinking Group for their feedback before publishing the provider preparedness tools and holding provider forums to support providers as they get ready for PBC implementation.

Provider preparedness tools include a Residential Provider Performance-Based Contracting Preparedness Assessment, which comes with a template to support providers developing plans to improve performance on the standards ahead of implementation in January 2025.

Once comments are reviewed and analyzed and any revisions made, the waiver application and amendments will be submitted to the Centers for Medicare & Medicaid Services (CMS) for review, and negotiations implementation target date is January 1, 2025.

RCPA is holding a meeting with our members to develop comments for submission to ODP on Thursday, May 9, 2024, from 9:30 am – 12:00 pm. We ask that you register for this meeting here in order to share your thoughts and help us as we develop our response.

For any questions, please contact Carol Ferenz.

The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2025 hospital inpatient prospective payment system (IPPS) proposed rule. While the proposed rule is focused primarily on provisions specific to acute care hospitals and long-term care hospitals (LTCH), the rule includes a proposed mandatory model — the Transforming Episode Accountability Model (TEAM) — that would implement episode-based payments for five procedures: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure.

Under the proposed program, selected acute care hospitals would coordinate care for fee-for-service (FFS) beneficiaries who undergo one of the listed procedures and assume responsibility for the cost and quality of care through the first 30 days after the Medicare beneficiary leaves the hospital. Hospitals required to participate would continue to bill Medicare FFS but would receive a target price based on all non-excluded Medicare Parts A & B items and services included in an episode; inpatient rehabilitation facility (IRF) care is listed among these covered services. Hospitals may earn a payment from CMS, subject to a quality performance adjustment, if their spending is below the target price (additionally, hospitals could owe CMS a repayment amount, subject to a quality performance adjustment, if their spending was above the target price). Hospitals will face a “graduated risk” scale through different participation tracks to allow participants to ease into full-risk participation.

Per CMS, the program aims to incentivize coordination between care providers during surgery, as well as the services provided during the 30 days that follow, and require referral to primary care services to support continuity of care. CMS notes that TEAM hospitals may “want to engage in financial arrangements with providers and suppliers or participants in Medicare Accountable Care Organization (ACO) initiatives who are making contributions to the TEAM participant’s performance in the model,” and TEAM hospitals could share reconciliation payment amounts or repayment amounts with these individuals and entities. IRFs are listed among the potential “TEAM Collaborators” by CMS. Comments are encouraged on both the proposed definition of a TEAM collaborator and their role in the model.

There are several other provisions notable for IRFs, including the fact that CMS is proposing to require that TEAM hospitals “must, as part of discharge planning, account for potential financial bias by providing TEAM beneficiaries with a complete list of all available post-acute care options in the Medicare program, including home health agencies (HHA), skilled nursing facilities (SNF), IRFs, or LTCHs, in the service area consistent with medical need, including beneficiary cost-sharing and quality information (where available and when applicable).” The list must also indicate whether the TEAM participant has a sharing arrangement with the post-acute care provider.

The model would begin in 2026 and run for five years and is intended to build on other episode-based models, such as the Bundled Payments for Care Improvement Advanced and Comprehensive Care for Joint Replacement Models. Like with other Center for Medicare and Medicaid Innovation (CMMI) programs, CMS will assess whether the model would reduce Medicare spending while maintaining or improving the quality of care.

The proposed rule will be published in the May 2, 2024, Federal Register and will be open for public comments.

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The Centers for Medicare and Medicaid Services (CMS) has announced two days of interactive training webinars that will cover Medicare basics. The webinars will be offered on April 16 and 17, 2024, from 1:00 pm – 3:30 pm. Attendees can attend one or both days, and space is limited. CEUs will not be offered. The topics for the webinars include:

Day 1 — Medicare enrollment and eligibility; SSA and CMS roles and responsibilities; cost and coverage under Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance); why enrolling on time is important; and an overview of Medicare Supplement Insurance (Medigap) policies.

Day 2 — Medicare drug coverage (Part D); Medicare Advantage Plans; coordination of benefits; how to detect and report suspected Medicare fraud, waste, and abuse; and different resources to help you find answers to Medicare policy and coverage questions.

To register for these events, visit the CMS National Training Program website. The webinars will be recorded and posted to the NTP website. To view the recordings, visit here.