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CMS

The purpose of the Office of Developmental Programs (ODP) Bulletin 00-22-01 is to communicate and clarify the requirements for Targeted Support Management (TSM) that were approved by the Centers for Medicare and Medicaid Services (CMS). Changes to TSM discussed in this bulletin include:

  • Expansion of TSM services, effective August 20, 2017, to individuals with autism.
  • Expansion of TSM services, effective July 1, 2021, to children age 8 or younger with a developmental disability who are eligible for Medical Assistance (MA) and who have been determined to need an Intermediate Care Facility for Other Related Conditions (ICF/ORC) level of care.
  • Expansion of TSM services, effective July 1, 2021, to individuals age 0 through 21 with a medically complex condition that is a chronic health condition that affects three or more organ systems, and that the individual requires medically necessary skilled nursing intervention to execute medical regimens to use technology for respiration, nutrition, medication administration, or other bodily functions. Individuals must be eligible for MA and have been determined to need an ICF/ORC level of care.
  • Clarification regarding the use of the LifeCourse framework and tools.
  • Clarification of expected assessment activities and the development of the Individual Support Plan (ISP).
  • Addition of enhanced qualification requirements for TSM providers and Targeted Support Manager Supervisors.
  • Clarification that individuals who are enrolled in and receiving case management services under any Home and Community-Based Services (HCBS) program administered via an 1115, 1915(b) and (c), or 1915(a), (b), or (c) waiver are not eligible to receive TSM.

The Centers for Medicare and Medicaid Services (CMS) recently released a revised Medicare Learning Network (MLN) resource, Medicare Payment Systems, to reflect the 2022 regulation changes to payment, quality, and policy for all health settings. These include acute care hospitals, inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home health, hospital outpatient, inpatient psychiatric facility, long-term care hospitals (LTCHs), ambulatory surgical centers (ASCs), and durable medical equipment, prosthetics, orthotics & supplies (DMEPOS).

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The Centers for Medicare and Medicaid Services (CMS) has announced a redesigned Accountable Care Organization (ACO) model that better reflects the agency’s vision of creating a health system that achieves equitable outcomes through high quality, affordable, person-centered care. The ACO Realizing Equity, Access, and Community Health (REACH) Model, a redesign of the Global and Professional Direct Contracting (GPDC) Model, addresses stakeholder feedback, participant experience, and Administration priorities, including CMS’ commitment to advancing health equity.

In addition to transitioning the GPDC Model to the ACO REACH Model, CMS is canceling the Geographic Direct Contracting Model (also known as the “Geo Model”), effective immediately. The Geographic Direct Contracting Model, which was announced in December 2020, was paused in March 2021 in response to stakeholder concerns. A comparison table of ACO REACH and GDCM is available for additional information.

CMS, through the Innovation Center, is testing new models of health care service delivery and payment to improve the quality of care that people receive, including those in underserved communities. The Innovation Center is making improvements to existing models and launching new models to increase participation in our portfolio, and CMS will be a strong collaborator to health care providers that participate in those models.”

As CMS works to achieve the vision outlined for the next decade of the Innovation Center, CMS wants to work with partners who share its vision and values for improving patient care, guided by three key principles. First, any model that CMS tests within Traditional Medicare must ensure that beneficiaries retain all rights that are afforded to them, including freedom of choice of all Medicare-enrolled providers and suppliers. Second, CMS must have confidence that any model it tests works to promote greater equity in the delivery of high-quality services. Third, CMS expects models to extend their reach into underserved communities to improve access to services and quality outcomes. Models that do not meet these core principles will be redesigned or will not move forward.

REACH ACOs will be responsible for helping all different types of health care providers — including primary and specialty care physicians — work together, so people get the care they need when they need it. In addition, people with Traditional Medicare who receive care through a REACH ACO may have greater access to enhanced benefits, such as telehealth visits, home care after leaving the hospital, and help with co-pays. They can expect the support of the REACH ACO to help them navigate an often complex health system.

The GPDC Model will continue until December 31, 2022, and then will transition to the ACO REACH Model. The first performance year of the redesigned ACO REACH Model will start on January 1, 2023, and the model performance period will run through 2026. CMS is releasing a Request for Applications for provider-led organizations interested in joining the ACO REACH Model. Current participants in the GPDC Model must agree to meet all the ACO REACH Model requirements by January 1, 2023, in order to participate.

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The Centers for Medicare and Medicaid Services (CMS) has released the updated Inpatient Rehabilitation Facility (IRF) Provider Preview Reports. These reports contain provider performance scores for quality measures and contain data submitted by IRFs from Quarter 3 (Q3) 2020 through Quarter 2 (Q2) 2021.

Providers have until February 25, 2022, to review their performance data. Providers can request CMS review their data during the preview period if they believe the scores are inaccurate. The final reports will be published on Care Compare and Provider Data Catalog (PDC) during the March 2022 refresh of the websites. For additional information, visit the CMS IRF QRP Public Reporting website.

A national stakeholder call with the Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure and her leadership team has been scheduled for January 18, 2022, from 1:00 pm–1:45 pm. Agenda topics include:

  • The legacy of Dr. Martin Luther King;
  • CMS strategic vision and key 2021 accomplishments; and
  • 2022 goals.

To participate in the call, please register here.