The State of Connecticut Health Plan is the first commercial plan in the country to have its episodes-of-care payment model designated as an Advanced APM by CMS. With limited Advanced APM options via CMS, this designation will provide specialty physicians in the state a path to value-based care payments through the private sector.
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On December 21, 2020, the House and Senate passed fiscal year (FY) 2021 federal omnibus appropriations legislation that included the fifth measure passed by Congress to address the COVID-19 pandemic. In addition to providing $1.4 trillion to fund the federal government through FY 2021, the legislation includes $900 billion in relief funds to address COVID-19. The bill also includes significant health care provisions unrelated to COVID-19, including a ban on surprise billing by health care providers.
The House passed the legislation in two parts, the first by a vote of 327-85, and the second by a vote of 359-53. The Senate passed the legislation by a vote of 92-6. The legislation is now being prepared for a signature by the President, who has indicated his support. In the meantime, Congress passed, and the President signed into law, a seven-day extension of federal funding through December 28, 2021, to provide ample time f
Highlights
The Centers for Medicare & Medicaid Services (CMS) has published the Calendar Year (CY) 2021 Final Rule for the Medicare Physician Fee Schedule (MPFS), which contains updates to the Quality Payment Program (QPP). The MPFS dictates Medicare rates and policies under Part B, while the QPP implements two value-based payment programs: the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
Among notable changes, CMS has proposed to make permanent certain telehealth changes that have been implemented in response to the COVID-19 public health emergency (PHE), confirmed the evaluation and management (E/M) documentation guidelines and payment changes finalized in the 2020 MPFS, and delayed the MIPS Value Pathway (MVP) until the 2022 performance period or later.