- Final Part Two Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs
- Ambulance Fee Schedule: Submit Comments by September 9
- Medicare Providers: Deadlines for Joining an Accountable Care Organization
- Skilled Nursing Facility Value-Based Purchasing Program: May 2 Webinar Materials Available
- CMS Roundup (July 12, 2024)
News
Final Part Two Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs
On July 16, 2024, CMS released the final part two guidance (PDF) regarding plan outreach and education for the Medicare Prescription Payment Plan, which aims to ensure that people with Medicare prescription drug coverage, especially those most likely to benefit, are aware of the payment option. Starting in 2025, the Medicare Prescription Payment Plan provides the option to people with Medicare prescription drug coverage to spread the costs of their prescription drugs over the calendar year rather than paying in full at the pharmacy counter each time they fill a prescription. People with Medicare must opt into the Medicare Prescription Payment Plan to utilize the new benefit. Notably, this payment option launches at the same time that all individuals with Medicare prescription drug coverage will begin to have their annual out-of-pocket prescription drug costs capped at $2,000, providing needed financial relief for high prescription drug costs.
More Information:
Ambulance Fee Schedule: Submit Comments by September 9
CMS issued the CY 2025 Physician Fee Schedule proposed rule announcing proposed policy changes for Medicare payments, including ambulance services. Visit Ambulances Services Center for details.
We encourage you to submit comments on these proposals by September 9, 2024; see the proposed rule for details on how to submit them.
Medicare Providers: Deadlines for Joining an Accountable Care Organization
To participate in an Accountable Care Organization (ACO) for performance year 2025, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 1 at:
- Noon ET for the Medicare Shared Savings Program
- 11:59 pm ET for the ACO Realizing Equity, Access, and Community Health Model (ACO REACH)
Participant taxpayer identification numbers can only appear on one ACO participant list. Resolve any overlaps by September 5.
More Information:
- Application Types & Timeline webpage
- Email questions to SharedSavingsProgram@cms.hhs.gov or ACOREACH@cms.hhs.gov
Skilled Nursing Facility Value-Based Purchasing Program: May 2 Webinar Materials Available
CMS posted the recording and materials from the Overview of the Early Look Performance Score Report for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program webinar. Learn about FY 2026:
- Planned format of the official Performance Score Report
- Planned scoring and payment methodology
- Expanding access to multiple quality measures
For questions about the webinar or SNF VBP Program, contact the SNF VBP Program Help Desk at SNFVBP@rti.org.
For help getting your facility’s report in iQIES, contact the QIES/iQIES Service Center by phone at 800-339-9313 or email at iqies@cms.hhs.gov.
CMS Roundup (July 12, 2024)
You may be interested in these topics from the CMS Roundup:
- CMS Issues 4th Evaluation Report of the Vermont All-Payer Accountable Care Organization Model
- CMS Announces First States to Participate in AHEAD Model
- CMS Releases 2nd Annual Evaluation Report for the Global and Professional Direct Contracting Model
- CMS Launches Making Care Primary Model and Announces Model Participants
Claims, Pricers, & Codes
ICD-10-CM Diagnosis Codes: FY 2025
Get FY 2025 ICD-10-CM diagnosis codes effective for patient discharges and encounters on or after October 1, 2024.
Events
Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests: Now Virtual-Only on July 25–26
Thursday, July 25 and Friday, July 26, 2024
Note: The CMS Central Office building is currently closed. We canceled the in-person option for this meeting.
See Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests to learn more. You don’t need to register to view or listen to the meeting virtually.
Publications
Guiding an Improved Dementia Experience Model
Learn about this 8-year voluntary national model (PDF) starting on July 1, 2024, including:
- What are the goals?
- Who can apply, and what’s the target participation?
- How does CMS pay participants?
- How do participants submit claims?
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