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About the Health FFRDC CMS

The Health FFRDC Operator is uniquely qualified and experienced to objectively analyze long-term health system problems, address complex technical questions, and generate creative and cost-effective solutions in strategic areas such as quality of care, new payment models, and healthcare system transformation.

Actived: 9 days ago

URL: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAMH/About-Health-FFRDC

Health Insurance Exchange Public Use Files (Exchange …

Health Insurance Exchange . Open Enrollment Period Public Use Files. Enrollment data is also contained in the Transparency in Coverage PUF. Users of the Health Insurance Exchange PUF data should review the associated Data Dictionary documents at Health Insurance Exchange PUFs to guide their research questions and activities. 1

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Medicare Home Health Benefit

health plan of care, both of which will occur every 60 days (or in the case of updates to the plan of care, more often as the patient’s condition warrants). Case-mix adjustment The PDGM places each 30-day period into 1 of 432 case-mix groups. The case-mix payment rate adjustment

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Medicare and Home Health Care

Home health care includes skilled nursing care, as well as other skilled care services, like physical and occupational therapy, speech-language therapy, and medical social services. These services are given by a variety of skilled health care professionals at home. The home health staff provides and helps coordinate the care and/or

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CMS Proposes Calendar Year 2022 Home Health …

Today, the Centers for Medicare & Medicaid Services (CMS) took action to improve home health care for older adults and people with disabilities through a proposed rule that would accelerate the shift from paying for Medicare home health services based on volume to a system that pays for value and quality by proposing a nationwide expansion of the Home Health Value-Based Purchasing …

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CMS Manual System

A. Background: Change Request (CR) 11642, transmittal 10315, issued August 21, 2020, titled "Updates to Nursing and Allied Health Education Medicare Advantage Payment Policies," provided the MACs with instructions on how to compute and/or reconcile nursing and allied health Medicare Advantage

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Application for Health Coverage

American Indians and Alaska Natives can get services from the Indian Health Service, tribal health programs, or urban Indian health programs. They also may not have to pay cost sharing and may get special monthly enrollment periods. Answer the questions below to make sure your household gets the most help possible. 1.

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Coronavirus Waivers CMS

Coronavirus waivers & flexibilities In certain circumstances, the Secretary of the Department of Health and Human Services (HHS) using section 1135 of the Social Security Act (SSA) can temporarily modify or waive certain Medicare, Medicaid, CHIP, or HIPAA requirements, called 1135 waivers. There are different kinds of 1135 waivers, including Medicare blanket waivers.

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Central Health Plan of California Close Out

DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 MEDICARE PARTS C AND D OVERSIGHT AND ENFORCEMENT GROUP February 26, 2014 E-MAIL: [email protected] Mr. Lee Suyenaga Chief Executive Officer Central Health Plan of California, Inc. 1540 Bridgegate Drive

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Health Coverage Basics

Health insurance is a contract that requires a health insurer or company to pay some or all of a consumer's health care costs in exchange for a premium. Note: Some health coverage programs provide their benefits through health insurance companies, typically

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Using Z Codes: The Social Determinants of Health (SDOH

service organizations, providers, health plans, and consumer/patient advisory boards to identify unmet needs. • A can be used to identify opportunities for advancing health equity. Disparities Impact Statement • Identify individuals’ social risk factors and unmet needs. • Inform health care and services, follow-up, and discharge

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Health Insurance Exchange Public Use Files (Exchange PUFs

Health Insurance Exchange Public Use Files General Information . Health Insurance Exchange Public Use Files (Exchange PUFs) General Information. This document outlines information about the Health Insurance Exchange Public Use Files (Exchange PUFs), including data source, file size, variables, key assumptions, analytic utility, and support

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Definition and Uses of Health Insurance Prospective

Under the home health prospective payment system (HH PPS), from October 1, 2000 to December 31, 2019, Original Medicare made a case-mix adjusted payment for up to 60 days of care using Home Health Resource Groups (HHRG). The HHRGs were represented on claims as HIPPS codes. Home health HIPPS codes were determined

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Healthcare Effectiveness Data and Information Set (HEDIS

HEDIS is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance. HEDIS Measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes.

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MAC Website List CMS

Find your Medicare Administrative Contractor's (MAC’s) website by selecting your place of business or MAC's name. Also included at the end of the “MAC Name” list are links to specialty contractors you may also interact with as a Medicare provider or supplier. Providers who submit claims not based on their place of business can use the MAC name list.

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Medicare Mental Health

health services, typically referred to as mental health services and includes substance abuse, affects a patient’s overall well-being. It’s important to understand Medicare coverage of these services. This booklet includes information on covered and non-covered services, eligible providers, Medicare

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CMS Disclaimer–User Agreement: Health Insurance Exchange

Health Plans (QHPs) and Stand-alone Dental Plans (SADPs). This disclaimer -user agreement details the sources and nature of the data, including potential limitations, and specifies the responsibility of the data user in regard to the processing and understanding of the data

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Glossary of Health Coverage and Medical Terms

health care facility licensed, certified or accredited as required by state law. Reconstructive Surgery . Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions. Rehabilitation Services .

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COVID-19 Emergency Declaration Blanket Waivers for Health

the public health emergency, active treatment will need to be modified. The requirements at 42 CFR §483.440(a)(1) require that each client must receive a continuous active treatment program, which includes consistent implementation of a program of specialized and generic training, treatment, health services and related services.

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Health Insurance Marketplace Brand Identity and Design

The Health Insurance Marketplace mark is composed of the words Health Insurance Marketplace . The words “Health Insurance” are black and the word “Marketplace” is turquoise in the 4 color versions . The logo is also available in black and white in both the single-lined and stacked versions of the logo .

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CMS Center for Consumer Information & Insurance Oversight

Transparency in Qualified Health Plan (QHP) coverage Public Use File (PUF) Data Dictionary 7 Variable Name: Number of Plan Level Claims with DOS in 2020 That Were Also Received in Calendar Year 2020 Variable Definition: Plan level number of claims received by an issuer asking for a payment or reimbursement by or on behalf of an in-network health

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CMS 837I NOA Companion Guide

report health care services. While the contents of this Transaction Instruction meet the compliance requirements described in sections 1.1.2 and 1.1.3, this is a non- standard use

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CMS Center for Consumer Information & Insurance Oversight

data on Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered through the Exchange in the individual market and Small Business Health Options Program (SHOP). The PUFs include data from states with Federally-facilitated Exchanges (FFEs) including states performing plan

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Commercial Repayment Center (CRC) Non -Group Health Plan

1 . Commercial Repayment Center (CRC) Non -Group Health Plan (NGHP) Recovery Town Hall Questions and Answers Below are answers to commonly asked questions from the CRC NGHP Recovery Town Hall held on

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Rural Maternal Healthcare CMS

Maternal Health Care in Rural Communities. A key objective of the CMS Rural Health Strategy is to leverage partnerships with stakeholders nationally, as well as at the regional, state, and local levels. One component in accomplishing this is working closely with partners and stakeholders to raise awareness on maternal health and access to care

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Glossary of Health Coverage and Medical Terms

health care expense) made by you or your health care provider to your health insurer or plan for items or services you think are covered . Coinsurance Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You generally pay coinsurance plus any deductibles you

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Medicare Mental Health

health services, typically referred to as mental health services and includes substance abuse, affects a patient’s overall well-being. It’s important to understand Medicare coverage of these services. This booklet includes information on covered and non-covered services, eligible providers, Medicare

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Home Health Grouper Software Beta Testing CMS

Signing Up for Beta Testing Each update of the Home Health Grouper software will be available for beta testing approximately 8-10 weeks prior to the implementation date. To sign up to beta test the Home Health October v03.0.21 Software release, please email [email protected] with contact information. The beta test period is from June 28 through July 16, 2021.

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HHS Marks Black Maternal Health Week by Announcing

Today, the U.S. Department of Health and Human Services (HHS) marked Black Maternal Health Week by announcing actions to expand access to continuous health care coverage and access to preventative care in rural areas to improve maternal health outcomes. HHS Secretary Xavier Becerra announced that Illinois is the first state to provide

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Home Health Patient-Driven Groupings Model CMS

Home Health PPS Grouper Software (HHGS) Package (for claims starting 01-01-2021): The January 2021 release of the HH PPS Grouper software (v02.1.21) is now available in the “Downloads” section of the HH Grouper Software webpage. Included in the v02.1.21 HH PPS Grouper software update are the FY 2021 International Classification of Diseases, Tenth Revision, Clinical …

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Statements from the Office of the National Coordinator for

Today, the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS), in conjunction with the HHS Office of Inspector General (OIG) announced a policy of enforcement discretion to allow compliance flexibilities regarding the implementation of the interoperability final rules announced on March 9 th in response to the …

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HEALTH ASSURANCE PENNSYLVANIA INC. TO OFFER MEDICARE

Health Assurance Pennsylvania, based in Pittsburgh, is now serving Medicare beneficiaries in Allegheny County, including the city of Pittsburgh. Beneficiaries can sign up for the plan during the current Medicare+Choice open enrollment. Health Assurance Pennsylvania is a subsidiary of Coventry Health Care Inc., based in Bethesda, Md.

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Home Health PPS Archive CMS

Home Health Case-Mix Changes 2000-2009 Report & Tables (ZIP) Revision of the Case-Mix Weights for the HH PPS Report, Figures & Tables (ZIP) Analysis of 2000-2008 Home Health Case-mix Change Report (ZIP) Analysis of 2006-2007 Home Health Case-Mix Change: Final Report (PDF) "Analyses in Support of Rebasing & Updating the Medicare Home Health

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Home Health PPS Grouper Software (HHGS) CMS

The PDGM, or Home Health PPS Grouper Software (HHGS), relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds. In conjunction with the implementation of the PDGM, there will be a change in the unit

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Follow-Up After Hospitalization for Mental Illness (FUH-

health treatment among individuals with schizophrenia and strategies for facilitating connections to care: A review of the literature. Schizophrenia Bulletin, 35, 696-703. Luxton DD, June JD, Comtois KA. (2013). Can postdischarge follow-up contacts prevent suicide and suicidal behavior A review of the evidence. Crisis.

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Merit-Based Incentive Payment System (MIPS) Promoting

primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. At a minimum this includes all transitions of care and referrals that are ordered by the MIPS eligible clinician.

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M PARTS C AND D OVERSIGHT AND ENFORCEMENT G

DEPARTMENT OF HEALTH & HUMAN SERVICES . Centers for Medicare & Medicaid Services . 7500 Security Boulevard . Baltimore, Maryland 21244-1850 . MEDICARE PARTS C AND D OVERSIGHT AND ENFORCEMENT GROUP. February 24, 2016

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An Overview of the Multi-State Plan Program

Background The Multi-State Plan (MSP) Program was established under Section 1334 of the Affordable Care Act (ACA), which directs OPM to: • Contract with private health insurance

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Better Care, Smarter Spending, Healthier People: Improving

The Health Care Innovation Awards Round One are funding up to $1 billion in awards to 107 organizations across the country that are implementing the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP. The Health Care Innovation Awards Round Two are funding up to

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MEDICARE TESTING PERSONAL HEALTH RECORDS TO HELP

This pilot program will enable certain beneficiaries to access and use a Personal Health Record (PHR) provided through participating health plans, and accessible through www.mymedicare.gov. In general, a PHR is a collection of information about an individual’s health or health care services, such as medical conditions, hospitalizations

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HEALTH CARE LAW SAVED AN ESTIMATED $2.1 BILLION FOR

The health care law – the Affordable Care Act – has saved consumers an estimated $2.1 billion on health insurance premiums according to a new report released today by the Department of Health and Human Services. For the first time ever, new rate review rules in the health care law prevent insurance companies in all states from raising rates

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Health Insurance Marketplace Open Enrollment Snapshot

Health Insurance Marketplace Open Enrollment Snapshot - Week 8 December 20 – December 26, 2015 Since Open Enrollment began on November 1, more than 8.5 million consumers signed-up for health coverage through the HealthCare.gov platform or had their coverage automatically renewed. Of the about 6 million Marketplace consumers whose coverage was renewed, about 3.6 …

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LOWER COSTS, BETTER CARE: REFORMING OUR HEALTH CARE

LOWER COSTS, BETTER CARE: REFORMING OUR HEALTH CARE DELIVERY SYSTEM Fixing America’s health care system means more than just guaranteeing that everyone has coverage. To address the rising costs of health care, we must improve the way that health care is delivered, including coordinating care better and improving the safety of care.

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National Health Spending Growth Remains Low for 4th

National Health Spending Growth Remains Low for 4th Consecutive Year WASHINGTON — Overall national health expenditures grew at an annual rate of 3.7 percent in 2012, marking the fourth consecutive year of low growth, the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary reported today. Health spending as a share of gross domestic product fell slightly from 17.3 …

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NEW HAMPSHIRE FIRST TO GET NEW HEALTH CARE LAW FUNDS …

The New Hampshire Department of Health and Human Services Balancing Incentive Program, in partnership with community organizations throughout the State, plans to further develop the systems of community-based care that serve seniors and individuals with behavioral health needs, physical disabilities, and intellectual disabilities.

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SECRETARY SEBELIUS ANNOUNCES NEXT STAGE FOR PROVIDERS

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it in a meaningful way.

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