Sample records for payment programs emergency

  1. 28 CFR 94.41 - Interim emergency payment.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Interim emergency payment. 94.41 Section 94.41 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Payment of Claims § 94.41 Interim emergency payment...

  2. 28 CFR 94.41 - Interim emergency payment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Interim emergency payment. 94.41 Section 94.41 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Payment of Claims § 94.41 Interim emergency payment...

  3. 28 CFR 94.41 - Interim emergency payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Interim emergency payment. 94.41 Section 94.41 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Payment of Claims § 94.41 Interim emergency payment...

  4. 28 CFR 94.41 - Interim emergency payment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Interim emergency payment. 94.41 Section 94.41 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Payment of Claims § 94.41 Interim emergency payment...

  5. 28 CFR 94.41 - Interim emergency payment.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Interim emergency payment. 94.41 Section 94.41 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Payment of Claims § 94.41 Interim emergency payment...

  6. 44 CFR 354.6 - Billing and payment of fees.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... EMERGENCY PREPAREDNESS PROGRAM § 354.6 Billing and payment of fees. (a) Electronic billing and payment. We will deposit all funds collected under this part to the Radiological Emergency Preparedness Fund as... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Billing and payment of fees...

  7. Existing and Emerging Payment and Delivery Reforms in Cardiology

    PubMed Central

    Farmer, Steven A.; Darling, Margaret L.; George, Meaghan; Casale, Paul N.; Hagan, Eileen; McClellan, Mark B.

    2017-01-01

    IMPORTANCE Recent health care reforms aim to increase patient access, reduce costs, and improve health care quality as payers turn to payment reform for greater value. Cardiologists need to understand emerging payment models to succeed in the evolving payment landscape. We review existing payment and delivery reforms that affect cardiologists, present 4 emerging examples, and consider their implications for clinical practice. OBSERVATIONS Public and commercial payers have recently implemented payment reforms and new models are evolving. Most cardiology models are modified fee-for-service or address procedural or episodic care, but population models are also emerging. Although there is widespread agreement that payment reform is needed, existing programs have significant limitations and the adoption ofnew programs has been slow. New payment reforms address some of these problems, but many details remain undefined. CONCLUSIONS AND RELEVANCE Early payment reforms were voluntary and cardiologists’ participation is variable. However, conventional fee-for-service will become less viable, and enrollment in new payment models will be unavoidable. Early participation in new payment models will allow clinicians to develop expertise in new care pathways during a period of relatively lower risk. PMID:27851858

  8. Financial Ties Between Emergency Physicians and Industry: Insights From Open Payments Data.

    PubMed

    Fleischman, William; Ross, Joseph S; Melnick, Edward R; Newman, David H; Venkatesh, Arjun K

    2016-08-01

    The Open Payments program requires reporting of payments by medical product companies to teaching hospitals and licensed physicians. We seek to describe nonresearch, nonroyalty payments made to emergency physicians in the United States. We performed a descriptive analysis of the most recent Open Payments data released to the public by the Centers for Medicare & Medicaid Services covering the 2014 calendar year. We calculated the median payment, the total pay per physician, the types of payments, and the drugs and devices associated with payments to emergency physicians. For context, we also calculated total pay per physician and the percentage of active physicians receiving payments for all specialties. There were 46,405 payments totaling $10,693,310 to 12,883 emergency physicians, representing 30% of active emergency physicians in 2013. The percentage of active physicians within a specialty who received a payment ranged from 14.6% in preventive medicine to 91% in orthopedic surgery. The median payment and median total pay to emergency physicians were $16 (interquartile range $12 to $68) and $44 (interquartile range $16 to $123), respectively. The majority of payments (83%) were less than $100. Food and beverage (86%) was the most frequent type of payment. The most common products associated with payments to emergency physicians were rivaroxaban, apixaban, ticagrelor, ceftaroline, canagliflozin, dabigatran, and alteplase. Nearly a third of emergency physicians received nonresearch, nonroyalty payments from industry in 2014. Most payments were of small monetary value and for activities related to the marketing of antithrombotic drugs. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  9. 76 FR 52962 - Notice of Submission of Proposed Information Collection to OMB; Emergency Homeowners' Loan...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-24

    ... Homeowners Loan Program. The program will offer a declining balance, deferred payment ``bridge loan'' (non.... The program will offer a declining balance, deferred payment ``bridge loan'' (non-recourse...

  10. 44 CFR 152.7 - Grant payment, reporting and other requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Grant payment, reporting and other requirements. 152.7 Section 152.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... program. The performance period of each grant will be detailed in the Articles of Agreement that we...

  11. 44 CFR 312.5 - Personnel.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS USE OF CIVIL DEFENSE PERSONNEL, MATERIALS, AND FACILITIES FOR NATURAL DISASTER PURPOSES § 312.5... programs, through payment of salaries and benefits of State and local civil defense staff, and the payment...

  12. 25 CFR 20.210 - Can eligibility criteria or payments for Burial Assistance, Child Assistance, and Disaster...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Assistance, Child Assistance, and Disaster Assistance and Emergency Assistance change? 20.210 Section 20.210... SOCIAL SERVICES PROGRAMS Welfare Reform § 20.210 Can eligibility criteria or payments for Burial Assistance, Child Assistance, and Disaster Assistance and Emergency Assistance change? No, unless otherwise...

  13. 25 CFR 20.210 - Can eligibility criteria or payments for Burial Assistance, Child Assistance, and Disaster...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Assistance, Child Assistance, and Disaster Assistance and Emergency Assistance change? 20.210 Section 20.210... SOCIAL SERVICES PROGRAMS Welfare Reform § 20.210 Can eligibility criteria or payments for Burial Assistance, Child Assistance, and Disaster Assistance and Emergency Assistance change? No, unless otherwise...

  14. 42 CFR 414.908 - Competitive acquisition program.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... emergency deliveries; (iv) Does not receive payment for the CAP drug; (v) Except where applicable State... Payment for Drugs and Biologicals Under Part B § 414.908 Competitive acquisition program. (a... subpart. (3) The physician participating in the CAP— (i) Elects to use an approved CAP vendor for the drug...

  15. 42 CFR 414.908 - Competitive acquisition program.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... emergency deliveries; (iv) Does not receive payment for the CAP drug; (v) Except where applicable State... Payment for Drugs and Biologicals Under Part B § 414.908 Competitive acquisition program. (a... subpart. (3) The physician participating in the CAP— (i) Elects to use an approved CAP vendor for the drug...

  16. 42 CFR 414.908 - Competitive acquisition program.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... emergency deliveries; (iv) Does not receive payment for the CAP drug; (v) Except where applicable State... Payment for Drugs and Biologicals Under Part B § 414.908 Competitive acquisition program. (a... subpart. (3) The physician participating in the CAP— (i) Elects to use an approved CAP vendor for the drug...

  17. 7 CFR 623.12 - Payments to landowners by NRCS.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., DEPARTMENT OF AGRICULTURE WATER RESOURCES EMERGENCY WETLANDS RESERVE PROGRAM § 623.12 Payments to landowners... payments may be authorized for the replacement or restoration of practices for which cost share assistance has been previously allowed under the EWRP, but only if: (1) Replacement or restoration of the...

  18. 42 CFR 447.90 - FFP: Conditions related to pending investigations of credible allegations of fraud against the...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... service is furnished as an emergency item or service, but not including items or services furnished in an emergency room of a hospital; or (2) The State determines and documents that good cause as specified at... ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing...

  19. 42 CFR 447.90 - FFP: Conditions related to pending investigations of credible allegations of fraud against the...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... service is furnished as an emergency item or service, but not including items or services furnished in an emergency room of a hospital; or (2) The State determines and documents that good cause as specified at... ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing...

  20. 42 CFR 447.90 - FFP: Conditions related to pending investigations of credible allegations of fraud against the...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... service is furnished as an emergency item or service, but not including items or services furnished in an emergency room of a hospital; or (2) The State determines and documents that good cause as specified at... ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing...

  1. 42 CFR 447.90 - FFP: Conditions related to pending investigations of credible allegations of fraud against the...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... required by § 455.23 of this chapter unless— (1) The item or service is furnished as an emergency item or service, but not including items or services furnished in an emergency room of a hospital; or (2) The... ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Medicaid Premiums and Cost Sharing...

  2. Medicare program: changes to the hospital outpatient prospective payment system and CY 2008 payment rates, the ambulatory surgical center payment system and CY 2008 payment rates, the hospital inpatient prospective payment system and FY 2008 payment rates; and payments for graduate medical education for affiliated teaching hospitals in certain emergency situations Medicare and Medicaid programs: hospital conditions of participation; necessary provider designations of critical access hospitals. Interim and final rule with comment period.

    PubMed

    2007-11-27

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. We describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2008. In addition, the rule sets forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which the final policies of the ASC payment system apply, and other pertinent rate setting information for the CY 2008 ASC payment system. Furthermore, this final rule with comment period will make changes to the policies relating to the necessary provider designations of critical access hospitals and changes to several of the current conditions of participation requirements. The attached document also incorporates the changes to the FY 2008 hospital inpatient prospective payment system (IPPS) payment rates made as a result of the enactment of the TMA, Abstinence Education, and QI Programs Extension Act of 2007, Public Law 110-90. In addition, we are changing the provisions in our previously issued FY 2008 IPPS final rule and are establishing a new policy, retroactive to October 1, 2007, of not applying the documentation and coding adjustment to the FY 2008 hospital-specific rates for Medicare-dependent, small rural hospitals (MDHs) and sole community hospitals (SCHs). In the interim final rule with comment period in this document, we are modifying our regulations relating to graduate medical education (GME) payments made to teaching hospitals that have Medicare affiliation agreements for certain emergency situations.

  3. 7 CFR 623.12 - Payments to landowners by NRCS.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... the practices specified in the WRPO; or pay the average cost of establishing the practices specified..., DEPARTMENT OF AGRICULTURE WATER RESOURCES EMERGENCY WETLANDS RESERVE PROGRAM § 623.12 Payments to landowners by NRCS. (a) NRCS will share the cost with landowners of rehabilitating the enrolled land in the EWRP...

  4. 7 CFR 623.12 - Payments to landowners by NRCS.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... the practices specified in the WRPO; or pay the average cost of establishing the practices specified..., DEPARTMENT OF AGRICULTURE WATER RESOURCES EMERGENCY WETLANDS RESERVE PROGRAM § 623.12 Payments to landowners by NRCS. (a) NRCS will share the cost with landowners of rehabilitating the enrolled land in the EWRP...

  5. 7 CFR 623.12 - Payments to landowners by NRCS.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... the practices specified in the WRPO; or pay the average cost of establishing the practices specified..., DEPARTMENT OF AGRICULTURE WATER RESOURCES EMERGENCY WETLANDS RESERVE PROGRAM § 623.12 Payments to landowners by NRCS. (a) NRCS will share the cost with landowners of rehabilitating the enrolled land in the EWRP...

  6. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice.

    PubMed

    Wiler, Jennifer L; Granovsky, Michael; Cantrill, Stephen V; Newell, Richard; Venkatesh, Arjun K; Schuur, Jeremiah D

    2016-03-01

    In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician's to focus on quality of care measures and report quality performance for the first time. Initially termed "The Physician Voluntary Reporting Program," various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the "traditional PQRS" reporting program and the newer "Value Modifier" program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

  7. 44 CFR 312.5 - Personnel.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....5 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS USE OF CIVIL DEFENSE PERSONNEL, MATERIALS, AND FACILITIES FOR NATURAL DISASTER... of specific programs, through payment of salaries and benefits of State and local civil defense staff...

  8. 44 CFR 312.5 - Personnel.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ....5 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS USE OF CIVIL DEFENSE PERSONNEL, MATERIALS, AND FACILITIES FOR NATURAL DISASTER... of specific programs, through payment of salaries and benefits of State and local civil defense staff...

  9. 44 CFR 312.5 - Personnel.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....5 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS USE OF CIVIL DEFENSE PERSONNEL, MATERIALS, AND FACILITIES FOR NATURAL DISASTER... of specific programs, through payment of salaries and benefits of State and local civil defense staff...

  10. 44 CFR 312.5 - Personnel.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....5 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS USE OF CIVIL DEFENSE PERSONNEL, MATERIALS, AND FACILITIES FOR NATURAL DISASTER... of specific programs, through payment of salaries and benefits of State and local civil defense staff...

  11. 7 CFR 1416.6 - Limitations on payments and other benefits.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Emergency Conservation Program; (4) The Hurricane Indemnity Program, subpart C of part 760 of this title. (i) An applicant's actual loss or actual costs incurred because of losses due to an eligible hurricane...

  12. 7 CFR 1416.6 - Limitations on payments and other benefits.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Emergency Conservation Program; (4) The Hurricane Indemnity Program, subpart C of part 760 of this title. (i) An applicant's actual loss or actual costs incurred because of losses due to an eligible hurricane...

  13. 7 CFR 1416.6 - Limitations on payments and other benefits.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Emergency Conservation Program; (4) The Hurricane Indemnity Program, subpart C of part 760 of this title. (i) An applicant's actual loss or actual costs incurred because of losses due to an eligible hurricane...

  14. 7 CFR 1416.6 - Limitations on payments and other benefits.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Emergency Conservation Program; (4) The Hurricane Indemnity Program, subpart C of part 760 of this title. (i) An applicant's actual loss or actual costs incurred because of losses due to an eligible hurricane...

  15. 7 CFR 1416.6 - Limitations on payments and other benefits.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Emergency Conservation Program; (4) The Hurricane Indemnity Program, subpart C of part 760 of this title. (i) An applicant's actual loss or actual costs incurred because of losses due to an eligible hurricane...

  16. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice

    PubMed Central

    Wiler, Jennifer L.; Granovsky, Michael; Cantrill, Stephen V.; Newell, Richard; Venkatesh, Arjun K.; Schuur, Jeremiah D.

    2016-01-01

    In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians. PMID:26973757

  17. The value transformation of health care: Impact on neuromuscular and electrodiagnostic medicine.

    PubMed

    Narayanaswami, Pushpa; Suk, Millie; Jones, Lyell K

    2017-10-01

    Beginning in 2017, most physicians who participate in Medicare are subject to the Medicare Access and CHIP Reauthorization Act (MACRA), the milestone legislation that signals the US health care system's transition from volume-based to value-based care. Here we review emerging trends in development of value-based healthcare systems in the US. MACRA and the resulting Quality Payment Program create 2 participation pathways, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM) pathway. Although there are several program incentives for AAPM participation, to date there have been few AAPM options for specialists. MIPS and its widening bonus and penalty window will likely be the primary participation pathway in the early years of the program. Value-based payment has the potential to reshape health care delivery in the United States, with implications for neuromuscular and electrodiagnostic (EDX) specialists. Meaningful quality measures are required for neuromuscular and EDX specialists. Muscle Nerve 56: 679-683, 2017. © 2017 Wiley Periodicals, Inc.

  18. 42 CFR 424.100 - Scope.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PROGRAM CONDITIONS FOR MEDICARE PAYMENT Special Conditions: Emergency Services Furnished by a... United States and does not have in effect a provider agreement, that is, an agreement to participate in...

  19. 7 CFR 1493.230 - Eligible transactions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC.... From time to time CCC will issue program announcements indicating the availability of facility payment... the emerging markets, the maximum amount, in U.S. dollars, of guarantee exposure that CCC will...

  20. 42 CFR 424.102 - Situations that do not constitute an emergency.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... themselves indicate a need for emergency services: (a) Lack of care at home. (b) Lack of transportation to a....102 Section 424.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Special Conditions...

  1. 78 FR 36092 - Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ... expanded veterans' eligibility for reimbursement. This document corrects a typographical error without... programs--Veterans, Health care, Health facilities, Health professions, Health records, Homeless, Medical and dental schools, Medical devices, Medical research, Mental health programs, Nursing homes...

  2. 7 CFR 1416.1 - Applicability.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... under Title III of the Emergency Supplemental Appropriations Act for Defense, the Global War on Terror... War on Terror, and Hurricane Recovery, 2006. (c) To be eligible for payments under these programs...

  3. 7 CFR 1416.1 - Applicability.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... under Title III of the Emergency Supplemental Appropriations Act for Defense, the Global War on Terror... War on Terror, and Hurricane Recovery, 2006. (c) To be eligible for payments under these programs...

  4. 7 CFR 1416.1 - Applicability.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... under Title III of the Emergency Supplemental Appropriations Act for Defense, the Global War on Terror... War on Terror, and Hurricane Recovery, 2006. (c) To be eligible for payments under these programs...

  5. 7 CFR 1416.1 - Applicability.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... under Title III of the Emergency Supplemental Appropriations Act for Defense, the Global War on Terror... War on Terror, and Hurricane Recovery, 2006. (c) To be eligible for payments under these programs...

  6. 7 CFR 1416.1 - Applicability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... under Title III of the Emergency Supplemental Appropriations Act for Defense, the Global War on Terror... War on Terror, and Hurricane Recovery, 2006. (c) To be eligible for payments under these programs...

  7. 40 CFR 307.30 - Requesting payment from the potentially responsible party.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS COMPREHENSIVE ENVIRONMENTAL... the potentially responsible party agree to a settlement involving a release from liability, the...

  8. 76 FR 63353 - Proposed Information Collection (Payment and Reimbursement for Emergency Services for Non Service...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-12

    ... (Payment and Reimbursement for Emergency Services for Non Service-Connected Conditions in Non-VA Facilities... to determine a claimant's eligibility for reimbursement or payment for emergency medical treatment at... information technology. Title: Payment and Reimbursement for Emergency Services for Non Service-Connected...

  9. 42 CFR 413.75 - Direct GME payments: General requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...-based providers for the costs of approved residency programs in medicine, osteopathy, dentistry, and... Council for Graduate Medical Education (ACGME) as a fellowship program in geriatric medicine. (4) Is a... Urban Consumers as compiled by the Bureau of Labor Statistics. Emergency Medicare GME affiliated group...

  10. 42 CFR 413.75 - Direct GME payments: General requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...-based providers for the costs of approved residency programs in medicine, osteopathy, dentistry, and... Council for Graduate Medical Education (ACGME) as a fellowship program in geriatric medicine. (4) Is a... Urban Consumers as compiled by the Bureau of Labor Statistics. Emergency Medicare GME affiliated group...

  11. 42 CFR 413.75 - Direct GME payments: General requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...-based providers for the costs of approved residency programs in medicine, osteopathy, dentistry, and... Council for Graduate Medical Education (ACGME) as a fellowship program in geriatric medicine. (4) Is a... Urban Consumers as compiled by the Bureau of Labor Statistics. Emergency Medicare GME affiliated group...

  12. Medicare program; participation in CHAMPUS and CHAMPVA, hospital admissions for veterans, discharge rights notice, and hospital responsibility for emergency care--HCFA and OIG. Interim final rule with comment period.

    PubMed

    1994-06-22

    We are revising requirements for Medicare participating hospitals by adding the following: A hospital must provide inpatient hospital services to individuals who have health coverage provided by either the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) or the Civilian Health and Medical Program of the Veterans Administration (CHAMPVA), subject to limitations provided by regulations that require the hospital to collect the beneficiary's cost-share and accept payment from the CHAMPUS/CHAMPVA programs as payment in full. A hospital must provide inpatient hospital services to military veterans (subject to the limitations provided in 38 CFR 17.50 ff.) and accept payment from the Department of Veterans Affairs as payment in full. A hospital must give each Medicare beneficiary (or his or her representative) at or about the time of admission, a written statement of his or her rights concerning discharge from the hospital. A hospital (including a rural primary care hospital) with an emergency department must provide, upon request and within the capabilities of the hospital or rural primary care hospital, an appropriate medical screening examination, stabilizing treatment and/or an appropriate transfer to another medical facility to any individual with an emergency medical condition, regardless of the individual's eligibility for Medicare. The statute provides for the termination of a provider's agreement for violation of any of these provisions. These revisions implement sections 9121 and 9122 of the Consolidated Omnibus Budget Reconciliation Act of 1985 (as amended by section 4009 of the Omnibus Budget Reconciliation Act of 1987), section 233 of the Veteran's Benefit Improvement and Health Care Authorization Act of 1986, sections 9305(b)(1) and 9307 of the Omnibus Budget Reconciliation Act of 1986, sections 6003(g)(3)(D)(xiv), 6018 and 6211 of the Omnibus Budget Reconciliation Act of 1989, and sections 4008(b), 4027(a), and 4027(k)(3) of the Omnibus Budget Reconciliation Act of 1990.

  13. 7 CFR 760.610 - Participant eligibility.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... producing the crop. (e) Participants receiving payments under the Emergency Assistance for Livestock, Honey Bees, and Farm-Raised Fish Program (ELAP) as specified in subpart C of this part are not eligible to...

  14. 7 CFR 760.610 - Participant eligibility.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... producing the crop. (e) Participants receiving payments under the Emergency Assistance for Livestock, Honey Bees, and Farm-Raised Fish Program (ELAP) as specified in subpart C of this part are not eligible to...

  15. 7 CFR 760.610 - Participant eligibility.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... producing the crop. (e) Participants receiving payments under the Emergency Assistance for Livestock, Honey Bees, and Farm-Raised Fish Program (ELAP) as specified in subpart C of this part are not eligible to...

  16. 7 CFR 760.610 - Participant eligibility.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... producing the crop. (e) Participants receiving payments under the Emergency Assistance for Livestock, Honey Bees, and Farm-Raised Fish Program (ELAP) as specified in subpart C of this part are not eligible to...

  17. 7 CFR 760.610 - Participant eligibility.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... producing the crop. (e) Participants receiving payments under the Emergency Assistance for Livestock, Honey Bees, and Farm-Raised Fish Program (ELAP) as specified in subpart C of this part are not eligible to...

  18. Something new in the air: Paying for community-based environmental approaches to asthma prevention and control.

    PubMed

    Tschudy, Megan M; Sharfstein, Joshua; Matsui, Elizabeth; Barnes, Charles S; Chacker, Stacey; Codina, Rosa; Cohn, John R; Sandel, Megan; Wedner, H James

    2017-11-01

    Despite the recommendation in national asthma guidelines to target indoor environmental exposures, most insurers generally have not covered the outreach, education, environmental assessments, or durable goods integral to home environmental interventions. However, emerging payment approaches offer new potential for coverage of home-based environmental intervention costs. These opportunities are becoming available as public and private insurers shift reimbursement to reward better health outcomes, and their key characteristic is a focus on the value rather than the volume of services. These new payment models for environmental interventions can be divided into 2 categories: enhanced fee-for-service reimbursement and set payments per patient that cover asthma-related costs. Several pilot programs across the United States are underway, and as they prove their value and as payment increasingly becomes aligned with better outcomes at lower cost, these efforts should have a bright future. Physicians should be aware that these new possibilities are emerging for payment of the goods and services needed for indoor environmental interventions for their patients with asthma. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  19. Sustaining SBIRT in the wild: simulating revenues and costs for Screening, Brief Intervention and Referral to Treatment programs.

    PubMed

    Cowell, Alexander J; Dowd, William N; Mills, Michael J; Hinde, Jesse M; Bray, Jeremy W

    2017-02-01

    To examine the conditions under which Screening, Brief Intervention and Referral to Treatment (SBIRT) programs can be sustained by health insurance payments. A mathematical model was used to estimate the number of patients needed for revenues to exceed costs. Three medical settings in the United States were examined: in-patient, out-patient and emergency department. Components of SBIRT were delivered by combinations of health-care practitioners (generalists) and behavioral health specialists. Practitioners in seven SBIRT programs who received grants from the US Substance Abuse and Mental Health Services Administration (SAMHSA). Program costs and revenues were measured using data from grantees. Patient flows were measured from administrative data and adjusted with prevalence and screening estimates from the literature. SBIRT can be sustained through health insurance reimbursement in out-patient and emergency department settings in most staffing mixes. To sustain SBIRT in in-patient programs, a patient flow larger than the national average may be needed; if that flow is achieved, the range of screens required to maintain a surplus is narrow. Sensitivity analyses suggest that the results are very sensitive to changes in the proportion of insured patients. Screening, Brief Intervention and Referral to Treatment programs in the United States can be sustained by health insurance payments under a variety of staffing models. Screening, Brief Intervention and Referral to Treatment programs can be sustained only in an in-patient setting with above-average patient flow (more than 2500 screens). Screening, Brief Intervention and Referral to Treatment programs in out-patient and emergency department settings can be sustained with below-average patient flows (fewer than 125 000 out-patient visits and fewer than 27 000 emergency department visits). © 2017 Society for the Study of Addiction.

  20. 38 CFR 17.1002 - Substantive conditions for payment or reimbursement.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice.... Payment or reimbursement under 38 U.S.C. 1725 for emergency services may be made only if all of the following conditions are met: (a) The emergency services were provided in a hospital emergency department or...

  1. 38 CFR 17.1002 - Substantive conditions for payment or reimbursement.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice.... Payment or reimbursement under 38 U.S.C. 1725 for emergency treatment (including medical services... medication related to and necessary for the treatment of the emergency condition that is provided directly to...

  2. 38 CFR 17.1002 - Substantive conditions for payment or reimbursement.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice.... Payment or reimbursement under 38 U.S.C. 1725 for emergency treatment (including medical services... medication related to and necessary for the treatment of the emergency condition that is provided directly to...

  3. 38 CFR 17.1002 - Substantive conditions for payment or reimbursement.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice.... Payment or reimbursement under 38 U.S.C. 1725 for emergency treatment (including medical services... medication related to and necessary for the treatment of the emergency condition that is provided directly to...

  4. 44 CFR 72.4 - Submittal/payment procedures and FEMA response.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Submittal/payment procedures and FEMA response. 72.4 Section 72.4 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... PROCEDURES AND FEES FOR PROCESSING MAP CHANGES § 72.4 Submittal/payment procedures and FEMA response. (a) The...

  5. 44 CFR 72.4 - Submittal/payment procedures and FEMA response.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Submittal/payment procedures and FEMA response. 72.4 Section 72.4 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... PROCEDURES AND FEES FOR PROCESSING MAP CHANGES § 72.4 Submittal/payment procedures and FEMA response. (a) The...

  6. 38 CFR 17.1000 - Payment or reimbursement for emergency services for nonservice-connected conditions in non-VA...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... for emergency services for nonservice-connected conditions in non-VA facilities. 17.1000 Section 17.1000 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-Va Facilities § 17.1000 Payment...

  7. 44 CFR 5.45 - Form of payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Form of payment. 5.45 Section... SECURITY GENERAL PRODUCTION OR DISCLOSURE OF INFORMATION Fees § 5.45 Form of payment. Payment shall be by check or money order payable to the Federal Emergency Management Agency and shall be addressed to the...

  8. 44 CFR 6.84 - Form of payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Form of payment. 6.84 Section... SECURITY GENERAL IMPLEMENTATION OF THE PRIVACY ACT OF 1974 Fees § 6.84 Form of payment. Payment shall be by check or money order payable to The Federal Emergency Management Agency and shall be addressed to the...

  9. Medicare incentive payments for meaningful use of electronic health records: accounting and reporting developments.

    PubMed

    2012-02-01

    The Healthcare Financial Management Association through its Principles and Practices (P&P) Board publishes issue analyses to provide short-term practical assistance on emerging issues in healthcare financial management. In a new issue analysis excerpted in this article, HFMA's P&P Board provides some clarity to the healthcare industry on certain accounting and reporting issues resulting from incentive payments under the Medicare program for the meaningful use of electronic health record (EHR) technology. Consultation on these matters with independent auditors is highly recommended.

  10. 75 FR 44067 - Conservation Reserve Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-28

    ... land, and installation of wind turbines. Therefore, Sec. 1410.63 is amended to implement the specific... emergencies, but was not specified as a permitted use in the CFR. Wind turbine installation provisions are... requires a payment reduction for the permissive use for wind turbine installation. All of the permissive...

  11. Paying physician group practices for quality: A statewide quasi-experiment.

    PubMed

    Conrad, Douglas A; Grembowski, David; Perry, Lisa; Maynard, Charles; Rodriguez, Hector; Martin, Diane

    2013-12-01

    This article presents the results of a unique quasi-experiment of the effects of a large-scale pay-for-performance (P4P) program implemented by a leading health insurer in Washington state during 2001-2007. The authors received external funding to provide an objective impact evaluation of the program. The program was unique in several respects: (1) It was designed dynamically, with two discrete intervention periods-one in which payment incentives were based on relative performance (the "contest" period) and a second in which payment incentives were based on absolute performance compared to achievable benchmarks. (2) The program was designed in collaboration with large multispecialty group practices, with an explicit run-in period to test the quality metrics. Public reporting of the quality scorecard for all participating medical groups was introduced 1 year before the quality incentive payment program's inception, and continued throughout 2002-2007. (3) The program was implemented in stages with distinct medical groups. A control group of comparable group practices also was assembled, and difference-in-differences methodology was applied to estimate program effects. Case mix measures were included in all multivariate analyses. The regression design permitted a contrast of intervention effects between the "contest" approach in the sub-period of 2003-2004 and the absolute standard, "achievable benchmarks of care" approach in sub-period 2005-2007. Most of the statistically significant quality incentive program coefficients were small and negative (opposite to program intent). A consistent pattern of differential intervention impact in the sub-periods did not emerge. Cumulatively, the probit regression estimates indicate that neither the quality scorecard nor the quality incentive payment program had a significant positive effect on general clinical quality. Based on key informant interviews with medical leaders, practicing physicians, and administrators of the participating groups, the authors conclude that several factors likely combined to dampen program effects: (1) modest size of the incentive; (2) use of rewards only, rather than a balance of rewards and penalties; (3) targeting incentive payments to the group, thus potentially weakening incentive effects at the individual level. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. 75 FR 66686 - Defense Federal Acquisition Regulation Supplement; Balance of Payments Program Exemption for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-29

    ... Federal Acquisition Regulation Supplement; Balance of Payments Program Exemption for Commercial... Balance of Payments Program for construction material that is commercial information technology. DATES..., Balance of Payments Program--Construction Material, and 252.225- 7045, Balance of Payments Program...

  13. Use of Diagnosis-Related Groups by Non-Medicare Payers

    PubMed Central

    Carter, Grace M.; Jacobson, Peter D.; Kominski, Gerald F.; Perry, Mark J.

    1994-01-01

    Medicare's prospective payment system (PPS) for hospital cases is based on diagnosis-related groups (DRGs). A wide variety of other third-party payers for hospital care have adapted elements of this system for their own use. The extent of DRG use varies considerably both by type of payer and by geographical area. Users include: 21 State Medicaid programs, 3 workers' compensation systems, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), more than one-half of the Blue Cross and Blue Shield Association (BCBSA) member plans, several self-insured employers, and a few employer coalitions. We describe how each of these payers use DRGs. No single approach is dominant. Some payers negotiate specific prices for so many combinations of DRG and hospital that the paradigm that payment equals rate times weight does not apply. What has emerged appears to be a very flexible payment system in which the only constant is the use of DRGs as a measure of output. PMID:10142368

  14. 76 FR 42771 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-19

    ...--Association of Freestanding Radiation Oncology Centers AFS--Ambulance Fee Schedule AHA--American Heart...) Update Committee AMA-DE--American Medical Association Drug Evaluations AMI--Acute Myocardial Infarction.../Low-density lipoprotein HDRT--High dose radiation therapy HEMS--Helicopter Emergency Medical Services...

  15. 76 FR 64049 - Bank Secrecy Act Regulations: Definition of “Monetary Instrument”

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-17

    ..., and anti-money laundering program requirements on providers and sellers of prepaid access. While the..., stated: \\13\\ See Money Laundering Using New Payment Methods, Financial Action Task Force, October 2010... Money Laundering Strategy stated that prepaid access is ``* * * an emerging cash alternative for both...

  16. 20 CFR 625.1 - Purpose; rules of construction.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... UNEMPLOYMENT ASSISTANCE § 625.1 Purpose; rules of construction. (a) Purpose. Section 410 of “The Robert T. Stafford Disaster Relief and Emergency Assistance Act” amended the program for the payment of unemployment assistance to unemployed individuals whose unemployment is caused by a major disaster, and to provide...

  17. 20 CFR 625.1 - Purpose; rules of construction.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... UNEMPLOYMENT ASSISTANCE § 625.1 Purpose; rules of construction. (a) Purpose. Section 410 of “The Robert T. Stafford Disaster Relief and Emergency Assistance Act” amended the program for the payment of unemployment assistance to unemployed individuals whose unemployment is caused by a major disaster, and to provide...

  18. 20 CFR 625.1 - Purpose; rules of construction.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... UNEMPLOYMENT ASSISTANCE § 625.1 Purpose; rules of construction. (a) Purpose. Section 410 of “The Robert T. Stafford Disaster Relief and Emergency Assistance Act” amended the program for the payment of unemployment assistance to unemployed individuals whose unemployment is caused by a major disaster, and to provide...

  19. 20 CFR 625.1 - Purpose; rules of construction.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... UNEMPLOYMENT ASSISTANCE § 625.1 Purpose; rules of construction. (a) Purpose. Section 410 of “The Robert T. Stafford Disaster Relief and Emergency Assistance Act” amended the program for the payment of unemployment assistance to unemployed individuals whose unemployment is caused by a major disaster, and to provide...

  20. 34 CFR 685.308 - Remedial actions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 4 2011-07-01 2011-07-01 false Remedial actions. 685.308 Section 685.308 Education... Payments for Direct Loan Program Schools § 685.308 Remedial actions. (a) General. The Secretary may require... fine or take an emergency action against a school or limit, suspend, or terminate a school's...

  1. The imperative for emergency medicine to create its own alternative payment model.

    PubMed

    Medford-Davis, Laura N

    2017-06-01

    Seven years after the Affordable Care Act legislated Alternative Payment Models, it is time for Emergency Medicine to find its place within this value-based trend by developing its own Alternative Payment Model. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Value-Based Payment Reform and the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons.

    PubMed

    Squitieri, Lee; Chung, Kevin C

    2017-07-01

    In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.

  3. 42 CFR § 510.320 - Treatment of incentive programs or add-on payments under existing Medicare payment systems.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.320 Treatment of incentive programs or add-on payments under existing Medicare payment systems. The CJR model... 42 Public Health 5 2017-10-01 2017-10-01 false Treatment of incentive programs or add-on payments...

  4. 42 CFR § 510.320 - Treatment of incentive programs or add-on payments under existing Medicare payment systems.

    Code of Federal Regulations, 2010 CFR

    2016-10-01

    ... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.320 Treatment of incentive programs or add-on payments under existing Medicare payment systems. The CJR model... 42 Public Health 5 2016-10-01 2016-10-01 false Treatment of incentive programs or add-on payments...

  5. 42 CFR § 512.320 - Treatment of incentive programs or add-on payments under existing Medicare payment systems.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Pricing and Payment § 512.320 Treatment of incentive... under such models are independent of, and do not affect, any incentive programs or add-on payments under... 42 Public Health 5 2017-10-01 2017-10-01 false Treatment of incentive programs or add-on payments...

  6. 42 CFR 417.558 - Emergency, urgently needed, and out-of-area services for which the HMO or CMP accepts...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... services for which the HMO or CMP accepts responsibility. 417.558 Section 417.558 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost...

  7. 48 CFR 252.232-7011 - Payments in Support of Emergencies and Contingency Operations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Emergencies and Contingency Operations. 252.232-7011 Section 252.232-7011 Federal Acquisition Regulations... Emergencies and Contingency Operations. As prescribed in section 232.908, use the following clause: PAYMENTS IN SUPPORT OF EMERGENCIES AND CONTINGENCY OPERATIONS (JUL 2010) (a) Definitions of pertinent terms...

  8. 7 CFR 4288.130 - Payment applications.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... process and procedures the Agency will use to make payments to eligible advanced biofuel producers. In order to receive payments under this Program, eligible advanced biofuel producers with valid contracts...

  9. 7 CFR 4288.130 - Payment applications.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... process and procedures the Agency will use to make payments to eligible advanced biofuel producers. In order to receive payments under this Program, eligible advanced biofuel producers with valid contracts...

  10. 7 CFR 4288.130 - Payment applications.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... identify the process and procedures the Agency will use to make payments to eligible advanced biofuel producers. In order to receive payments under this Program, eligible advanced biofuel producers with valid...

  11. 44 CFR 206.205 - Payment of claims.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Payment of claims. 206.205 Section 206.205 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Public Assistance Project Administration...

  12. Medicare program; hospital outpatient prospective payment system and CY 2007 payment rates; CY 2007 update to the ambulatory surgical center covered procedures list; Medicare administrative contractors; and reporting hospital quality data for FY 2008 inpatient prospective payment system annual payment update program--HCAHPS survey, SCIP, and mortality. Final rule with comment period and final rule.

    PubMed

    2006-11-24

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system, and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and the Deficit Reduction Act (DRA) of 2005. In this final rule with comment period, we describe changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2007. In addition, this final rule with comment period implements future CY 2009 required reporting on quality measures for hospital outpatient services paid under the prospective payment system. This final rule with comment period revises the current list of procedures that are covered when furnished in a Medicare-approved ambulatory surgical center (ASC), which are applicable to services furnished on or after January 1, 2007. This final rule with comment period revises the emergency medical screening requirements for critical access hospitals (CAHs). This final rule with comment period supports implementation of a restructuring of the contracting entities responsibilities and functions that support the adjudication of Medicare fee-for-service (FFS) claims. This restructuring is directed by section 1874A of the Act, as added by section 911 of the MMA. The prior separate Medicare intermediary and Medicare carrier contracting authorities under Title XVIII of the Act have been replaced with the Medicare Administrative Contractor (MAC) authority. This final rule continues to implement the requirements of the DRA that require that we expand the "starter set" of 10 quality measures that we used in FY 2005 and FY 2006 for the hospital inpatient prospective payment system (IPPS) Reporting Hospital Quality Data for the Annual Payment Update (RHQDAPU) program. We began to adopt expanded measures effective for payments beginning in FY 2007. In this rule, we are finalizing additional quality measures for the expanded set of measures for FY 2008 payment purposes. These measures include the HCAHPS survey, as well as Surgical Care Improvement Project (SCIP, formerly Surgical Infection Prevention (SIP)), and Mortality quality measures.

  13. 7 CFR 1469.23 - Program payments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM Contracts and Payments § 1469.23 Program payments. (a) Stewardship component of CSP payments. (1) The conservation stewardship plan... Agriculture Statistics Service (NASS) land rental data, and Conservation Reserve Program (CRP) rental rates...

  14. 38 CFR 17.120 - Payment or reimbursement for emergency treatment furnished by non-VA providers to certain...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... for emergency treatment furnished by non-VA providers to certain veterans with service-connected... Payment or reimbursement for emergency treatment furnished by non-VA providers to certain veterans with... emergency treatment, not previously authorized, in a private or public (or Federal) hospital not operated by...

  15. 38 CFR 17.120 - Payment or reimbursement for emergency treatment furnished by non-VA providers to certain...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... for emergency treatment furnished by non-VA providers to certain veterans with service-connected... Payment or reimbursement for emergency treatment furnished by non-VA providers to certain veterans with... emergency treatment, not previously authorized, in a private or public (or Federal) hospital not operated by...

  16. 38 CFR 17.120 - Payment or reimbursement for emergency treatment furnished by non-VA providers to certain...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... for emergency treatment furnished by non-VA providers to certain veterans with service-connected... Payment or reimbursement for emergency treatment furnished by non-VA providers to certain veterans with... emergency treatment, not previously authorized, in a private or public (or Federal) hospital not operated by...

  17. 44 CFR 204.53 - Certifying costs and payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....21 and U. S. Treasury 31 CFR part 205, Cash Management Improvement Act. ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Certifying costs and payments. 204.53 Section 204.53 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY...

  18. 44 CFR 204.53 - Certifying costs and payments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ....21 and U. S. Treasury 31 CFR part 205, Cash Management Improvement Act. ... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Certifying costs and payments. 204.53 Section 204.53 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY...

  19. 42 CFR § 414.1460 - Monitoring and program integrity.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1460 Monitoring and program integrity. (a) Vetting eligible clinicians prior to payment of the APM Incentive Payment. Prior to...

  20. 76 FR 13292 - Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2011...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-11

    ... Prospective Payment System and CY 2011 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Changes to Payments to Hospitals for Graduate Medical Education Costs..., 2010, entitled ``Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment...

  1. 7 CFR 4288.131 - Payment provisions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions Payment Provisions § 4288.131 Payment provisions. Payments to advanced biofuel producers for eligible advanced biofuel production will be determined in accordance with the provisions of...

  2. 5 CFR 890.1046 - Effect of debarment or suspension on payments for services furnished in emergency situations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Exceptions to the Effect of... situations. A debarred or suspended health care provider may receive FEHBP funds paid for items or services... provider's treatment was essential to the health and safety of the covered individual; and (b) No other...

  3. 5 CFR 890.1046 - Effect of debarment or suspension on payments for services furnished in emergency situations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Exceptions to the Effect of... situations. A debarred or suspended health care provider may receive FEHBP funds paid for items or services... provider's treatment was essential to the health and safety of the covered individual; and (b) No other...

  4. 77 FR 41547 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2013...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-13

    ... comment period. 3. By express or overnight mail. You may send written comments to the following address..., generally beginning approximately 3 weeks after publication of a document, at the headquarters of the... Reconciliation Act of 1987, Pub. L. 100-2-3, enacted December 22, 1987 OCESAA Omnibus Consolidated and Emergency...

  5. 44 CFR 151.13 - Reconsideration of amount authorized for payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reconsideration of amount authorized for payment. 151.13 Section 151.13 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY FIRE PREVENTION AND CONTROL REIMBURSEMENT FOR COSTS OF...

  6. 44 CFR 151.12 - Determination of amount authorized for payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Determination of amount authorized for payment. 151.12 Section 151.12 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY FIRE PREVENTION AND CONTROL REIMBURSEMENT FOR COSTS OF...

  7. 76 FR 7935 - Advanced Biofuel Payment Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ...The Rural Business-Cooperative Service (Agency) is establishing the Advanced Biofuel Payment Program authorized under the Food, Conservation, and Energy Act of 2008. Under this Program, the Agency will enter into contracts with advanced biofuel producers to pay such producers for the production of eligible advanced biofuels. To be eligible for payments, advanced biofuels must be produced from renewable biomass, excluding corn kernel starch, in a biofuel facility located in a State. In addition, this interim rule establishes new program requirements for applicants to submit applications for Fiscal Year 2010 payments for the Advanced Biofuel Payment Program. These new program requirements supersede the Notice of Contract Proposal (NOCP) for Payments to Eligible Advanced Biofuel Producers in its entirety.

  8. 48 CFR 252.225-7035 - Buy American Act-Free Trade Agreements-Balance of Payments Program Certificate.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Trade Agreements-Balance of Payments Program Certificate. 252.225-7035 Section 252.225-7035 Federal... Trade Agreements—Balance of Payments Program Certificate. As prescribed in 225.1101(10)(i), use the following provision: Buy American Act—Free Trade Agreements—Balance of Payments Program Certificate (DEC...

  9. 48 CFR 252.225-7036 - Buy American Act-Free Trade Agreements-Balance of Payments Program.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Trade Agreements-Balance of Payments Program. 252.225-7036 Section 252.225-7036 Federal Acquisition... Trade Agreements—Balance of Payments Program. As prescribed in 225.1101(11)(i)(A), use the following clause: Buy American Act—Free Trade Agreements—Balance of Payments Program (DEC 2010) (a) Definitions. As...

  10. 48 CFR 252.225-7036 - Buy American Act-Free Trade Agreements-Balance of Payments Program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Trade Agreements-Balance of Payments Program. 252.225-7036 Section 252.225-7036 Federal Acquisition... Trade Agreements—Balance of Payments Program. As prescribed in 225.1101(11)(i), use the following clause: Buy American Act—Free Trade Agreements—Balance of Payments Program (JUL 2009) (a) Definitions. As used...

  11. 48 CFR 252.225-7035 - Buy American Act-Free Trade Agreements-Balance of Payments Program Certificate.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Trade Agreements-Balance of Payments Program Certificate. 252.225-7035 Section 252.225-7035 Federal... Trade Agreements—Balance of Payments Program Certificate. As prescribed in 225.1101(10), use the following provision: Buy American Act—Free Trade Agreements—Balance of Payments Program Certificate (DEC...

  12. 40 CFR 303.32 - Pre-payment offers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 28 2014-07-01 2014-07-01 false Pre-payment offers. 303.32 Section 303.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... SUPERFUND Criteria for Payment of Award § 303.32 Pre-payment offers. Prior to the actual payment of an award...

  13. 40 CFR 303.32 - Pre-payment offers.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Pre-payment offers. 303.32 Section 303.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... SUPERFUND Criteria for Payment of Award § 303.32 Pre-payment offers. Prior to the actual payment of an award...

  14. 40 CFR 303.32 - Pre-payment offers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 27 2010-07-01 2010-07-01 false Pre-payment offers. 303.32 Section 303.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... SUPERFUND Criteria for Payment of Award § 303.32 Pre-payment offers. Prior to the actual payment of an award...

  15. 40 CFR 303.32 - Pre-payment offers.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Pre-payment offers. 303.32 Section 303.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... SUPERFUND Criteria for Payment of Award § 303.32 Pre-payment offers. Prior to the actual payment of an award...

  16. 40 CFR 303.32 - Pre-payment offers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Pre-payment offers. 303.32 Section 303.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... SUPERFUND Criteria for Payment of Award § 303.32 Pre-payment offers. Prior to the actual payment of an award...

  17. 20 CFR 627.305 - Payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Federal or federally assisted program based on need, other than as provided under the Social Security Act... are: Needs-based payments for eligible individuals in programs under title II; incentive and bonus payments for participants in title II programs; work-based training payments for work experience, entry...

  18. 7 CFR 4288.134 - Refunds and interest payments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.134 Refunds and interest payments. An eligible advanced biofuel producer...) An eligible advanced biofuel producer receiving payments under this subpart shall become ineligible...

  19. 7 CFR 4288.134 - Refunds and interest payments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.134 Refunds and interest payments. An eligible advanced biofuel producer...) An eligible advanced biofuel producer receiving payments under this subpart shall become ineligible...

  20. 7 CFR 4288.131 - Payment provisions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.131 Payment provisions. Payments to advanced biofuel producers for eligible advanced biofuel production will be determined in accordance with the provisions of this section. (a) Types...

  1. 7 CFR 4288.131 - Payment provisions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.131 Payment provisions. Payments to advanced biofuel producers for eligible advanced biofuel production will be determined in accordance with the provisions of this section. (a) Types...

  2. 7 CFR 1427.1204 - Eligible domestic users and exporters.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) Cotton Competitiveness Payment Program § 1427.1204 Eligible domestic users and exporters. (a) For the... entered into an agreement with CCC to participate in the ELS Cotton Competitiveness Payment Program; or (2... Competitiveness Payment Program. (b) Payment applications must contain the documentation required by this subpart...

  3. A New Culture of Transparency: Industry Payments to Orthopedic Surgeons.

    PubMed

    Lopez, Joseph; Ahmed, Rizwan; Bae, Sunjae; Hicks, Caitlin W; El Dafrawy, Mostafa; Osgood, Greg M; Segev, Dorry L

    2016-11-01

    Under the Physician Payments Sunshine Act, "payments or transfers of value" by biomedical companies to physicians must be disclosed through the Open Payments Program. Designed to provide transparency of financial transactions between medication and device manufacturers and health care providers, the Open Payments Program shows financial relationships between industry and health care providers. Awareness of this program is crucial because its interpretation or misinterpretation by patients, physicians, and the general public can affect patient care, clinical practice, and research. This study evaluated nonresearch payments by industry to orthopedic surgeons. A retrospective cross-sectional review of the first wave of Physician Payments Sunshine Act data (August through December 2013) was performed to characterize industry payments to orthopedic surgeons by subspecialty, amount, type, origin, and geographic distribution. During this 5-month period, orthopedic surgeons (n=14,828) received $107,666,826, which included 3% of those listed in the Open Payments Program and 23% of the total amount paid. Of orthopedic surgeons who received payment, 45% received less than $100 and 1% received $100,000 or more. Median payment (interquartile range) was $119 ($34-$636), and mean payment was $7261±95,887. The largest payment to an individual orthopedic surgeon was $7,849,711. The 2 largest payment categories were royalty or license fees (68%) and consulting fees (13%). During the study period, orthopedic surgeons had substantial financial ties to industry. Of orthopedic surgeons who received payments, the largest proportion (45%) received less than $100 and only 1% received large payments (≥$100,000). The Open Payments Program offers insight into industry payments to orthopedic surgeons. [Orthopedics. 2016; 39(6):e1058-e1062.]. Copyright 2016, SLACK Incorporated.

  4. The cost of cancer care: Part II.

    PubMed

    Eagle, David

    2012-11-01

    The rising cost of cancer treatment competes with the availability of effective therapy as a limiting factor in our war on cancer. Specific programs are being developed that have the potential to slow the growth in spending on oncology care. The Affordable Care Act includes provisions for containing healthcare costs, such as accountable care organizations and the Independent Payment Advisory Board. Within oncology, specific programs have emerged, including clinical pathways, episode-of-care based payment arrangements, and the oncology medical home. All models of cost containment have strengths and weaknesses. Outside of the United States, explicit rationing exists' through national health technology assessment organizations. Excessive demands on physicians to limit spending at the bedside could potentially create conflicts with their professional responsibility to patients. While spending for cancer care in the US is high, its "worth" is ultimately a societal decision. Recent economic modeling suggests that we may be achieving value for the money we spend.

  5. 42 CFR 495.208 - Avoiding duplicate payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.208 Avoiding duplicate payment. (a) Unless a qualifying MA EP is entitled to a maximum payment for a year under the Medicare FFS EHR incentive program, payment for such an individual is only made under the MA EHR incentive program...

  6. 42 CFR 495.208 - Avoiding duplicate payment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.208 Avoiding duplicate payment. (a) Unless a qualifying MA EP is entitled to a maximum payment for a year under the Medicare FFS EHR incentive program, payment for such an individual is only made under the MA EHR incentive program...

  7. 42 CFR 495.208 - Avoiding duplicate payment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.208 Avoiding duplicate payment. (a) Unless a qualifying MA EP is entitled to a maximum payment for a year under the Medicare FFS EHR incentive program, payment for such an individual is only made under the MA EHR incentive program...

  8. 7 CFR 760.506 - Payment calculations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... who meets all of the requirements of § 760.504(b) or be considered the owner of the trees under... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.506 Payment calculations. (a) Payment to an eligible orchardist or nursery tree grower for the cost of replanting or...

  9. 7 CFR 760.506 - Payment calculations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... who meets all of the requirements of § 760.504(b) or be considered the owner of the trees under... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.506 Payment calculations. (a) Payment to an eligible orchardist or nursery tree grower for the cost of replanting or...

  10. 7 CFR 760.506 - Payment calculations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... who meets all of the requirements of § 760.504(b) or be considered the owner of the trees under... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.506 Payment calculations. (a) Payment to an eligible orchardist or nursery tree grower for the cost of replanting or...

  11. 7 CFR 760.506 - Payment calculations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... who meets all of the requirements of § 760.504(b) or be considered the owner of the trees under... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.506 Payment calculations. (a) Payment to an eligible orchardist or nursery tree grower for the cost of replanting or...

  12. 42 CFR 422.304 - Monthly payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422.304 Monthly... original fee-for-service benefits for an individual in an MA payment area for a month. (1) Payment of bid...

  13. AMCP Guide to Pharmaceutical Payment Methods, 2009 Update (Version 2.0).

    PubMed

    2009-08-01

    The methods by which the U.S. health care system pays for prescription drugs have faced increasing scrutiny in recent years. Two key developments have emerged: (a) congressional enactment of important changes in the basis for payments for prescription drugs in the Medicare and Medicaid programs; and (b) a March 2009 decision in a federal class action lawsuit that alleged fraudulent manipulation of the dominant pricing benchmark (average wholesale price, AWP), used primarily as the basis for payment for brand-name prescription drugs. The debate about prescription drug payment methods centers on determining the most appropriate basis for calculating how payers, including patients, government agencies, employers, and health plans, should pay pharmacies and other providers for drugs. Historically, payment for prescription drugs has been based on published prices that do not necessarily reflect the actual acquisition costs paid by providers, primarily pharmacies, physicians, and hospitals. This has led policymakers to believe that Medicare and Medicaid programs have paid more than is necessary for prescription drugs. Thus, in an effort to reform the payment system and reduce drug expenditures, policymakers have made significant changes to the benchmarks used by public programs to pay for drugs, and in some instances have created new benchmarks. Private payers have followed the government's lead and begun to change their own payment methods and benchmarks. They can be expected to accelerate the change as a result of the settlement agreement approved in the March 2009 federal court decision. The settlement will result in the lowering of the AWP for more than 400 generic and brand-name drugs. In addition - and technically unrelated to the litigation and any appeals that may be taken - 2 major price data reporting companies, First DataBank and Medi-Span, announced their intent to discontinue publication of AWP within 2 years of September 26, 2009. (At the time this report was prepared, there have been no similar announcements from Thomson Healthcare for Redbook or from Elsevier for Gold Standard [ProspectoRx], who are 2 other publishers of prescription drug prices). Furthermore, several manufacturers have announced that they will no longer provide either an AWP or a markup percentage on certain pharmaceuticals.3 Thus, by 2011, the AWP benchmark as we know it will no longer be widely available for use by public or commercial payers for payment of pharmaceutical products.

  14. 20 CFR 408.1205 - How can a State have SSA administer its State recognition payment program?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... recognition payment program? 408.1205 Section 408.1205 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Federal Administration of State Recognition Payments § 408.1205 How can a State have SSA administer its State recognition payment program? A State (or...

  15. 75 FR 55801 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-14

    ... 0938-AP87 Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing... Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2011.'' DATES: Effective... illustrate the skilled nursing facility (SNF) prospective payment system (PPS) payment rate computations for...

  16. 77 FR 60315 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-03

    ... Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality... entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

  17. Medicare program; additional extension of the payment adjustment for low-volume hospitals and the Medicare-dependent hospital (MDH) program under the hospital Inpatient Prospective Payment Systems (IPPS) for acute care hospitals for fiscal year 2014. Extension of a payment adjustment and a program.

    PubMed

    2014-06-17

    This document announces changes to the payment adjustment for low-volume hospitals and to the Medicare-dependent hospital (MDH) program under the hospital inpatient prospective payment systems (IPPS) for the second half of FY 2014 (April 1, 2014 through September 30, 2014) in accordance with sections 105 and 106, respectively, of the Protecting Access to Medicare Act of 2014 (PAMA).

  18. 7 CFR 760.6 - Information to be furnished.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

  19. 7 CFR 760.6 - Information to be furnished.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

  20. 7 CFR 760.6 - Information to be furnished.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

  1. 7 CFR 760.6 - Information to be furnished.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

  2. Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

    PubMed

    Squitieri, Lee; Chung, Kevin C

    2017-07-01

    In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

  3. 76 FR 24343 - Advanced Biofuel Payment Program; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-02

    ...-AA75 Advanced Biofuel Payment Program; Correction AGENCY: Rural Business-Cooperative Service; Rural... Federal Register of February 11, 2011, establishing the Advanced Biofuel Payment Program authorized under... this Program, the Agency will enter into contracts with advanced biofuel producers to pay such...

  4. 24 CFR 888.315 - Restrictions on retroactive payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... PROGRAM, SECTION 202 SUPPORTIVE HOUSING FOR THE ELDERLY PROGRAM AND SECTION 811 SUPPORTIVE HOUSING FOR PERSONS WITH DISABILITIES PROGRAM) SECTION 8 HOUSING ASSISTANCE PAYMENTS PROGRAM-FAIR MARKET RENTS AND... Elderly or Handicapped, and Special Allocations Projects § 888.315 Restrictions on retroactive payments...

  5. 7 CFR 1493.60 - Payment guarantee.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the...

  6. 7 CFR 1493.60 - Payment guarantee.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the...

  7. 7 CFR 1493.60 - Payment guarantee.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the...

  8. How alternative payment models in emergency medicine can benefit physicians, payers, and patients.

    PubMed

    Harish, Nir J; Miller, Harold D; Pines, Jesse M; Zane, Richard D; Wiler, Jennifer L

    2017-06-01

    While there has been considerable effort devoted to developing alternative payment models (APMs) for primary care physicians and for episodes of care beginning with inpatient admissions, there has been relatively little attention by payers to developing APMs for specialty ambulatory care, and no efforts to develop APMs that explicitly focus on emergency care. In order to ensure that emergency care is appropriately integrated and valued in future payment models, emergency physicians (EPs) must engage with the stakeholders within the broader health care system. In this article, we describe a framework for the development of APMs for emergency medicine and present four examples of APMs that may be applicable in emergency medicine. A better understanding of how APMs can work in emergency medicine will help EPs develop new APMs that improve the cost and quality of care, and leverage the value that emergency care brings to the system. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. 7 CFR 226.11 - Program payments for centers.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.11 Program... payments for administrative costs to the amount approved in the annual administrative budget of the...

  10. 7 CFR 226.11 - Program payments for centers.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.11 Program... payments for administrative costs to the amount approved in the annual administrative budget of the...

  11. 7 CFR 226.11 - Program payments for centers.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.11 Program... payments for administrative costs to the amount approved in the annual administrative budget of the...

  12. 41 CFR 301-73.301 - How do we obtain travel payment system services?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... payment system services? 301-73.301 Section 301-73.301 Public Contracts and Property Management Federal... PROGRAMS Travel Payment System § 301-73.301 How do we obtain travel payment system services? You may participate in GSA's or another Federal agency's travel payment system services program or you may contract...

  13. Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. Final rule with comment period.

    PubMed

    2016-11-04

    The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS. This final rule with comment period establishes incentives for participation in certain alternative payment models (APMs) and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models (PFPMs). Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. This final rule with comment period also establishes the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. In this final rule with comment period we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that will be more easily identified and understood by our stakeholders.

  14. 75 FR 41397 - Asparagus Revenue Market Loss Assistance Payment Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-16

    ... Revenue Market Loss Assistance Payment Program AGENCY: Commodity Credit Corporation and Farm Service... to implement the new Asparagus Revenue Market Loss Assistance Payment (ALAP) Program authorized by the Food, Conservation, and Energy Act of 2008 (the 2008 Farm Bill). The purpose of the program is to...

  15. The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study.

    PubMed

    Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

    2016-04-01

    When a country's health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people's behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. With regard to the current challenges in Iran's health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system's features. However, future research should focus on the development of the risk-adjusted capitation model.

  16. 7 CFR 4288.113 - Payment record requirements.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment... for Program payments, an advanced biofuel producer must maintain records for all relevant fiscal years and fiscal year quarters for each advanced biofuel facility indicating: (a) The type of eligible...

  17. 7 CFR 1416.304 - Payment calculations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Payment calculations. 1416.304 Section 1416.304 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT... PROGRAMS Citrus Disaster Program § 1416.304 Payment calculations. (a) Payments will be calculated by...

  18. 42 CFR § 414.1310 - Applicability.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1310 Applicability. (a) Program Implementation. Except as specified in paragraph (b) of this section, MIPS applies to payments for items and...

  19. 7 CFR 4288.132 - Payment adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... otherwise payable to the advanced biofuel producer if there is a difference between the amount actually...

  20. 7 CFR 4288.132 - Payment adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... to the advanced biofuel producer if there is a difference between the amount actually produced and...

  1. 7 CFR 4288.132 - Payment adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... to the advanced biofuel producer if there is a difference between the amount actually produced and...

  2. 31 CFR 560.522 - Allowable payments for overflights of Iranian airspace.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... payments for overflights of Iranian airspace. (a) Payments to Iran of charges for services rendered by the Government of Iran in connection with the overflight of Iran or emergency landing in Iran of aircraft owned...

  3. 31 CFR 560.522 - Allowable payments for overflights of Iranian airspace.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... payments for overflights of Iranian airspace. (a) Payments to Iran of charges for services rendered by the Government of Iran in connection with the overflight of Iran or emergency landing in Iran of aircraft owned...

  4. Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2017, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and SNF Payment Models Research. Final rule.

    PubMed

    2016-08-05

    This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2017. In addition, it specifies a potentially preventable readmission measure for the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP), and implements requirements for that program, including performance standards, a scoring methodology, and a review and correction process for performance information to be made public, aimed at implementing value-based purchasing for SNFs. Additionally, this final rule includes additional polices and measures in the Skilled Nursing Facility Quality Reporting Program (SNF QRP). This final rule also responds to comments on the SNF Payment Models Research (PMR) project.

  5. 45 CFR 400.66 - Eligibility and payment levels in a publicly-administered RCA program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Eligibility and payment levels in a publicly... REFUGEE RESETTLEMENT PROGRAM Refugee Cash Assistance § 400.66 Eligibility and payment levels in a publicly-administered RCA program. (a) In administering a publicly-administered refugee cash assistance program, the...

  6. 7 CFR 1400.106 - Payment limits.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Limitation § 1400.106 Payment limits. (a) Payments made to...

  7. 7 CFR 1493.60 - Payment guarantee.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC...

  8. 7 CFR 1493.60 - Payment guarantee.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC...

  9. 7 CFR 4288.133 - Payment liability.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... lien against the advanced biofuel, or proceeds thereof, in favor of the owner or any other creditor...

  10. 7 CFR 4288.133 - Payment liability.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... lien against the advanced biofuel, or proceeds thereof, in favor of the owner or any other creditor...

  11. 7 CFR 220.18 - Withholding payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.18 Withholding payments. In accordance...'s acceptance of the corrective actions, payments will be released for any breakfasts served in...

  12. 7 CFR 220.18 - Withholding payments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.18 Withholding payments. In accordance...'s acceptance of the corrective actions, payments will be released for any breakfasts served in...

  13. Creative payment strategy helps ensure a future for teaching hospitals.

    PubMed

    Vancil, D R; Shroyer, A L

    1998-11-01

    The Colorado Medicaid Program in years past relied on disproportionate share hospital (DSH) payment programs to increase access to hospital care for Colorado citizens, ensure the future financial viability of key safety-net hospitals, and partially offset the state's cost of funding the Medicaid program. The options to finance Medicaid care using DSH payments, however, recently have been severely limited by legislative and regulatory changes. Between 1991 and 1997, a creative Medicaid refinancing strategy called the major teaching hospital (MTH) payment program enabled $131 million in net payments to be distributed to the two major teaching hospitals in Colorado to provide enhanced funding related to their teaching programs and to address the ever-expanding healthcare needs of their low-income patients. This new Medicaid payment mechanism brought the state $69.5 million in Federal funding that otherwise would not have been received.

  14. An E-payment system based on quantum group signature

    NASA Astrophysics Data System (ADS)

    Xiaojun, Wen

    2010-12-01

    Security and anonymity are essential to E-payment systems. However, existing E-payment systems will easily be broken into soon with the emergence of quantum computers. In this paper, we propose an E-payment system based on quantum group signature. In contrast to classical E-payment systems, our quantum E-payment system can protect not only the users' anonymity but also the inner structure of customer groups. Because of adopting the two techniques of quantum key distribution, a one-time pad and quantum group signature, unconditional security of our E-payment system is guaranteed.

  15. Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, and End-Stage Renal Disease Quality Incentive Program. Final rule.

    PubMed

    2017-11-01

    This rule updates and makes revisions to the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2018. It also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also sets forth requirements for the ESRD Quality Incentive Program (QIP), including for payment years (PYs) 2019 through 2021.

  16. US hospital payment adjustments for innovative technology lag behind those in Germany, France, and Japan.

    PubMed

    Hernandez, John; Machacz, Susanne F; Robinson, James C

    2015-02-01

    Medicare pioneered add-on payments to facilitate the adoption of innovative technologies under its hospital prospective payment system. US policy makers are now experimenting with broader value-based payment initiatives, but these have not been adjusted for innovation. This article examines the structure, processes, and experience with Medicare's hospital new technology add-on payment program since its inception in 2001 and compares it with analogous payment systems in Germany, France, and Japan. Between 2001 and 2015 CMS approved nineteen of fifty-three applications for the new technology add-on payment program. We found that the program resulted in $201.7 million in Medicare payments in fiscal years 2002-13-less than half the level anticipated by Congress and only 34 percent of the amount projected by CMS. The US program approved considerably fewer innovative technologies, compared to analogous technology payment mechanisms in Germany, France and Japan. We conclude that it is important to adjust payments for new medical innovations within prospective and value-based payment systems explicitly as well as implicitly. The most straightforward method to use in adjusting value-based payments is for the insurer to retrospectively adjust spending targets to account for the cost of new technologies. If CMS made such retrospective adjustments, it would not financially penalize hospitals for adopting beneficial innovations. Project HOPE—The People-to-People Health Foundation, Inc.

  17. 42 CFR 418.307 - Periodic interim payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.307 Periodic interim payments... payments. The biweekly interim payment amount is based on the total estimated Medicare payments for the...

  18. 7 CFR 1493.450 - Payment guarantee.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount not to exceed the guaranteed...

  19. 7 CFR 1493.450 - Payment guarantee.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount not to exceed the guaranteed...

  20. 7 CFR 1493.450 - Payment guarantee.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount not to exceed the guaranteed...

  1. 42 CFR 415.55 - General payment rules.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... availability services, except for reasonable availability services furnished for emergency rooms and the... Physician Services § 415.55 General payment rules. (a) Allowable costs. Except as specified otherwise in... physician compensation costs), and 415.162 (concerning payment for physician services furnished to...

  2. 42 CFR 415.55 - General payment rules.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... availability services, except for reasonable availability services furnished for emergency rooms and the... Physician Services § 415.55 General payment rules. (a) Allowable costs. Except as specified otherwise in... physician compensation costs), and 415.162 (concerning payment for physician services furnished to...

  3. 42 CFR 415.55 - General payment rules.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... availability services, except for reasonable availability services furnished for emergency rooms and the... Physician Services § 415.55 General payment rules. (a) Allowable costs. Except as specified otherwise in... physician compensation costs), and 415.162 (concerning payment for physician services furnished to...

  4. 7 CFR 4288.133 - Payment liability.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... to any claim or lien against the advanced biofuel, or proceeds thereof, in favor of the owner or any...

  5. 42 CFR 110.83 - Payment of all benefits.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Secretary determines the mechanism of payment of Program benefits. She may choose to pay any benefits under... Secretary has the discretion to make interim payments of benefits under this Program, even before a final... only in exceptional cases. The Secretary may, for example, make an interim payment of medical benefits...

  6. 48 CFR 252.225-7044 - Balance of Payments Program-Construction Material.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Balance of Payments... AND CONTRACT CLAUSES Text of Provisions And Clauses 252.225-7044 Balance of Payments Program—Construction Material. As prescribed in 225.7503(a), use the following clause: Balance of Payments Program...

  7. 48 CFR 252.225-7044 - Balance of Payments Program-Construction Material.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Balance of Payments... AND CONTRACT CLAUSES Text of Provisions And Clauses 252.225-7044 Balance of Payments Program—Construction Material. As prescribed in 225.7503(a)(1), use the following clause: Balance of Payments Program...

  8. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital. Final rule with comment period and interim final rule with comment period.

    PubMed

    2016-11-14

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.

  9. An Analysis of Medicare's Incentive Payment Program for Physicians in Health Professional Shortage Areas

    ERIC Educational Resources Information Center

    Chan, Leighton; Hart, L. Gary; Ricketts III, Thomas C.; Beaver, Shelli K.

    2004-01-01

    Medicare's Incentive Payment (MIP) program provides a 10% bonus payment to providers who treat Medicare patients in rural and urban areas where there is a shortage of generalist physicians. Purpose: To examine the experience of Alaska, Idaho, North Carolina, South Carolina, and Washington with the MIP program. We determined the program's…

  10. 7 CFR 80.1 - Applicability and payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PROGRAMS FRESH RUSSET POTATO DIVERSION PROGRAM Fresh Russet Potato Diversion Program § 80.1 Applicability and payments. Payment be received or retained with respect to diversions of 2001 Fresh Russet potatoes... producers or other persons under this part based upon their diversion of potatoes, shall be allowed except...

  11. 48 CFR 225.003 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the meaning given in the clauses at 252.225-7001, Buy American Act and Balance of Payments Program; and 252.225-7036, Buy American Act—Free Trade Agreements—Balance of Payments Program, instead of the....225-7036, Buy American Act—Free Trade Agreements—Balance of Payments Program. Qualifying country end...

  12. 76 FR 6313 - Asparagus Revenue Market Loss Assistance Payment Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-04

    ... Revenue Market Loss Assistance Payment Program AGENCY: Commodity Credit Corporation and Farm Service Agency, USDA. ACTION: Final rule. SUMMARY: This rule implements the Asparagus Revenue Market Loss Assistance Payment (ALAP) Program authorized by the Food, Conservation and Energy Act of 2008 (the 2008 Farm...

  13. 7 CFR 80.1 - Applicability and payments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... PROGRAMS FRESH RUSSET POTATO DIVERSION PROGRAM Fresh Russet Potato Diversion Program § 80.1 Applicability and payments. Payment be received or retained with respect to diversions of 2001 Fresh Russet potatoes... producers or other persons under this part based upon their diversion of potatoes, shall be allowed except...

  14. 7 CFR 80.1 - Applicability and payments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... PROGRAMS FRESH RUSSET POTATO DIVERSION PROGRAM Fresh Russet Potato Diversion Program § 80.1 Applicability and payments. Payment be received or retained with respect to diversions of 2001 Fresh Russet potatoes... producers or other persons under this part based upon their diversion of potatoes, shall be allowed except...

  15. 7 CFR 80.1 - Applicability and payments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PROGRAMS FRESH RUSSET POTATO DIVERSION PROGRAM Fresh Russet Potato Diversion Program § 80.1 Applicability and payments. Payment be received or retained with respect to diversions of 2001 Fresh Russet potatoes... producers or other persons under this part based upon their diversion of potatoes, shall be allowed except...

  16. 7 CFR 80.1 - Applicability and payments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... PROGRAMS FRESH RUSSET POTATO DIVERSION PROGRAM Fresh Russet Potato Diversion Program § 80.1 Applicability and payments. Payment be received or retained with respect to diversions of 2001 Fresh Russet potatoes... producers or other persons under this part based upon their diversion of potatoes, shall be allowed except...

  17. 38 CFR 21.5136 - Benefit payments-secondary school program.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-secondary school program. 21.5136 Section 21.5136 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...—secondary school program. (a) Restrictions on payments. (1) The Department of Veterans Affairs may authorize... secondary school diploma or an equivalency certificate without charge to entitlement. Payments may be made...

  18. 38 CFR 21.5136 - Benefit payments-secondary school program.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-secondary school program. 21.5136 Section 21.5136 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...—secondary school program. (a) Restrictions on payments. (1) The Department of Veterans Affairs may authorize... secondary school diploma or an equivalency certificate without charge to entitlement. Payments may be made...

  19. Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care.

    PubMed

    Wang, C Jason; Cheng, Skye H; Wu, Jen-You; Lin, Yi-Ping; Kao, Wen-Hsin; Lin, Chia-Li; Chen, Yin-Jou; Tsai, Shu-Ling; Kao, Feng-Yu; Huang, Andrew T

    2017-03-01

    Value-driven payment system reform is a potential tool for aligning economic incentives with the improvement of quality and efficiency of health care and containment of cost. Such a payment system has not been researched satisfactorily in full-cycle cancer care. To examine the association of outcomes and medical expenditures with a bundled-payment pay-for-performance program for breast cancer in Taiwan compared with a fee-for-service (FFS) program. Data were obtained from the Taiwan Cancer Database, National Health Insurance Claims Data, the National Death Registry, and the bundled-payment enrollment file. Women with newly diagnosed breast cancer and a documented first cancer treatment from January 1, 2004, to December 31, 2008, were selected from the Taiwan Cancer Database and followed up for 5 years, with the last follow-up data available on December 31, 2013. Patients in the bundled-payment program were matched at a ratio of 1:3 with control individuals in an FFS program using a propensity score method. The final sample of 17 940 patients included 4485 (25%) in the bundled-payment group and 13 455 (75%) in the FFS group. Rates of adherence to quality indicators, survival rates, and medical payments (excluding bonuses paid in the bundled-payment group). The Kaplan-Meier method was used to calculate 5-year overall and event-free survival rates by cancer stage, and the Cox proportional hazards regression model was used to examine the effect of the bundled-payment program on overall and event-free survival. Sensitivity analysis for bonus payments in the bundled-payment group was also performed. The study population included 17 940 women (mean [SD] age, 52.2 [10.3] years). In the bundled-payment group, 1473 of 4215 patients (34.9%) with applicable quality indicators had full (100%) adherence to quality indicators compared with 3438 of 12 506 patients (27.5%) with applicable quality indicators in the FFS group (P < .001). The 5-year event-free survival rates for patients with stages 0 to III breast cancer were 84.48% for the bundled-payment group and 80.88% for the FFS group (P < .01). Although the 5-year medical payments of the bundled-payment group remained stable, the cumulative medical payments for the FFS group steadily increased from $16 000 to $19 230 and exceeded pay-for-performance bundled payments starting in 2008. In Taiwan, compared with the regular FFS program, bundled payment may lead to better adherence to quality indicators, better outcomes, and more effective cost-control over time.

  20. 7 CFR 82.10 - Claim for payment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PROGRAMS CLINGSTONE PEACH DIVERSION PROGRAM § 82.10 Claim for payment. To obtain payment for the trees... form shall include the CCPA's certification that the qualifying trees from the acreage have been...

  1. 7 CFR 82.10 - Claim for payment.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PROGRAMS CLINGSTONE PEACH DIVERSION PROGRAM § 82.10 Claim for payment. To obtain payment for the trees... form shall include the CCPA's certification that the qualifying trees from the acreage have been...

  2. Solving Disparities Through Payment And Delivery System Reform: A Program To Achieve Health Equity.

    PubMed

    DeMeester, Rachel H; Xu, Lucy J; Nocon, Robert S; Cook, Scott C; Ducas, Andrea M; Chin, Marshall H

    2017-06-01

    Payment systems generally do not directly encourage or support the reduction of health disparities. In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction. Most proposed general pay-for-performance, global payment, or shared savings plans, combined with multicomponent system interventions. None of the applicants proposed making any financial payments contingent on having successfully reduced disparities. Most applicants did not address how they would optimize providers' intrinsic and extrinsic motivation to reduce disparities. A better understanding of how payment and care delivery models might be designed and implemented to reduce health disparities is essential. Project HOPE—The People-to-People Health Foundation, Inc.

  3. 44 CFR 17.615 - Grounds for suspension of payments, suspension or termination of grants, or suspension or debarment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Grounds for suspension of... Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (GRANTS) § 17.615 Grounds for suspension of payments...

  4. 42 CFR 460.180 - Medicare payment to PACE organizations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Payment § 460.180 Medicare payment to PACE organizations. (a) Principle of...

  5. 7 CFR 760.4 - Normal marketings of milk.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... section are adjusted for any change in the daily average number of cows milked during each pay period the milk is off the market compared with the average number of cows milked daily during the base period. (d...

  6. 48 CFR 252.225-7013 - Duty-free entry.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the Buy American Act-Free Trade Agreements-Balance of Payments Program clause of this contract; or... product have the meanings given in the Trade Agreements clause, the Buy American Act and Balance of Payments Program clause, or the Buy American Act—Free Trade Agreements—Balance of Payments Program clause...

  7. 42 CFR 455.23 - Suspension of payments in cases of fraud.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Suspension of payments in cases of fraud. 455.23... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and Investigation Program § 455.23 Suspension of payments in cases of fraud. (a) Basis for...

  8. 78 FR 77418 - Notice of Request for Revision of a Currently Approved Information Collection

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-23

    ... to a currently approved information collection for the Advanced Biofuel Payment Program. DATES... INFORMATION: Title: Advanced Biofuel Payment Program. OMB Number: OMB No. 0570-0063. Expiration Date of... collection. Abstract: The Advanced Biofuel Payment Program was authorized under section 9005 of Title IX of...

  9. 78 FR 27485 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment... [CMS-1599-P] RIN 0938-AR53 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute... capital-related costs of acute care hospitals to implement changes arising from our continuing experience...

  10. 7 CFR 1463.113 - Issuance of payments in event of death.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Issuance of payments in event of death. 1463.113 Section 1463.113 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT... PROGRAM Tobacco Transition Payment Program § 1463.113 Issuance of payments in event of death. If a quota...

  11. 7 CFR 1463.113 - Issuance of payments in event of death.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Issuance of payments in event of death. 1463.113 Section 1463.113 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT... PROGRAM Tobacco Transition Payment Program § 1463.113 Issuance of payments in event of death. If a quota...

  12. 7 CFR 1463.113 - Issuance of payments in event of death.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Issuance of payments in event of death. 1463.113 Section 1463.113 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT... PROGRAM Tobacco Transition Payment Program § 1463.113 Issuance of payments in event of death. If a quota...

  13. 7 CFR 1463.113 - Issuance of payments in event of death.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Issuance of payments in event of death. 1463.113 Section 1463.113 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT... PROGRAM Tobacco Transition Payment Program § 1463.113 Issuance of payments in event of death. If a quota...

  14. 77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-17

    ... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for...

  15. 7 CFR 1400.105 - Attribution of payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Limitation § 1400.105 Attribution of payments...

  16. 42 CFR 422.316 - Special rules for payments to Federally qualified health centers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422.316 Special rules for payments to Federally qualified health centers...

  17. 7 CFR 220.4 - Payment of funds to States and FNSROs.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.4 Payment of funds to States and FNSROs. (a) To the extent funds are available, the Secretary shall make breakfast assistance payments to each State agency for breakfasts served to children under the Program. Subject to § 220.13(b)(2...

  18. 7 CFR 220.4 - Payment of funds to States and FNSROs.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.4 Payment of funds to States and FNSROs. (a) To the extent funds are available, the Secretary shall make breakfast assistance payments to each State agency for breakfasts served to children under the Program. Subject to § 220.13(b)(2...

  19. 75 FR 81138 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-27

    ... [CMS-1510-CN2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home Health Agencies and Hospices AGENCY... ``Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in...

  20. 48 CFR 252.225-7000 - Buy American Act-Balance of Payments Program Certificate.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Buy American Act-Balance... PROVISIONS AND CONTRACT CLAUSES Text of Provisions And Clauses 252.225-7000 Buy American Act—Balance of Payments Program Certificate. Buy American Act—Balance of Payments Program Certificate (DEC 2009) (a...

  1. 48 CFR 252.225-7001 - Buy American Act and Balance of Payments Program.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Balance of Payments Program. 252.225-7001 Section 252.225-7001 Federal Acquisition Regulations System... AND CONTRACT CLAUSES Text of Provisions And Clauses 252.225-7001 Buy American Act and Balance of Payments Program. As prescribed in 225.1101(2)(i), use the following clause: Buy American Act and Balance...

  2. 75 FR 81915 - Defense Federal Acquisition Regulation Supplement; Foreign Participation in Acquisitions in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ...) states; and Determination of inapplicability of the Balance of Payments Program evaluation factor to... the provisions of the Balance of Payments Program to offers of products (other than arms, ammunition... supplies. (1)(i) Use the provision at 252.225-7000, Buy American Act--Balance of Payments Program...

  3. 48 CFR 252.225-7001 - Buy American Act and Balance of Payments Program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Balance of Payments Program. 252.225-7001 Section 252.225-7001 Federal Acquisition Regulations System... AND CONTRACT CLAUSES Text of Provisions And Clauses 252.225-7001 Buy American Act and Balance of Payments Program. As prescribed in 225.1101(2), use the following clause: Buy American Act and Balance of...

  4. 7 CFR 784.6 - Rate of payment and limitations on funding.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS 2004 EWE LAMB REPLACEMENT AND RETENTION PAYMENT PROGRAM § 784.6... proration provisions of § 784.7, payments for qualifying operations shall be $18 for each qualifying ewe...

  5. Do heart failure disease management programs make financial sense under a bundled payment system?

    PubMed

    Eapen, Zubin J; Reed, Shelby D; Curtis, Lesley H; Hernandez, Adrian F; Peterson, Eric D

    2011-05-01

    Policy makers have proposed bundling payments for all heart failure (HF) care within 30 days of an HF hospitalization in an effort to reduce costs. Disease management (DM) programs can reduce costly HF readmissions but have not been economically attractive for caregivers under existing fee-for-service payment. Whether a bundled payment approach can address the negative financial impact of DM programs is unknown. Our study determined the cost-neutral point for the typical DM program and examined whether published HF DM programs can be cost saving under bundled payment programs. We used a decision analytic model using data from retrospective cohort studies, meta-analyses, 5 randomized trials evaluating DM programs, and inpatient claims for all Medicare beneficiaries discharged with an HF diagnosis from 2001 to 2004. We determined the costs of DM programs and inpatient care over 30 and 180 days. With a baseline readmission rate of 22.9%, the average cost for readmissions over 30 days was $2,272 per patient. Under base-case assumptions, a DM program that reduced readmissions by 21% would need to cost $477 per patient to be cost neutral. Among evaluated published DM programs, 2 of the 5 would increase provider costs (+$15 to $283 per patient), whereas 3 programs would be cost saving (-$241 to $347 per patient). If bundled payments were broadened to include care over 180 days, then program saving estimates would increase, ranging from $419 to $1,706 per patient. Proposed bundled payments for HF admissions provide hospitals with a potential financial incentive to implement DM programs that efficiently reduce readmissions. Copyright © 2011 Mosby, Inc. All rights reserved.

  6. 20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

  7. 20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

  8. 20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

  9. 20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

  10. 20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

  11. Medicare and Medicaid programs: hospital outpatient prospective payment; ambulatory surgical center payment; hospital value-based purchasing program; physician self-referral; and patient notification requirements in provider agreements. Final rule with comment period.

    PubMed

    2011-11-30

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) for CY 2012 to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we set forth the relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other ratesetting information for the CY 2012 ASC payment system. We are revising the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, adding new requirements for ASC Quality Reporting System, and making additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are allowing eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. Finally, we are making changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

  12. 42 CFR 412.110 - Total Medicare payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.110 Total Medicare payment. Under the prospective payment systems, Medicare... 42 Public Health 2 2010-10-01 2010-10-01 false Total Medicare payment. 412.110 Section 412.110...

  13. Payments for carbon sequestration to alleviate development pressure in a rapidly urbanizing region

    USGS Publications Warehouse

    Smith, Jordan W.; Dorning, Monica; Shoemaker, Douglas A.; Méley, Andréanne; Dupey, Lauren; Meentemeyer, Ross K.

    2017-01-01

    The purpose of this study was to determine individuals' willingness to enroll in voluntary payments for carbon sequestration programs through the use of a discrete choice experiment delivered to forest owners living in the rapidly urbanizing region surrounding Charlotte, North Carolina. We examined forest owners' willingness to enroll in payments for carbon sequestration policies under different levels of financial incentives (annual revenue), different contract lengths, and different program administrators (e.g., private companies versus a state or federal agency). We also examined the influence forest owners' sense of place had on their willingness to enroll in hypothetical programs. Our results showed a high level of ambivalence toward participating in payments for carbon sequestration programs. However, both financial incentives and contract lengths significantly influenced forest owners' intent to enroll. Neither program administration nor forest owners' sense of place influenced intent to enroll. Although our analyses indicated that payments from carbon sequestration programs are not currently competitive with the monetary returns expected from timber harvest or property sales, certain forest owners might see payments for carbon sequestration programs as a viable option for offsetting increasing tax costs as development encroaches and property values rise.

  14. 7 CFR 1430.302 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DAIRY PRODUCTS 2004 Dairy Disaster Assistance Payment... purposes of administering the 2004 Dairy Disaster Assistance Payment Program established by this subpart. Application means the 2004 Dairy Disaster Assistance Payment Program Application. Application period means the...

  15. 7 CFR 1430.302 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DAIRY PRODUCTS 2004 Dairy Disaster Assistance Payment... purposes of administering the 2004 Dairy Disaster Assistance Payment Program established by this subpart. Application means the 2004 Dairy Disaster Assistance Payment Program Application. Application period means the...

  16. 7 CFR 1430.302 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DAIRY PRODUCTS 2004 Dairy Disaster Assistance Payment... purposes of administering the 2004 Dairy Disaster Assistance Payment Program established by this subpart. Application means the 2004 Dairy Disaster Assistance Payment Program Application. Application period means the...

  17. Report: EPA Needs to Reexamine How It Defines Its Payment Recapture Audit Program

    EPA Pesticide Factsheets

    Report #11-P-0362, July 19, 2011. EPA makes numerous efforts to recapture improper payments, but does not consider its activities to be a formal payment recapture audit program, as defined by OMB guidance.

  18. 46 CFR 308.507 - Security for payment of premiums.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 8 2013-10-01 2013-10-01 false Security for payment of premiums. 308.507 Section 308.507 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.507 Security for payment of...

  19. 46 CFR 308.3 - Applications for insurance; warranties; supporting documents; payment of binder fees.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... documents; payment of binder fees. 308.3 Section 308.3 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE General § 308.3 Applications for insurance; warranties; supporting documents; payment of binder fees. (a) Application, binder forms. A single application for War...

  20. 46 CFR 308.3 - Applications for insurance; warranties; supporting documents; payment of binder fees.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... documents; payment of binder fees. 308.3 Section 308.3 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE General § 308.3 Applications for insurance; warranties; supporting documents; payment of binder fees. (a) Application, binder forms. A single application for War...

  1. 46 CFR 308.3 - Applications for insurance; warranties; supporting documents; payment of binder fees.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... documents; payment of binder fees. 308.3 Section 308.3 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE General § 308.3 Applications for insurance; warranties; supporting documents; payment of binder fees. (a) Application, binder forms. A single application for War...

  2. 46 CFR 308.507 - Security for payment of premiums.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Security for payment of premiums. 308.507 Section 308.507 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk Cargo Insurance § 308.507 Security for payment of...

  3. 46 CFR 308.507 - Security for payment of premiums.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Security for payment of premiums. 308.507 Section 308.507 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.507 Security for payment of...

  4. 46 CFR 308.507 - Security for payment of premiums.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 8 2012-10-01 2012-10-01 false Security for payment of premiums. 308.507 Section 308.507 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.507 Security for payment of...

  5. 46 CFR 308.3 - Applications for insurance; warranties; supporting documents; payment of binder fees.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... documents; payment of binder fees. 308.3 Section 308.3 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE General § 308.3 Applications for insurance; warranties; supporting documents; payment of binder fees. (a) Application, binder forms. A single application for War...

  6. 46 CFR 308.507 - Security for payment of premiums.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Security for payment of premiums. 308.507 Section 308.507 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.507 Security for payment of...

  7. Potential cost to Western Australia of proposed patient co-payments according to healthcare organisational structure: A preliminary analysis.

    PubMed

    Millar, J Alasdair; Millar, Robyn C

    2014-01-01

    The Australian federal government has proposed an AUD $7 patient co-payment for a general practitioner (GP) consultation. One effect of the co-payment may be that patients will seek assistance at public hospital emergency departments (EDs), where currently there is no user charge. We studied the possible financial impact of patient diversion on the Western Australia (WA) health budget. We constructed a spreadsheet model of changes in annual cash flows including the co-payment, GP fees for service, and rates of diversion to emergency departments with additional marginal costs for ED attendance. Changes in WA cash flows are the aggregate of marginal ED costs of treating diverted patients and added expenditure in fees paid to rural doctors who also man local emergency centres. The estimated costs to WA are AUD $6.3 million, $35.9 million and $87.4 million at 1, 5, and 10 per cent diversion, respectively. Commonwealth receipts increase and expenditure on Medicare benefits declines. A diversion of patients from GP surgeries to ED in WA caused by the co-payment will result in increased costs to the state, which may be substantial, and will reduce net costs to the Commonwealth.

  8. 20 CFR 411.355 - What payment options does a State VR agency have?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

  9. 20 CFR 411.355 - What payment options does a State VR agency have?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

  10. 20 CFR 411.355 - What payment options does a State VR agency have?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

  11. 20 CFR 411.355 - What payment options does a State VR agency have?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

  12. 20 CFR 411.355 - What payment options does a State VR agency have?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

  13. 78 FR 41013 - Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-09

    ... [CMS-1450-CN] RIN 0938-AR52 Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014, Home Health Quality Reporting Requirements, and Cost Allocation of Home Health Survey... period titled ``Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY...

  14. 7 CFR 4288.134 - Refunds and interest payments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment... advanced biofuel producer who receives payments under this subpart may be required to refund such payments... General for appropriate action. (a) An eligible advanced biofuel producer receiving payments under this...

  15. Insurer and employer views on pediatric obesity treatment: a qualitative study.

    PubMed

    Hampl, S E; Davis, A M; Sampilo, M L; Stephens, K L; Dean, K

    2013-04-01

    The effectiveness of group-based comprehensive, multidisciplinary (stage 3) pediatric weight management programs is backed by a growing body of literature, yet insurance coverage of these programs is scarce to nonexistent, limiting their reach and long-term survival. The objective of this study was to better understand the perspectives of insurers and large employers on the issue of group-based treatment coverage. The authors performed a qualitative study utilizing structured interviews with these stakeholders, following accepted techniques. Six major themes emerged: cost, program effectiveness, corporate social responsibility, secondary parental (employee) benefits, coverage options and new benefit determination. Future efforts to secure payment for group-based pediatric weight management programs should address these key themes. Copyright © 2012 The Obesity Society.

  16. 7 CFR 4288.121 - Contract.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.121 Contract. Advanced biofuel producers determined to be eligible to receive payments must... Agency will forward the contract to the advanced biofuel producer. The advanced biofuel producer must...

  17. 7 CFR 4288.121 - Contract.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.121 Contract. Advanced biofuel producers determined to be eligible to receive payments must... Agency will forward the contract to the advanced biofuel producer. The advanced biofuel producer must...

  18. 34 CFR 80.21 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... program income, refunds, and audit recoveries on payment. (1) Grantees and subgrantees shall disburse repayments to and interest earned on a revolving fund before requesting additional cash payments for the same... disburse program income, rebates, refunds, contract settlements, audit recoveries and interest earned on...

  19. 24 CFR Appendix A to Part 4001 - Calculation of Upfront Payment or Future Appreciation Payment

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... to Housing and Urban Development (Continued) BOARD OF DIRECTORS OF THE HOPE FOR HOMEOWNERS PROGRAM HOPE FOR HOMEOWNERS PROGRAM Pt. 4001, App. A Appendix A to Part 4001—Calculation of Upfront Payment or...

  20. 75 FR 19185 - Direct and Counter-Cyclical Program and Average Crop Revenue Election Program, Disaster...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-14

    ... Program, Disaster Assistance Programs, Marketing Assistance Loans and Loan Deficiency Payments Program... Disaster Program (LFP), the Supplemental Revenue Assistance Payments Program (SURE) and the Marketing... losses, unless the loss has already been reported for the Noninsured Crop Disaster Assistance Program...

  1. Episodes of care: is emergency medicine ready?

    PubMed

    Wiler, Jennifer L; Beck, Dennis; Asplin, Brent R; Granovsky, Michael; Moorhead, John; Pilgrim, Randy; Schuur, Jeremiah D

    2012-05-01

    Optimizing resource use, eliminating waste, aligning provider incentives, reducing overall costs, and coordinating the delivery of quality care while improving outcomes have been major themes of health care reform initiatives. Recent legislation contains several provisions designed to move away from the current fee-for-service payment mechanism toward a model that reimburses providers for caring for a population of patients over time while shifting more financial risk to providers. In this article, we review current approaches to episode of care development and reimbursement. We describe the challenges of incorporating emergency medicine into the episode of care approach and the uncertain influence this delivery model will have on emergency medicine care, including quality outcomes. We discuss the limitations of the episode of care payment model for emergency services and advocate retention of the current fee-for-service payment model, as well as identify research gaps that, if addressed, could be used to inform future policy decisions of emergency medicine health policy leaders. We then describe a meaningful role for emergency medicine in an episode of care setting. Copyright © 2011. Published by Mosby, Inc.

  2. Medicaid payment policies for nursing home care: A national survey

    PubMed Central

    Buchanan, Robert J.; Madel, R. Peter; Persons, Dan

    1991-01-01

    This research gives a comprehensive overview of the nursing home payment methodologies used by each State Medicaid program. To present this comprehensive overview, 1988 data were collected by survey from 49 States and the District of Columbia. The literature was reviewed and integrated into the study to provide a theoretical framework to analyze the collected data. The data are organized and presented as follows: payment levels, payment methods, payment of capital-related costs, and incentives in nursing home payment. We conclude with a discussion of the impact these different methodologies have on program cost containment, quality, and recipient access. PMID:10114935

  3. 7 CFR 784.1 - Applicability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SPECIAL PROGRAMS 2004 EWE LAMB REPLACEMENT AND RETENTION PAYMENT PROGRAM § 784.1 Applicability. (a... Lamb Replacement and Retention Payment Program will be administered. (b) Unless otherwise determined by...

  4. 7 CFR 4288.105 - Oversight and monitoring.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... of biofuel produced and the type and amount of feedstocks used. (2) Blending verification. The Agency... advanced biofuel eligible for payment. (3) Certificate of Analysis. The Agency will review the producer...

  5. 7 CFR 4288.105 - Oversight and monitoring.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... of biofuel produced and the type and amount of feedstocks used. (2) Blending verification. The Agency... advanced biofuel eligible for payment. (3) Certificate of Analysis. The Agency will review the producer...

  6. 7 CFR 4288.105 - Oversight and monitoring.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... of biofuel produced and the type and amount of feedstocks used. (2) Blending verification. The Agency... advanced biofuel eligible for payment. (3) Certificate of Analysis. The Agency will review the producer...

  7. 48 CFR 225.7503 - Contract clauses.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Balance of Payments Program 225.7503 Contract clauses. Unless the entire acquisition is exempt from the Balance of Payments Program— (a)(1) Use the clause at 252.225-7044, Balance of Payments Program—Construction Material, in solicitations and contracts...

  8. 48 CFR 225.7503 - Contract clauses.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Balance of Payments Program 225.7503 Contract clauses. Unless the entire acquisition is exempt from the Balance of Payments Program— (a) Use the clause at 252.225-7044, Balance of Payments Program—Construction Material, in solicitations and contracts...

  9. 42 CFR § 512.460 - Compliance enforcement.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Quality Measures, Beneficiary... regulations under this part must not be construed to affect the applicable payment, coverage, program..., commonly referred to as a CAP. (iii) Reducing or eliminating the EPM participant's reconciliation payment...

  10. 7 CFR 1493.450 - Payment guarantee.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount...

  11. 7 CFR 1493.450 - Payment guarantee.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount...

  12. 42 CFR 412.120 - Reductions to total payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.120 Reductions to total payments. (a) Deductible and coinsurance... 42 Public Health 2 2010-10-01 2010-10-01 false Reductions to total payments. 412.120 Section 412...

  13. Medicare physician payment systems: impact of 2011 schedule on interventional pain management.

    PubMed

    Manchikanti, Laxmaiah; Singh, Vijay; Caraway, David L; Benyamin, Ramsin M; Hirsch, Joshua A

    2011-01-01

    Physicians in the United States have been affected by significant changes in the patterns of medical practice evolving over the last several decades. The recently passed affordable health care law, termed the Patient Protection and Affordable Care Act of 2010 (the ACA, for short) affects physicians more than any other law. Physician services are an integral part of health care. Physicians are paid in the United States for their personal services. This payment also includes the overhead expenses for maintaining an office and providing services. The payment system is highly variable in the private insurance market; however, governmental systems have a formula-based payment, mostly based on the Medicare payment system. Physician services are billed under Part B. Since the inception of the Medicare program in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. Initially, the payment systems compensated physicians on the basis of their charges. In 1975, just over 10 years after the inception of the Medicare program, payments changed so as not to exceed the increase in the Medical Economic Index (MEI). Nevertheless, the policy failed to curb increases in costs, leading to the determination of a yearly change in fees by legislation from 1984 to 1991. In 1992, the fee schedule essentially replaced the prior payment system that was based on the physician's charges, which also failed to live up to expectations for operational success. Then, in 1998, the sustainable growth rate (SGR) system was introduced. In 2009, multiple attempts were made by Congress to repeal the formula - rather unsuccessfully. Consequently, the SGR formula continues to hamper physician payments. The mechanism of the SGR includes 3 components that are incorporated into a statutory formula: expenditure targets, growth rate period, and annual adjustments of payment rates for physician services. Further, the relative value of a physician fee schedule is based on 3 components: physician work, practice expense (PE), and malpractice expense that are used to determine a value ranking for each service to which it is applied. On average, the work component represents 53.5% of a service's relative value, the fee component represents 43.6%, and the malpractice component represents 3.9%. The final schedule for physician payment was issued on November 24, 2010. This was based on a total cut of 30.8% with 24.9% of the cut attributed to SGR. However, as usual, with patchwork efficiency, Congress passed a one-year extension of the 0% update, effective through December 2011. Consequently, CMS issued an emergency update of the 2011 Medicare fee schedule, with multiple revisions, resulting in a reduction of the conversion factor of $36.8729 from December 2010 to $33.9764 for 2011.

  14. 7 CFR 215.15 - Withholding payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Withholding payments. 215.15 Section 215.15 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.15 Withholding payments. In...

  15. 7 CFR 215.15 - Withholding payments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 4 2012-01-01 2012-01-01 false Withholding payments. 215.15 Section 215.15 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.15 Withholding payments. In...

  16. 7 CFR 215.15 - Withholding payments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 4 2013-01-01 2013-01-01 false Withholding payments. 215.15 Section 215.15 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.15 Withholding payments. In...

  17. 7 CFR 215.15 - Withholding payments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 4 2011-01-01 2011-01-01 false Withholding payments. 215.15 Section 215.15 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.15 Withholding payments. In...

  18. 7 CFR 215.15 - Withholding payments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 4 2014-01-01 2014-01-01 false Withholding payments. 215.15 Section 215.15 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.15 Withholding payments. In...

  19. 7 CFR 505.6 - Payment of fees.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE NATIONAL AGRICULTURAL LIBRARY FEES FOR LOANS AND COPYING § 505.6 Payment of fees. NAL charges for interlibrary loans through OCLC's IFM Program (an electronic debit/credit payment program for libraries using...

  20. 7 CFR 505.6 - Payment of fees.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE NATIONAL AGRICULTURAL LIBRARY FEES FOR LOANS AND COPYING § 505.6 Payment of fees. NAL charges for interlibrary loans through OCLC's IFM Program (an electronic debit/credit payment program for libraries using...

  1. Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; electronic reporting pilot; Inpatient Rehabilitation Facilities Quality Reporting Program; revision to Quality Improvement Organization regulations. Final rule with comment period.

    PubMed

    2012-11-15

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2013 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program. We are continuing the electronic reporting pilot for the Electronic Health Record (EHR) Incentive Program, and revising the various regulations governing Quality Improvement Organizations (QIOs), including the secure transmittal of electronic medical information, beneficiary complaint resolution and notification processes, and technical changes. The technical changes to the QIO regulations reflect CMS' commitment to the general principles of the President's Executive Order on Regulatory Reform, Executive Order 13563 (January 18, 2011).

  2. 31 CFR 203.10 - Electronic payment methods.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

  3. 42 CFR 460.180 - Medicare payment to PACE organizations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medicare payment to PACE organizations. 460.180... FOR THE ELDERLY (PACE) Payment § 460.180 Medicare payment to PACE organizations. (a) Principle of payment. Under a PACE program agreement, CMS makes a prospective monthly payment to the PACE organization...

  4. 31 CFR 203.10 - Electronic payment methods.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

  5. 31 CFR 203.10 - Electronic payment methods.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

  6. 31 CFR 203.10 - Electronic payment methods.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

  7. 31 CFR 203.10 - Electronic payment methods.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

  8. 20 CFR 411.525 - What payments are available under each of the EN payment systems?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... EN payment systems? 411.525 Section 411.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.525 What payments... beneficiary. For each month during the beneficiary's outcome payment period for which Social Security...

  9. 20 CFR 411.525 - What payments are available under each of the EN payment systems?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... EN payment systems? 411.525 Section 411.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.525 What payments... beneficiary. For each month during the beneficiary's outcome payment period for which Social Security...

  10. 20 CFR 411.525 - What payments are available under each of the EN payment systems?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... EN payment systems? 411.525 Section 411.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.525 What payments... beneficiary. For each month during the beneficiary's outcome payment period for which Social Security...

  11. Comparison of Medicaid Payments Relative to Medicare Using Inpatient Acute Care Claims from the Medicaid Program: Fiscal Year 2010-Fiscal Year 2011.

    PubMed

    Stone, Devin A; Dickensheets, Bridget A; Poisal, John A

    2018-02-01

    To compare Medicaid fee-for-service (FFS) inpatient hospital payments to expected Medicare payments. Medicaid and Medicare claims data, Medicare's MS-DRG grouper and inpatient prospective payment system pricer (IPPS pricer). Medicaid FFS inpatient hospital claims were run through Medicare's MS-DRG grouper and IPPS pricer to compare Medicaid's actual payment against what Medicare would have paid for the same claim. Average inpatient hospital claim payments for Medicaid were 68.8 percent of what Medicare would have paid in fiscal year 2010, and 69.8 percent in fiscal year 2011. Including Medicaid disproportionate share hospital (DSH), graduate medical education (GME), and supplemental payments reduces a substantial proportion of the gap between Medicaid and Medicare payments. Medicaid payments relative to expected Medicare payments tend to be lower and vary by state Medicaid program, length of stay, and whether payments made outside of the Medicaid claims process are included. © Health Research and Educational Trust.

  12. 7 CFR 1400.5 - Denial of program benefits.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS General Provisions § 1400.5 Denial of program benefits...

  13. Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement

    PubMed Central

    Whitcomb, Winthrop F.; Lagu, Tara; Krushell, Robert J.; Lehman, Andrew P.; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S.; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K.

    2015-01-01

    Background Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Methods Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. Results The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls— patients treated before bundle implementation—45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p = .24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p = .43), and lower median posthospital payments ($704 versus $1,121, p = .002), and were more likely to receive guideline-consistent care (99% versus 95%, p = .05). Discussion The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams. PMID:26289235

  14. Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement.

    PubMed

    Whitcomb, Winthrop F; Lagu, Tara; Krushell, Robert J; Lehman, Andrew P; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K

    2015-09-01

    Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls-patients treated before bundle implementation-45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p=.24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p=.43), and lower median posthospital payments ($704 versus $1,121, p=.002), and were more likely to receive guideline-consistent care (99% versus 95%, p=.05). The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams.

  15. 75 FR 11836 - Bioenergy Program for Advanced Biofuels

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-12

    ... (NOCP); additional payment for advanced biofuel produced from October 1, 2008 through September 30, 2009. SUMMARY: RBS is announcing additional payments to advanced biofuel producers determined eligible in Fiscal... biofuel produced in FY 2009, the request must include: Form RD 9005-3, ``Advanced Biofuel Program Payment...

  16. 7 CFR 215.5 - Method of payment to States.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.5 Method of payment to States. (a... Authorities and child-care institutions through presentation by designated State officials of a Payment...

  17. 7 CFR 215.5 - Method of payment to States.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.5 Method of payment to States. (a... Authorities and child-care institutions through presentation by designated State officials of a Payment...

  18. 7 CFR 215.5 - Method of payment to States.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.5 Method of payment to States. (a... Authorities and child-care institutions through presentation by designated State officials of a Payment...

  19. 7 CFR 215.5 - Method of payment to States.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.5 Method of payment to States. (a... Authorities and child-care institutions through presentation by designated State officials of a Payment...

  20. 10 CFR 611.111 - Default, demand, payment, and collateral liquidation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Default, demand, payment, and collateral liquidation. 611.111 Section 611.111 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS ADVANCED TECHNOLOGY VEHICLES MANUFACTURER ASSISTANCE PROGRAM Direct Loan Program § 611.111 Default, demand, payment, and...

  1. 7 CFR 1400.210 - Deceased and incapacitated persons.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... CORPORATION, DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Eligibility § 1400.210 Deceased and... determination to be in effect for that program year or fiscal year, as applicable. However, the following year...

  2. 20 CFR 416.520 - Emergency advance payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... of expected eligibility for payment of benefits. (2) For a couple, we separately compute each member... not established. If a presumptively eligible individual (or spouse) or couple is determined to be...

  3. Contrary To Popular Belief, Medicaid Hospital Admissions Are Often Profitable Because Of Additional Medicare Payments.

    PubMed

    Stensland, Jeffrey; Gaumer, Zachary R; Miller, Mark E

    2016-12-01

    It is generally believed that most hospitals lose money on Medicaid admissions. The data suggest otherwise. Medicaid admissions are often profitable for hospitals because of payments from both the Medicaid program and the Medicare program, including payments for uncompensated care and from the Medicare disproportionate-share hospital program. On average, adding a single Medicaid patient day in fiscal year 2017 will increase most hospitals' Medicare payments by more than $300. When added to Medicaid payments, these payments often cause Medicaid patients to be profitable for hospitals. In contrast, adding a single charity care day in the same year will decrease overall Medicare payments by about $20 on average. The Centers for Medicare and Medicaid Services recently announced a proposal to shift some Medicare payments from supporting hospitals' costs for Medicaid patients to directly supporting their costs for uncompensated care. If that proposal is adopted, hospitals' profits on Medicaid patients would decrease, but their losses on care for the uninsured would be reduced. Project HOPE—The People-to-People Health Foundation, Inc.

  4. Medicare’s Payment Strategy For End-Stage Renal Disease Now Embraces Bundled Payment And Pay-For-Performance To Cut Costs

    PubMed Central

    Swaminathan, Shailender; Mor, Vincent; Mehrotra, Rajnish; Trivedi, Amal

    2013-01-01

    Since 1973 Medicare has provided health insurance coverage to all people who have been diagnosed with end-stage renal disease, or kidney failure. In this article we trace the history of payment policies in Medicare’s dialysis program from 1973 to 2011, while also providing some insight into the rationale for changes made over time. Initially, Medicare adopted a fee-for-service payment policy for dialysis care, using the same reimbursement standards employed in the broader Medicare program. However, driven by rapid spending growth in this population, the dialysis program has implemented innovative payment reforms, such as prospective bundled payments and pay-for-performance incentives. It is uncertain whether these strategies can stem the increase in the total cost of dialysis to Medicare, or whether they can do so without adversely affecting the quality of care. Future research on the intended and unintended consequences of payment reform will be critical. PMID:22949455

  5. Medicare program; Part B advance payments to suppliers furnishing items or services under Medicare Part B--HCFA. Final rule.

    PubMed

    1996-09-19

    This rule establishes requirements and procedures for advance payments to suppliers of Medicare Part B services. An advance payment will be made only if the carrier is unable to process a claim timely; the supplier requests advance payment; we determine that payment of interest is insufficient to compensate the supplier for loss of the use of the funds; and, we expressly approve the advance payment in writing. These rules are necessary to address deficiencies noted by the General Accounting Office in its report analyzing current procedures for making advance payments. The intent of this rule is to ensure more efficient and effective administration of this aspect of the Medicare program.

  6. 20 CFR 411.580 - Can an EN receive payments for milestones or outcome payment months that occur before the...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ....580 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.580 Can an EN receive payments for milestones or outcome payment...

  7. 20 CFR 411.580 - Can an EN receive payments for milestones or outcome payment months that occur before the...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ....580 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.580 Can an EN receive payments for milestones or outcome payment...

  8. 20 CFR 411.580 - Can an EN receive payments for milestones or outcome payment months that occur before the...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ....580 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.580 Can an EN receive payments for milestones or outcome payment...

  9. 75 FR 50041 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-16

    ... Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment... Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment... inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals...

  10. 42 CFR 412.125 - Effect of change of ownership on payments under the prospective payment systems.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... prospective payment systems. 412.125 Section 412.125 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.125 Effect of change of...

  11. 42 CFR 412.112 - Payments determined on a per case basis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.112 Payments determined on a per case basis. A hospital is... 42 Public Health 2 2010-10-01 2010-10-01 false Payments determined on a per case basis. 412.112...

  12. 42 CFR § 510.315 - Composite quality scores for determining reconciliation payment eligibility and quality incentive...

    Code of Federal Regulations, 2010 CFR

    2016-10-01

    ... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.315 Composite quality scores for determining reconciliation payment eligibility and quality incentive payments... reconciliation payment eligibility and quality incentive payments. § 510.315 Section § 510.315 Public Health...

  13. 42 CFR § 414.1450 - APM incentive payment.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1450 APM incentive payment. (a) In... 42 Public Health 3 2017-10-01 2017-10-01 false APM incentive payment. § 414.1450 Section § 414...

  14. 42 CFR § 510.315 - Composite quality scores for determining reconciliation payment eligibility and quality incentive...

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.315 Composite quality scores for determining reconciliation payment eligibility and quality incentive payments... reconciliation payment eligibility and quality incentive payments. § 510.315 Section § 510.315 Public Health...

  15. 42 CFR § 414.1405 - Payment.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ...) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1405 Payment. (a) General. Each MIPS eligible... 42 Public Health 3 2017-10-01 2017-10-01 false Payment. § 414.1405 Section § 414.1405 Public...

  16. 7 CFR 81.10 - Claim for payment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PROGRAMS PRUNE/DRIED PLUM DIVERSION PROGRAM § 81.10 Claim for payment. (a) To obtain payment for the trees... Committee. Such form shall include the Committee's certification that the qualifying trees from the blocks... check to the producer in the amount of $8.50 per eligible tree removed. (b) [Reserved] ...

  17. 42 CFR 422.308 - Adjustments to capitation rates, benchmarks, bids, and payments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Adjustments to capitation rates, benchmarks, bids, and payments. 422.308 Section 422.308 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to...

  18. 75 FR 32635 - Defense Acquisition Regulations System; Defense Federal Acquisition Regulation Supplement...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-08

    ... Regulations System; Defense Federal Acquisition Regulation Supplement; Balance of Payments Program Exemption... implement the exemption from the Balance of Payments Program for construction material that is commercial... is proposing to amend the DFARS to implement in the clauses at 252.225-7044, Balance of Payments...

  19. 7 CFR 81.10 - Claim for payment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... check to the producer in the amount of $8.50 per eligible tree removed. (b) [Reserved] ... PROGRAMS PRUNE/DRIED PLUM DIVERSION PROGRAM § 81.10 Claim for payment. (a) To obtain payment for the trees... Committee. Such form shall include the Committee's certification that the qualifying trees from the blocks...

  20. 7 CFR 81.10 - Claim for payment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... check to the producer in the amount of $8.50 per eligible tree removed. (b) [Reserved] ... PROGRAMS PRUNE/DRIED PLUM DIVERSION PROGRAM § 81.10 Claim for payment. (a) To obtain payment for the trees... Committee. Such form shall include the Committee's certification that the qualifying trees from the blocks...

  1. 7 CFR 81.10 - Claim for payment.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... check to the producer in the amount of $8.50 per eligible tree removed. (b) [Reserved] ... PROGRAMS PRUNE/DRIED PLUM DIVERSION PROGRAM § 81.10 Claim for payment. (a) To obtain payment for the trees... Committee. Such form shall include the Committee's certification that the qualifying trees from the blocks...

  2. 7 CFR 81.10 - Claim for payment.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... check to the producer in the amount of $8.50 per eligible tree removed. (b) [Reserved] ... PROGRAMS PRUNE/DRIED PLUM DIVERSION PROGRAM § 81.10 Claim for payment. (a) To obtain payment for the trees... Committee. Such form shall include the Committee's certification that the qualifying trees from the blocks...

  3. 7 CFR 215.5 - Method of payment to States.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.5 Method of payment to States. (a... Authorities and child-care institutions through presentation by designated State officials of a Payment... delay for the purpose for which drawn. Notwithstanding the foregoing provisions, if funds are made...

  4. Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

    PubMed

    Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

    2012-09-01

    In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

  5. 76 FR 11371 - Defense Federal Acquisition Regulation Supplement; Payments in Support of Emergencies and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-02

    ... Contingency Operations (DFARS Case 2009- D020) AGENCY: Defense Acquisition Regulations System, Department of... exemptions from the Prompt Payment Act. The interim rule exempted military payments related to contingencies.... 93-288, as amended (42 U.S.C. 5121, et seq.); contingency operations (as defined in 10 U.S.C. 101(a...

  6. 7 CFR 4288.120 - Enrollment.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General... the Program is presented in this section. Advanced biofuel producers who expect to produce eligible.... (a) Enrollment. To enroll in the Program, an advanced biofuel producer must submit to the Agency a...

  7. 7 CFR 4288.120 - Enrollment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General... the Program is presented in this section. Advanced biofuel producers who expect to produce eligible.... (a) Enrollment. To enroll in the Program, an advanced biofuel producer must submit to the Agency a...

  8. 7 CFR 1493.200 - General statement.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Facility Guarantee Program... (CCC) Facility Guarantee Program (FGP). CCC will issue facility payment guarantees for project... so, will be incorporated by reference on the face of the facility payment guarantee issued by CCC. ...

  9. 7 CFR 1493.200 - General statement.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Facility Guarantee Program... (CCC) Facility Guarantee Program (FGP). CCC will issue facility payment guarantees for project... so, will be incorporated by reference on the face of the facility payment guarantee issued by CCC. ...

  10. 7 CFR 1493.200 - General statement.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Facility Guarantee Program... (CCC) Facility Guarantee Program (FGP). CCC will issue facility payment guarantees for project... so, will be incorporated by reference on the face of the facility payment guarantee issued by CCC. ...

  11. 42 CFR 412.300 - Scope of subpart and definition.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment... payment system for inpatient hospital capital-related costs. Under this system, payment is made on the... hospitals subject to the prospective payment system under subpart B of this part. (b) Definition. For...

  12. 42 CFR § 512.700 - Basis and scope.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL CR Incentive Payment Model... implements the cardiac rehabilitation (CR) and intensive cardiac rehabilitation (ICR) incentive payment model... in the CR incentive payment model. (2) The CR/ICR services that count toward CR incentive payments...

  13. 7 CFR 4288.110 - Applicant eligibility.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... requirements associated with advanced biofuel producer eligibility, biofuel eligibility, eligibility... not eligible for this Program. (a) Eligible producer. The applicant must be an advanced biofuel...

  14. 7 CFR 4288.110 - Applicant eligibility.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... requirements associated with advanced biofuel producer eligibility, biofuel eligibility, eligibility... not eligible for this Program. (a) Eligible producer. The applicant must be an advanced biofuel...

  15. 7 CFR 4288.120 - Enrollment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General... enrolling in the Program is presented in this section. Advanced biofuel producers who expect to produce... section. (a) Enrollment. To enroll in the Program, an advanced biofuel producer must submit to the Agency...

  16. 42 CFR § 512.310 - Appeals process.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Pricing and Payment § 512.310... related to payment, a CR incentive payment, reconciliation amounts, repayment amounts, the use of quality..., CMS deems final the reconciliation report and CR incentive payment report 45 calendar days after the...

  17. 76 FR 42169 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-18

    ...This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. These proposed changes would be applicable to services furnished on or after January 1, 2012. In addition, this proposed rule would update the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we set forth the proposed relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these proposed changes would apply, and other proposed ratesetting information for the CY 2012 ASC payment system. These proposed changes would be applicable to services furnished on or after January 1, 2012. We are proposing to revise the requirements for the Hospital Outpatient Quality Reporting (IQR) Program, add new requirements for ASC Quality Reporting System, and make additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are proposing to allow eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. In addition, we are proposing to make changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

  18. 76 FR 78281 - Medicare Program; First Semi-Annual Meeting of the Advisory Panel on Hospital Outpatient Payment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-16

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1586-N] Medicare Program; First Semi-Annual Meeting of the Advisory Panel on Hospital Outpatient Payment (HOP--Formerly Known as the Advisory Panel on Ambulatory Payment Classification Groups--APC Panel)--February 27...

  19. 48 CFR 225.1101 - Acquisition of supplies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...—Balance of Payments Program Certificate, instead of the provision at FAR 52.225-2, Buy American Act... and Balance of Payments Program. (2) Use the clause at 252.225-7001, Buy American Act and Balance of... requirement for use of domestic components); (iii) An exception to the Buy American Act or Balance of Payments...

  20. 42 CFR 495.320 - FFP for payments to Medicaid providers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false FFP for payments to Medicaid providers. 495.320 Section 495.320 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.320 FFP for payments to Medicaid...

  1. 77 FR 43232 - National School Lunch, Special Milk, and School Breakfast Programs, National Average Payments...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-24

    ... ``national average payments,'' the amount of money the Federal Government provides States for lunches... with pricing programs that elect to serve milk free to eligible children continue to receive the... during the second preceding school year were served free or at a reduced price. The higher payment level...

  2. 76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-26

    ... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012...

  3. 7 CFR 784.13 - Refunds; joint and several liability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS 2004 EWE LAMB REPLACEMENT AND RETENTION PAYMENT PROGRAM § 784.13... application, or this part, all related payments made under this part to any sheep and lamb operation shall be... late payment charges as provided in part 1403 of this title. (b) All persons signing a sheep and lamb...

  4. 7 CFR 275.23 - Determination of State agency program performance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE FOOD STAMP AND FOOD DISTRIBUTION PROGRAM PERFORMANCE REPORTING... section, the adjusted regressed payment error rate shall be calculated to yield the State agency's payment error rate. The adjusted regressed payment error rate is given by r 1″ + r 2″. (ii) If FNS determines...

  5. 78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-26

    ... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2013 Through June 30, 2014...

  6. 76 FR 43254 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-20

    ... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012...

  7. 42 CFR 413.87 - Payments for Medicare+Choice nursing and allied health education programs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Payments for Medicare+Choice nursing and allied... NURSING FACILITIES Specific Categories of Costs § 413.87 Payments for Medicare+Choice nursing and allied... reimbursement for approved nursing and allied health education programs and the methodology for determining the...

  8. 42 CFR 413.87 - Payments for Medicare+Choice nursing and allied health education programs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Payments for Medicare+Choice nursing and allied... NURSING FACILITIES Specific Categories of Costs § 413.87 Payments for Medicare+Choice nursing and allied... reimbursement for approved nursing and allied health education programs and the methodology for determining the...

  9. 42 CFR 413.87 - Payments for Medicare+Choice nursing and allied health education programs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Payments for Medicare+Choice nursing and allied... NURSING FACILITIES Specific Categories of Costs § 413.87 Payments for Medicare+Choice nursing and allied... reimbursement for approved nursing and allied health education programs and the methodology for determining the...

  10. 42 CFR 413.87 - Payments for Medicare+Choice nursing and allied health education programs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Payments for Medicare+Choice nursing and allied... NURSING FACILITIES Specific Categories of Costs § 413.87 Payments for Medicare+Choice nursing and allied... reimbursement for approved nursing and allied health education programs and the methodology for determining the...

  11. 42 CFR 413.87 - Payments for Medicare+Choice nursing and allied health education programs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payments for Medicare+Choice nursing and allied... NURSING FACILITIES Specific Categories of Costs § 413.87 Payments for Medicare+Choice nursing and allied... reimbursement for approved nursing and allied health education programs and the methodology for determining the...

  12. A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease

    PubMed Central

    Lavergne, M. Ruth; Law, Michael R.; Peterson, Sandra; Garrison, Scott; Hurley, Jeremiah; Cheng, Lucy; McGrail, Kimberlyn

    2016-01-01

    Background: In 2007, the province of British Columbia implemented incentive payments to primary care physicians for the provision of comprehensive, continuous, guideline-informed care for patients with 2 or more chronic conditions. We examined the impact of this program on primary care access and continuity, rates of hospital admission and costs. Methods: We analyzed all BC patients who qualified for the incentive based on their diagnostic profile. We tracked primary care contacts and continuity, hospital admissions (total, via the emergency department and for targeted conditions), and cost of physician services, hospital care and pharmaceuticals, for 24 months before and 24 months after the intervention. Results: Of 155 754 eligible patients, 63.7% had at least 1 incentive payment billed. Incentive payments had no impact on primary care contacts (change in contacts per patient per month: 0.016, 95% confidence interval [CI] −0.047 to 0.078) or continuity of care (mean monthly change: 0.012, 95% CI −0.001 to 0.024) and were associated with increased total rates of hospital admission (change in hospital admissions per 1000 patients per month: 1.46, 95% CI 0.04 to 2.89), relative to preintervention trends. Annual costs per patient did not decline (mean change: $455.81, 95% CI −$2.44 to $914.08). Interpretation: British Columbia’s $240-million investment in this program improved compensation for physicians doing the important work of caring for complex patients, but did not appear to improve primary care access or continuity, or constrain resource use elsewhere in the health care system. Policymakers should consider other strategies to improve care for this patient population. PMID:27527484

  13. 7 CFR 220.5 - Method of payment to States.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.5 Method of payment to States. Funds to be paid to any State for the School Breakfast Program shall be made available by means of Letters of...

  14. 7 CFR 220.5 - Method of payment to States.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.5 Method of payment to States. Funds to be paid to any State for the School Breakfast Program shall be made available by means of Letters of...

  15. 42 CFR 408.88 - Refund of group payments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Refund of group payments. 408.88 Section 408.88... PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Group Payment § 408.88 Refund of group payments. (a) Basis for refund. Group payments are refunded only in the following circumstances...

  16. 42 CFR 408.88 - Refund of group payments.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Refund of group payments. 408.88 Section 408.88... PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Group Payment § 408.88 Refund of group payments. (a) Basis for refund. Group payments are refunded only in the following circumstances...

  17. 42 CFR 408.88 - Refund of group payments.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Refund of group payments. 408.88 Section 408.88... PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Group Payment § 408.88 Refund of group payments. (a) Basis for refund. Group payments are refunded only in the following circumstances...

  18. 42 CFR 408.88 - Refund of group payments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Refund of group payments. 408.88 Section 408.88... PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Group Payment § 408.88 Refund of group payments. (a) Basis for refund. Group payments are refunded only in the following circumstances...

  19. 42 CFR 408.88 - Refund of group payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Refund of group payments. 408.88 Section 408.88... PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Group Payment § 408.88 Refund of group payments. (a) Basis for refund. Group payments are refunded only in the following circumstances...

  20. 42 CFR § 414.1375 - Advancing care information performance category.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1375... final score for MIPS payment year 2019 and each MIPS payment year thereafter. (b) Reporting for the...

  1. 42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR... inpatient psychiatric facility receives payment under this subpart for inpatient operating cost and capital-related costs for each inpatient stay following submission of a bill. (b) Periodic interim payments (PIP...

  2. 24 CFR 982.604 - SRO: Voucher housing assistance payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... URBAN DEVELOPMENT SECTION 8 TENANT BASED ASSISTANCE: HOUSING CHOICE VOUCHER PROGRAM Special Housing... residing in SRO housing, the payment standard is 75 percent of the zero-bedroom payment standard amount on... payment standard is 75 percent of the HUD-approved zero-bedroom exception payment standard amount. (b) The...

  3. 24 CFR 982.604 - SRO: Voucher housing assistance payment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... URBAN DEVELOPMENT SECTION 8 TENANT BASED ASSISTANCE: HOUSING CHOICE VOUCHER PROGRAM Special Housing... residing in SRO housing, the payment standard is 75 percent of the zero-bedroom payment standard amount on... payment standard is 75 percent of the HUD-approved zero-bedroom exception payment standard amount. (b) The...

  4. 7 CFR 760.1302 - Definitions and acronyms.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Economic Loss Assistance Payment Program § 760... programs in a specific areas, sometimes encompassing more than one county, in a State. Dairy operation... milk commercially produced from cows, and whose production facilities are located in the United States...

  5. 7 CFR 760.1302 - Definitions and acronyms.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Economic Loss Assistance Payment Program § 760... programs in a specific areas, sometimes encompassing more than one county, in a State. Dairy operation... milk commercially produced from cows, and whose production facilities are located in the United States...

  6. 7 CFR 760.1302 - Definitions and acronyms.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Economic Loss Assistance Payment Program § 760... programs in a specific areas, sometimes encompassing more than one county, in a State. Dairy operation... milk commercially produced from cows, and whose production facilities are located in the United States...

  7. 7 CFR 760.1302 - Definitions and acronyms.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Economic Loss Assistance Payment Program § 760... programs in a specific areas, sometimes encompassing more than one county, in a State. Dairy operation... milk commercially produced from cows, and whose production facilities are located in the United States...

  8. 7 CFR 215.8 - Reimbursement payments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.8 Reimbursement payments. (a... programs to all children; (ii) served to all children in pricing programs by institutions and School Food...

  9. 7 CFR 215.8 - Reimbursement payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.8 Reimbursement payments. (a... programs to all children; (ii) served to all children in pricing programs by institutions and School Food...

  10. 7 CFR 215.8 - Reimbursement payments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.8 Reimbursement payments. (a... programs to all children; (ii) served to all children in pricing programs by institutions and School Food...

  11. 7 CFR 215.8 - Reimbursement payments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.8 Reimbursement payments. (a... programs to all children; (ii) served to all children in pricing programs by institutions and School Food...

  12. 7 CFR 215.8 - Reimbursement payments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.8 Reimbursement payments. (a... programs to all children; (ii) served to all children in pricing programs by institutions and School Food...

  13. 7 CFR 1493.120 - Payment for loss.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.120 Payment for loss. (a) Determination of CCC's liability. Upon receipt in good order of the information and...

  14. 7 CFR 1493.120 - Payment for loss.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.120 Payment for loss. (a) Determination of CCC's liability. Upon receipt in good order of the information and...

  15. 7 CFR 1493.120 - Payment for loss.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.120 Payment for loss. (a) Determination of CCC's liability. Upon receipt in good order of the information and...

  16. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program. Final rule.

    PubMed

    2017-11-15

    This major final rule addresses changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies such as changes to the Medicare Shared Savings Program, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. In addition, this final rule includes policies necessary to begin offering the expanded Medicare Diabetes Prevention Program model.

  17. 7 CFR 1427.1200 - Applicability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Competitiveness Payment Program § 1427.1200 Applicability. (a) These regulations set forth the terms and... collections necessary in administering the ELS cotton competitiveness payment program. Additional terms and...

  18. PACE and the Medicare+Choice risk-adjusted payment model.

    PubMed

    Temkin-Greener, H; Meiners, M R; Gruenberg, L

    2001-01-01

    This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.

  19. 20 CFR 404.2112 - Payment for VR services in a case where an individual continues to receive disability payments...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program. 404... Payment for VR services in a case where an individual continues to receive disability payments based on...

  20. 20 CFR 404.2112 - Payment for VR services in a case where an individual continues to receive disability payments...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program. 404... Payment for VR services in a case where an individual continues to receive disability payments based on...

  1. 20 CFR 404.2112 - Payment for VR services in a case where an individual continues to receive disability payments...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program. 404... Payment for VR services in a case where an individual continues to receive disability payments based on...

  2. 20 CFR 404.2112 - Payment for VR services in a case where an individual continues to receive disability payments...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program. 404... Payment for VR services in a case where an individual continues to receive disability payments based on...

  3. 20 CFR 404.2112 - Payment for VR services in a case where an individual continues to receive disability payments...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program. 404... Payment for VR services in a case where an individual continues to receive disability payments based on...

  4. 75 FR 73169 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ...This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It finalizes the calendar year (CY) 2010 interim relative value units (RVUs) and issues interim RVUs for new and revised procedure codes for CY 2011. It also addresses, implements, or discusses certain provisions of both the Affordable Care Act (ACA) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). In addition, this final rule with comment period discusses payments under the Ambulance Fee Schedule (AFS), the Ambulatory Surgical Center (ASC) payment system, and the Clinical Laboratory Fee Schedule (CLFS), payments to end-stage renal disease (ESRD) facilities, and payments for Part B drugs. Finally, this final rule with comment period also includes a discussion regarding the Chiropractic Services Demonstration program, the Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (CBP DMEPOS), and provider and supplier enrollment issues associated with air ambulances.

  5. 75 FR 41365 - Dairy Product Price Support Program and Dairy Indemnity Payment Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-16

    ...;Prices of new books are listed in the first FEDERAL REGISTER issue of each #0;week. #0; #0; #0; #0;#0... 0560-AH88 Dairy Product Price Support Program and Dairy Indemnity Payment Program AGENCY: Commodity... regulations for the Dairy Product Price Support Program (DPPSP), which has replaced the Price Support Program...

  6. 76 FR 9502 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-18

    ... [CMS-1510-F2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home Health Agencies and Hospices; Correction... set forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: The...

  7. 78 FR 45178 - National School Lunch, Special Milk, and School Breakfast Programs, National Average Payments...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-26

    ... ``national average payments,'' the amount of money the Federal Government provides States for lunches... institutions with pricing programs that elect to serve milk free to eligible children continue to receive the... during the second preceding school year were served free or at a reduced price. The higher payment level...

  8. 76 FR 43256 - National School Lunch, Special Milk, and School Breakfast Programs, National Average Payments...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-20

    ... ``national average payments,'' the amount of money the Federal Government provides States for lunches... institutions with pricing programs that elect to serve milk free to eligible children continue to receive the... during the second preceding school year were served free or at a reduced price. The higher payment level...

  9. 20 CFR 408.1235 - How does the State transfer funds to SSA to administer its recognition payment program?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... administer its recognition payment program? 408.1235 Section 408.1235 Employees' Benefits SOCIAL SECURITY... United States Department of the Treasury. (c) State audit. Any State entering into an agreement with SSA which provides for Federal administration of the State's recognition payments has the right to an audit...

  10. 20 CFR 408.1235 - How does the State transfer funds to SSA to administer its recognition payment program?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... administer its recognition payment program? 408.1235 Section 408.1235 Employees' Benefits SOCIAL SECURITY... United States Department of the Treasury. (c) State audit. Any State entering into an agreement with SSA which provides for Federal administration of the State's recognition payments has the right to an audit...

  11. A comprehensive obstetric patient safety program reduces liability claims and payments.

    PubMed

    Pettker, Christian M; Thung, Stephen F; Lipkind, Heather S; Illuzzi, Jessica L; Buhimschi, Catalin S; Raab, Cheryl A; Copel, Joshua A; Lockwood, Charles J; Funai, Edmund F

    2014-10-01

    Begun in 2003, the Yale-New Haven Hospital comprehensive obstetric safety program consisted of measures to standardize care, improve teamwork and communication, and optimize oversight and quality review. Prior publications have demonstrated improvements in adverse outcomes and safety culture associated with this program. In this analysis, we aimed to assess the impact of this program on liability claims and payments at a single institution. We reviewed liability claims at a single, tertiary-care, teaching hospital for two 5-year periods (1998-2002 and 2003-2007), before and after implementing the safety program. Connecticut statute of limitations for professional malpractice is 36 months from injury. Claims/events were classified by event-year and payments were adjusted for inflation. We analyzed data for trends as well as differences between periods before and after implementation. Forty-four claims were filed during the 10-year study period. Annual cases per 1000 deliveries decreased significantly over the study period (P < .01). Claims (30 vs 14) and payments ($50.7 million vs $2.9 million) decreased in the 5-years after program inception. Compared with before program inception, median annual claims dropped from 1.31 to 0.64 (P = .02), and median annual payments per 1000 deliveries decreased from $1,141,638 to $63,470 (P < .01). Even estimating the monetary awards for the 2 remaining open cases using the median payments for the surrounding 5 years, a reduction in the median monetary amount per case resulting in payment to the claimant was also statistically significant ($632,262 vs $216,815, P = .046). In contrast, the Connecticut insurance market experienced a stable number of claims and markedly increased cost per claim during the same period. We conclude that an obstetric safety initiative can improve liability claims exposure and reduce liability payments. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Affordability, accountability, and accessibility in health care reform: implications for cardiovascular and pulmonary rehabilitation.

    PubMed

    King, Marjorie L

    2013-01-01

    Because health care costs in the United States have been growing disproportionately compared to inflation for many years, without a clear connection to improved quality or increased access to care, employers and payers have begun to test new models of health care delivery and payment. These models are linked to the concepts of affordability, accountability, and accessibility and incorporate the premise that there must be shared responsibility for improving meaningful patient outcomes, with attention to the coordination of team-based and patient-centered care, and value for services purchased. This article explores emerging health care delivery and payment models, including expanded access to care related to the Affordable Care Act of 2010, patient-centered medical homes and neighborhoods, accountable and coordinated care organizations, and value-based purchasing and insurance design, with an emphasis on implications for cardiovascular and pulmonary rehabilitation programs and the American Association of Cardiovascular and Pulmonary Rehabilitation.

  13. 7 CFR 1400.209 - Sharecroppers.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Eligibility § 1400.209 Sharecroppers. (a) Notwithstanding...

  14. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review. Final rule with comment period; final rule.

    PubMed

    2015-11-13

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.

  15. 78 FR 50495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-19

    ... Prospective Payment Systems for Acute Care Hospitals and the Long Term Care; Hospital Prospective Payment... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective... prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to...

  16. 42 CFR § 512.315 - Composite quality scores for determining reconciliation payment eligibility and effective and...

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Pricing and Payment § 512.315... and suppresses the measure value. (5) Establishing SHFFT model reconciliation payment eligibility and... factor for reconciliation payments. (A) A 3.0 percentage point effective discount factor for SHFFT model...

  17. 42 CFR § 512.703 - CR incentive payment model participants.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... 42 Public Health 5 2017-10-01 2017-10-01 false CR incentive payment model participants. § 512.703... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants § 512.703 CR incentive payment model...

  18. 42 CFR § 512.300 - Determination of episode quality-adjusted target prices and actual episode payments.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... PROGRAMS EPISODE PAYMENT MODEL Pricing and Payment § 512.300 Determination of episode quality-adjusted... historical episode payments. (iii) For the AMI model, quality-adjusted target prices for anchor MS-DRGs 246... 100 percent regional historical episode payments. (iv) For the CABG model, quality-adjusted target...

  19. 45 CFR 400.60 - Payment levels.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Payment levels. 400.60 Section 400.60 Public... Assistance § 400.60 Payment levels. (a) Under the public/private RCA program, States and the local... the State's TANF payment for the same sized family unit. In States that have TANF payment levels that...

  20. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... and for costs of an approved education program and other costs paid outside the prospective payment... must be approved by the intermediary and us. (3) Amount of payment. The amount of the accelerated...

  1. 22 CFR 226.22 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Financial and Program Management § 226.22 Payment. (a) Payment methods...

  2. 22 CFR 226.22 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Financial and Program Management § 226.22 Payment. (a) Payment methods...

  3. 22 CFR 226.22 - Payment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Financial and Program Management § 226.22 Payment. (a) Payment methods...

  4. 22 CFR 226.22 - Payment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Financial and Program Management § 226.22 Payment. (a) Payment methods...

  5. 29 CFR 95.22 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... and Human Services, Payment Management System, P.O. Box 6021, Rockville, MD 20852. Interest amounts up... FOREIGN GOVERNMENTS, AND INTERNATIONAL ORGANIZATIONS Post-Award Requirements Financial and Program Management § 95.22 Payment. (a) Payment methods shall minimize the time elapsing between the transfer of...

  6. 20 CFR 411.597 - Will SSA periodically review the outcome payment system and the outcome-milestone payment system...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ....597 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.597 Will SSA periodically review the outcome payment system and the...

  7. 20 CFR 411.597 - Will SSA periodically review the outcome payment system and the outcome-milestone payment system...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ....597 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.597 Will SSA periodically review the outcome payment system and the...

  8. 20 CFR 411.597 - Will SSA periodically review the outcome payment system and the outcome-milestone payment system...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ....597 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.597 Will SSA periodically review the outcome payment system and the...

  9. 20 CFR 411.597 - Will SSA periodically review the outcome payment system and the outcome-milestone payment system...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ....597 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.597 Will SSA periodically review the outcome payment system and the...

  10. 20 CFR 411.597 - Will SSA periodically review the outcome payment system and the outcome-milestone payment system...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ....597 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.597 Will SSA periodically review the outcome payment system and the...

  11. 7 CFR 226.10 - Program payment procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.10 Program... claimed and to enable the State agency to provide the final Report of the Child and Adult Care Food...

  12. 7 CFR 226.10 - Program payment procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.10 Program... claimed and to enable the State agency to provide the final Report of the Child and Adult Care Food...

  13. 7 CFR 226.10 - Program payment procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.10 Program... claimed and to enable the State agency to provide the final Report of the Child and Adult Care Food...

  14. 7 CFR 3431.19 - Payment and tax liability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., AND EXTENSION SERVICE, DEPARTMENT OF AGRICULTURE VETERINARY MEDICINE LOAN REPAYMENT PROGRAM Administration of the Veterinary Medicine Loan Repayment Program § 3431.19 Payment and tax liability. (a) Loan...

  15. 31 CFR 560.522 - Allowable payments for overflights of Iranian airspace.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... overflights of Iranian airspace. Payments to Iran of charges for services rendered by the Government of Iran in connection with the overflight of Iran or emergency landing in Iran of aircraft owned by a United...

  16. 31 CFR 560.522 - Allowable payments for overflights of Iranian airspace.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... overflights of Iranian airspace. Payments to Iran of charges for services rendered by the Government of Iran in connection with the overflight of Iran or emergency landing in Iran of aircraft owned by a United...

  17. 31 CFR 560.522 - Allowable payments for overflights of Iranian airspace.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... overflights of Iranian airspace. Payments to Iran of charges for services rendered by the Government of Iran in connection with the overflight of Iran or emergency landing in Iran of aircraft owned by a United...

  18. 46 CFR 308.513 - Payment of premiums and fees.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk Cargo Insurance § 308.513 Payment of premiums and fees. The... ”Maritime Administration, Department of Transportation.” ...

  19. Prospective Bundled Payments in a Changing Environment: The Experience of a Self-Funded, State-Sponsored Plan.

    PubMed

    Lawler, Frank H; Wilson, Frank R; Smith, G Keith; Mitchell, Lynn V

    2017-12-01

    Healthcare reimbursement, which has traditionally been based on the quantity of services delivered, is currently moving toward value-based reimbursement-a system that addresses the quantity, quality, and cost of services. One such arrangement has been the evolution of bundled payments for a specific procedure or for an episode of care, paid prospectively or through post-hoc reconciliation. To evaluate the impact of instituting bundled payments that incorporate facility charges, physician fees, and all ancillary charges by the State of Oklahoma HealthChoice public employee insurance plan. From January 1 through December 31, 2016, HealthChoice, a large, government-sponsored Oklahoma health plan, implemented a voluntary, prospective, bundled payment system with network facilities, called Select. The Select program allows members at the time of certification of the services to opt to use participating facilities for specified services at a bundled rate, with deductible and coinsurance covered by the health plan. That is, the program allows any plan member to choose either a participating Select facility with no out-of-pocket costs or standard benefits at a participating network facility. During 2016, more than 7900 procedures were performed for 5907 patients who chose the Select arrangement (also designated as the intervention group). The most common outpatient Select procedures were for cardiology, colonoscopy, and magnetic resonance imaging scans. The most common inpatient procedures for Select-covered patients were in 6 diagnosis-related groups covering spinal fusions, joint replacement surgeries, and percutaneous coronary artery stenting. The allowable costs were similar for bundled procedures at ambulatory surgery centers and at outpatient hospital facilities; the allowable costs for patients not in the Select program (mean, $813) were lower at ambulatory surgery centers than at outpatient hospital departments (mean, $3086) because of differences in case mix. Patients in the Select system who had outpatient procedures had significantly fewer subsequent claims than those who were not in Select for hospitalization (1.7% vs 2.5%, respectively) and emergency department visits (4.4% vs 11.5%, respectively) in the 30 days postprocedure. Quality measures (eg, wound infection and reoperation) were similar for patients who were and were not in the Select group and had procedures. Surgical complication (ie, return to surgery) rates were higher for the Select group. The Select program demonstrated promising results during its first year of operation, suggesting that prospective bundled payment arrangements can be implemented successfully. Further research on reimbursement mechanisms, that is, how to pay physicians and facilities, and quality of outcomes is needed, especially with respect to which procedures are most suitable for this payment arrangement.

  20. Prospective Bundled Payments in a Changing Environment: The Experience of a Self-Funded, State-Sponsored Plan

    PubMed Central

    Lawler, Frank H.; Wilson, Frank R.; Smith, G. Keith; Mitchell, Lynn V.

    2017-01-01

    Background Healthcare reimbursement, which has traditionally been based on the quantity of services delivered, is currently moving toward value-based reimbursement—a system that addresses the quantity, quality, and cost of services. One such arrangement has been the evolution of bundled payments for a specific procedure or for an episode of care, paid prospectively or through post-hoc reconciliation. Objective To evaluate the impact of instituting bundled payments that incorporate facility charges, physician fees, and all ancillary charges by the State of Oklahoma HealthChoice public employee insurance plan. Method From January 1 through December 31, 2016, HealthChoice, a large, government-sponsored Oklahoma health plan, implemented a voluntary, prospective, bundled payment system with network facilities, called Select. The Select program allows members at the time of certification of the services to opt to use participating facilities for specified services at a bundled rate, with deductible and coinsurance covered by the health plan. That is, the program allows any plan member to choose either a participating Select facility with no out-of-pocket costs or standard benefits at a participating network facility. Results During 2016, more than 7900 procedures were performed for 5907 patients who chose the Select arrangement (also designated as the intervention group). The most common outpatient Select procedures were for cardiology, colonoscopy, and magnetic resonance imaging scans. The most common inpatient procedures for Select-covered patients were in 6 diagnosis-related groups covering spinal fusions, joint replacement surgeries, and percutaneous coronary artery stenting. The allowable costs were similar for bundled procedures at ambulatory surgery centers and at outpatient hospital facilities; the allowable costs for patients not in the Select program (mean, $813) were lower at ambulatory surgery centers than at outpatient hospital departments (mean, $3086) because of differences in case mix. Patients in the Select system who had outpatient procedures had significantly fewer subsequent claims than those who were not in Select for hospitalization (1.7% vs 2.5%, respectively) and emergency department visits (4.4% vs 11.5%, respectively) in the 30 days postprocedure. Quality measures (eg, wound infection and reoperation) were similar for patients who were and were not in the Select group and had procedures. Surgical complication (ie, return to surgery) rates were higher for the Select group. Conclusion The Select program demonstrated promising results during its first year of operation, suggesting that prospective bundled payment arrangements can be implemented successfully. Further research on reimbursement mechanisms, that is, how to pay physicians and facilities, and quality of outcomes is needed, especially with respect to which procedures are most suitable for this payment arrangement. PMID:29403570

  1. 50 CFR 80.16 - Payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ASSISTANCE-WILDLIFE SPORT FISH RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS § 80.16 Payments. Payments must be made for the...

  2. 15 CFR 14.22 - Payment.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... transfer of funds and disbursement by the recipient, and financial management systems that meet the... accounts shall be remitted annually to Department of Health and Human Services, Payment Management System... ORGANIZATIONS Post-Award Requirements Financial and Program Management § 14.22 Payment. (a) Payment methods...

  3. 15 CFR 14.22 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... transfer of funds and disbursement by the recipient, and financial management systems that meet the... accounts shall be remitted annually to Department of Health and Human Services, Payment Management System... ORGANIZATIONS Post-Award Requirements Financial and Program Management § 14.22 Payment. (a) Payment methods...

  4. 45 CFR 2543.22 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... and disbursement by the recipient, and (2) Financial management systems that meet the standards for... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Requirements Financial and Program Management § 2543.22 Payment. (a) Payment methods shall minimize the time...

  5. 15 CFR 14.22 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... transfer of funds and disbursement by the recipient, and financial management systems that meet the... accounts shall be remitted annually to Department of Health and Human Services, Payment Management System... ORGANIZATIONS Post-Award Requirements Financial and Program Management § 14.22 Payment. (a) Payment methods...

  6. 45 CFR 2543.22 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... and disbursement by the recipient, and (2) Financial management systems that meet the standards for... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Requirements Financial and Program Management § 2543.22 Payment. (a) Payment methods shall minimize the time...

  7. 20 CFR 435.22 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., and (ii) Financial management systems that meet the standards for fund control and accountability as..., Payment Management System, Rockville, MD 20852. Interest amounts up to $250 per year may be retained by...-Award Requirements Financial and Program Management § 435.22 Payment. (a) Introduction. Payment methods...

  8. 45 CFR 2543.22 - Payment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... and disbursement by the recipient, and (2) Financial management systems that meet the standards for... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Requirements Financial and Program Management § 2543.22 Payment. (a) Payment methods shall minimize the time...

  9. 7 CFR 1493.200 - General statement.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC... Commodity Credit Corporation's (CCC) Facility Guarantee Program (FGP). CCC will issue facility payment... payment guarantee issued by CCC. ...

  10. 7 CFR 1493.200 - General statement.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC... Commodity Credit Corporation's (CCC) Facility Guarantee Program (FGP). CCC will issue facility payment... payment guarantee issued by CCC. ...

  11. 7 CFR 4288.111 - Biofuel eligibility.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Biofuel eligibility. 4288.111 Section 4288.111... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions Eligibility Provisions § 4288.111 Biofuel eligibility. To be eligible for this Program...

  12. 77 FR 67449 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-09

    ... Blended Payment a. Update to the Drug Add-on to the Composite Rate Portion of the ESRD Blended Payment Rate i. Estimating Growth in Expenditures for Drugs and Biologicals in CY 2013 ii. Estimating Per Patient Growth iii. Applying the Growth Update to the Drug Add-On Adjustment iv. Update to the Drug Add-On...

  13. 76 FR 40497 - Medicare Program; Changes to the End-Stage Renal Disease Prospective Payment System for CY 2012...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-08

    ...] RIN 0938-AQ27 Medicare Program; Changes to the End-Stage Renal Disease Prospective Payment System for... through Federal Digital System (FDsys), a service of the U.S. Government Printing Office. This database... Internet on the CMS Web site. The Addenda to the End-Stage Renal Disease (ESRD) Prospective Payment System...

  14. Workforce Downsizing and Restructuring in the Department of Defense: The Voluntary Separation Incentive Payment Program Versus Involuntary Separation

    DTIC Science & Technology

    2016-01-01

    Workforce Downsizing and Restructuring in the Department of Defense The Voluntary Separation Incentive Payment Program Versus Involuntary...Voluntary Separation Incentive Payment (VSIP). The purposes of this research are to place VSIP in context relative to involuntary separation, determine...5 CHAPTER TWO Review of Severance Pay, Voluntary Separation Incentive Pay, and Voluntary

  15. Effect of medicare payment on rural health care systems.

    PubMed

    McBride, Timothy D; Mueller, Keith J

    2002-01-01

    Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

  16. 7 CFR 1400.202 - Persons.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Eligibility § 1400.202 Persons. (a) A person will be...

  17. 7 CFR 1400.203 - Joint operations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Eligibility § 1400.203 Joint operations. (a) A...

  18. 7 CFR 1400.107 - Notification of interests.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Limitation § 1400.107 Notification of interests...

  19. 7 CFR 1400.207 - Landowners.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Eligibility § 1400.207 Landowners. (a) A person or legal...

  20. 42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... payment system for long-term care hospitals. 412.505 Section 412.505 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...

  1. 20 CFR 411.536 - Under what circumstances can we make a reconciliation payment under the outcome-milestone payment...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Under what circumstances can we make a reconciliation payment under the outcome-milestone payment system? 411.536 Section 411.536 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment...

  2. 20 CFR 411.550 - How are the outcome payments calculated under the outcome payment system?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How are the outcome payments calculated under the outcome payment system? 411.550 Section 411.550 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.550 How are...

  3. 20 CFR 411.550 - How are the outcome payments calculated under the outcome payment system?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false How are the outcome payments calculated under the outcome payment system? 411.550 Section 411.550 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.550 How are...

  4. 20 CFR 411.536 - Under what circumstances can we make a reconciliation payment under the outcome-milestone payment...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Under what circumstances can we make a reconciliation payment under the outcome-milestone payment system? 411.536 Section 411.536 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment...

  5. 20 CFR 411.536 - Under what circumstances can we make a reconciliation payment under the outcome-milestone payment...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Under what circumstances can we make a reconciliation payment under the outcome-milestone payment system? 411.536 Section 411.536 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment...

  6. 20 CFR 411.550 - How are the outcome payments calculated under the outcome payment system?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false How are the outcome payments calculated under the outcome payment system? 411.550 Section 411.550 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.550 How are...

  7. 20 CFR 411.536 - Under what circumstances can we make a reconciliation payment under the outcome-milestone payment...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Under what circumstances can we make a reconciliation payment under the outcome-milestone payment system? 411.536 Section 411.536 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment...

  8. 20 CFR 411.550 - How are the outcome payments calculated under the outcome payment system?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false How are the outcome payments calculated under the outcome payment system? 411.550 Section 411.550 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.550 How are...

  9. 20 CFR 411.536 - Under what circumstances can we make a reconciliation payment under the outcome-milestone payment...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Under what circumstances can we make a reconciliation payment under the outcome-milestone payment system? 411.536 Section 411.536 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment...

  10. 20 CFR 411.550 - How are the outcome payments calculated under the outcome payment system?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false How are the outcome payments calculated under the outcome payment system? 411.550 Section 411.550 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.550 How are...

  11. An Assessment of the Industry-Faculty Surgeon Relationship Within Colon and Rectum Surgical Training Programs.

    PubMed

    Patel, Sunil V; Klingel, Michelle; Sonoda, Toyooki

    2016-01-01

    Industry funding of surgical training programs poses a potential conflict of interest. With the recent implementation of the Sunshine Act, industry funding can be more accurately determined. To determine the financial relationship between faculty surgeons within colon and rectal fellowship programs and industry. Review of industry funding based on the first reporting period (August-December, 2013) using the Centers for Medicare and Medicaid Services online database. ACGME certified colon and rectum surgical fellowship programs. Overall, 343 Faculty surgeons from 55 colon and rectum surgical fellowship programs were identified using the American Board of Colon and Rectum Surgery website. There was complete identification of faculty surgeons in 47 (85.5%) programs, partially complete identification (i.e., >80%) in 6 (10.9%) programs, and inadequate identification of faculty in 2 (3.6%) programs. Industry funding as defined by the Sunshine Act included general payments (honorariums, consulting fees, food and beverage, and travel), research payments, and amount invested. In all, 69.1% of program directors and 59.4% of other faculty received at least one payment during the reporting period (Δ9.7%, 95% CI: -4.4% to 23.8%, p = 0.18). Program directors received higher amounts of funding than other faculty ($7072.90 vs. $2,819.29, Δ$4,253.61, 95% CI: $1132-$7375, p = 0.008). Overall, 49 of 53 (93%) programs had surgeons receive funding, with a median of 3.5 surgeons receiving funding per program. A total of 65 companies made payments to surgeons, with 80.1% of the funding categorized as general payments, 16.2% as investments, and 3.7% as research payments. Industry funding was common. This financial relationship poses a potential conflict of interest in training fellows for future practice. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  12. Adapting Evaluations of Alternative Payment Models to a Changing Environment.

    PubMed

    Grannemann, Thomas W; Brown, Randall S

    2018-04-01

    To identify the most robust methods for evaluating alternative payment models (APMs) in the emerging health care delivery system environment. We assess the impact of widespread testing of alternative payment models on the ability to find credible comparison groups. We consider the applicability of factorial research designs for assessing the effects of these models. The widespread adoption of alternative payment models could effectively eliminate the possibility of comparing APM results with a "pure" control or comparison group unaffected by other interventions. In this new environment, factorial experiments have distinct advantages over the single-model experimental or quasi-experimental designs that have been the mainstay of recent tests of Medicare payment and delivery models. The best prospects for producing definitive evidence of the effects of payment incentives for APMs include fractional factorial experiments that systematically vary requirements and payment provisions within a payment model. © Health Research and Educational Trust.

  13. 7 CFR 1400.102 - States, political subdivisions, and agencies thereof.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Limitation...

  14. What should we call instruments commonly known as payments for environmental services? A review of the literature and a proposal.

    PubMed

    Shelley, Barry G

    2011-02-01

    Researchers, policy makers, and practitioners have used various terms to describe instruments that reward the stewardship of ecosystem services that benefit "external" actors. Payments for environmental services, or PES, has been the predominant name. However, critics have challenged both the payments and environmental components of this nomenclature, most commonly proposing markets, compensation, or rewards as alternatives for the former, and ecosystem for the latter. Additional questions arise regarding what to call the agents directly involved in the transaction: sellers and buyers, or stewards and beneficiaries? For some, concerns about this terminology have emerged from so-called "pro-poor PES" debates that ask if actors could and should incorporate poverty alleviation goals into PES instruments. This review of the modulating use of terms and the arguments about which best fit theory and experience points to the key policy and ethical issues at stake as PES programs face critical and timely questions about the direction they will head. The author contends that the choices of terms will influence that direction and proposes a new alternative-rewards for ecosystem service stewardship (RESS)-that better encompasses pro-poor options. © 2011 New York Academy of Sciences.

  15. 42 CFR 408.65 - Payment options.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment options. 408.65 Section 408.65 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Individual Payment § 408.65 Payment options...

  16. 42 CFR 412.332 - Payment based on the hospital-specific rate.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs Determination of Transition Period Payment Rates for... (f) is determined by multiplying the applicable hospital-specific rate by the DRG weighting factor...

  17. 42 CFR § 414.1380 - Scoring.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ...) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1380 Scoring. (a) General. MIPS eligible... payment year 2019. Instead, these measures as well as measures that are below the data completeness...

  18. 45 CFR 2400.56 - Payment of stipend.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Payment of stipend. 2400.56 Section 2400.56 Public Welfare Regulations Relating to Public Welfare (Continued) JAMES MADISON MEMORIAL FELLOWSHIP FOUNDATION FELLOWSHIP PROGRAM REQUIREMENTS Fellowship Stipend § 2400.56 Payment of stipend. Payment for tuition...

  19. 45 CFR 2400.56 - Payment of stipend.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 4 2013-10-01 2013-10-01 false Payment of stipend. 2400.56 Section 2400.56 Public Welfare Regulations Relating to Public Welfare (Continued) JAMES MADISON MEMORIAL FELLOWSHIP FOUNDATION FELLOWSHIP PROGRAM REQUIREMENTS Fellowship Stipend § 2400.56 Payment of stipend. Payment for tuition...

  20. 45 CFR 2400.56 - Payment of stipend.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Payment of stipend. 2400.56 Section 2400.56 Public Welfare Regulations Relating to Public Welfare (Continued) JAMES MADISON MEMORIAL FELLOWSHIP FOUNDATION FELLOWSHIP PROGRAM REQUIREMENTS Fellowship Stipend § 2400.56 Payment of stipend. Payment for tuition...

  1. 7 CFR 240.8 - Payments to program schools, service institutions, nonresidential child care institutions and...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CASH IN LIEU OF DONATED FOODS § 240.8 Payments to program schools, service institutions... disburse any cash received in lieu of donated foods under this part to eligible program schools, service...

  2. 40 CFR 610.14 - Payment of program costs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... from the costs of testing a device, EPA shall be responsible for costs of formulating its engineering... 40 Protection of Environment 31 2012-07-01 2012-07-01 false Payment of program costs. 610.14... program costs. (a) All costs incurred in an evaluation program initiated at the request of the FTC or at...

  3. 40 CFR 610.14 - Payment of program costs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... from the costs of testing a device, EPA shall be responsible for costs of formulating its engineering... 40 Protection of Environment 30 2011-07-01 2011-07-01 false Payment of program costs. 610.14... program costs. (a) All costs incurred in an evaluation program initiated at the request of the FTC or at...

  4. 40 CFR 610.14 - Payment of program costs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... from the costs of testing a device, EPA shall be responsible for costs of formulating its engineering... 40 Protection of Environment 31 2013-07-01 2013-07-01 false Payment of program costs. 610.14... program costs. (a) All costs incurred in an evaluation program initiated at the request of the FTC or at...

  5. 40 CFR 610.14 - Payment of program costs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... from the costs of testing a device, EPA shall be responsible for costs of formulating its engineering... 40 Protection of Environment 30 2014-07-01 2014-07-01 false Payment of program costs. 610.14... program costs. (a) All costs incurred in an evaluation program initiated at the request of the FTC or at...

  6. 42 CFR 62.11 - When can a scholarship program payment obligation be discharged in bankruptcy?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false When can a scholarship program payment obligation... HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS National Health Service Corps Scholarship Program § 62.11 When can a...

  7. 42 CFR 62.11 - When can a scholarship program payment obligation be discharged in bankruptcy?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false When can a scholarship program payment obligation... HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS National Health Service Corps Scholarship Program § 62.11 When can a...

  8. 42 CFR 62.11 - When can a scholarship program payment obligation be discharged in bankruptcy?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false When can a scholarship program payment obligation... HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS National Health Service Corps Scholarship Program § 62.11 When can a...

  9. 42 CFR 62.11 - When can a scholarship program payment obligation be discharged in bankruptcy?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false When can a scholarship program payment obligation... HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS National Health Service Corps Scholarship Program § 62.11 When can a...

  10. 42 CFR 62.11 - When can a scholarship program payment obligation be discharged in bankruptcy?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false When can a scholarship program payment obligation... HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS National Health Service Corps Scholarship Program § 62.11 When can a...

  11. 48 CFR 2825.302 - Policy.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... ACQUISITION Balance of Payments Program 2825.302 Policy. The HCA, or designee at a level not lower than the... evaluation of domestic and foreign offers under the Balance of Payments Program. All determinations made...

  12. 48 CFR 2825.302 - Policy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ACQUISITION Balance of Payments Program 2825.302 Policy. The HCA, or designee at a level not lower than the... evaluation of domestic and foreign offers under the Balance of Payments Program. All determinations made...

  13. 7 CFR 4288.111 - Biofuel eligibility.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Biofuel eligibility. 4288.111 Section 4288.111... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.111 Biofuel eligibility. To be eligible for this Program, a biofuel must meet...

  14. 7 CFR 4288.111 - Biofuel eligibility.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Biofuel eligibility. 4288.111 Section 4288.111... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.111 Biofuel eligibility. To be eligible for this Program, a biofuel must meet...

  15. 7 CFR 220.10 - Effective date for reimbursement.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.10 Effective date for reimbursement. Reimbursement payments under the School Breakfast Program may be made only to School Food... execution of the agreement. Such payments may include reimbursement in connection with breakfasts served in...

  16. 7 CFR 220.10 - Effective date for reimbursement.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.10 Effective date for reimbursement. Reimbursement payments under the School Breakfast Program may be made only to School Food... execution of the agreement. Such payments may include reimbursement in connection with breakfasts served in...

  17. 7 CFR 1493.310 - Payment for loss.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Facility Guarantee Program (FGP) Operations § 1493.310 Payment for loss. (a) Determination of CCC's liability. Upon receipt in good order of the information and documents required under § 1493.300, CCC will determine whether or...

  18. 7 CFR 1493.120 - Payment for loss.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.120 Payment for loss. (a) Determination of CCC's liability. Upon receipt in good order of...

  19. 7 CFR 1493.310 - Payment for loss.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Facility Guarantee Program (FGP) Operations § 1493.310 Payment for loss. (a) Determination of CCC's liability. Upon receipt in good order of the information and documents required under § 1493.300, CCC will determine whether or...

  20. 7 CFR 1493.310 - Payment for loss.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Facility Guarantee Program (FGP) Operations § 1493.310 Payment for loss. (a) Determination of CCC's liability. Upon receipt in good order of the information and documents required under § 1493.300, CCC will determine whether or...

  1. Episode-Based Payment and Direct Employer Purchasing of Healthcare Services: Recent Bundled Payment Innovations and the Geisinger Health System Experience.

    PubMed

    Slotkin, Jonathan R; Ross, Olivia A; Newman, Eric D; Comrey, Janet L; Watson, Victoria; Lee, Rachel V; Brosious, Megan M; Gerrity, Gloria; Davis, Scott M; Paul, Jacquelyn; Miller, E Lynn; Feinberg, David T; Toms, Steven A

    2017-04-01

    One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms. The Patient Protection and Affordable Care Act has allowed many care delivery systems to partner with Medicare in episode-based payment programs such as the Bundled Payments for Care Improvement (BPCI) initiative, and in patient-based models such as the Medicare Shared Savings Program. Several employer purchasers of healthcare services are experimenting with innovative payment models to include episode-based bundled rate destination centers of excellence programs and the direct purchasing of accountable care organization services. The Geisinger Health System has over 10 years of experience with episode-based payment bundling coupled with the care delivery reengineering which is integral to its ProvenCare® program. Recent experiences at Geisinger have included participation in BPCI and also partnership with employer-purchasers of healthcare through the Pacific Business Group on Health (representing Walmart, Lowe's, and JetBlue Airways). As the shift towards value-focused care delivery and patient experience progresses forward, bundled payment arrangements and direct purchasing of healthcare will be critical financial drivers in effecting change. Copyright © 2017 by the Congress of Neurological Surgeons.

  2. 75 FR 21191 - Subpart B-Advanced Biofuel Payment Program; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-23

    ... Service 7 CFR Part 4288 RIN 0570-AA75 Subpart B--Advanced Biofuel Payment Program; Correction AGENCY... for producers of advanced biofuels to supporting existing advanced biofuel production and to encourage...

  3. 24 CFR 888.405 - Amount of the retroactive Housing Assistance Payments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... DIRECT LOAN PROGRAM, SECTION 202 SUPPORTIVE HOUSING FOR THE ELDERLY PROGRAM AND SECTION 811 SUPPORTIVE... retroactive payment, a project owner must, if the information is available, submit documentation of occupancy...

  4. 24 CFR 888.405 - Amount of the retroactive Housing Assistance Payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... DIRECT LOAN PROGRAM, SECTION 202 SUPPORTIVE HOUSING FOR THE ELDERLY PROGRAM AND SECTION 811 SUPPORTIVE... retroactive payment, a project owner must, if the information is available, submit documentation of occupancy...

  5. 7 CFR 784.12 - Maintaining records.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SPECIAL PROGRAMS 2004 EWE LAMB REPLACEMENT AND RETENTION PAYMENT PROGRAM § 784.12 Maintaining records... accounts must be retained for 3 years after the date of payment to the sheep and lamb operations under this...

  6. 77 FR 72920 - Federal Housing Administration (FHA) Section 232 Healthcare Mortgage Insurance Program: Partial...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-07

    ...This rule amends the regulations governing FHA's Section 232 Healthcare Mortgage Insurance program (Section 232 program) by establishing the criteria and process by which FHA will accept and pay a partial payment of a claim under the FHA mortgage insurance contract. The Section 232 program insures mortgage loans to facilitate the construction, substantial rehabilitation, purchase, and refinancing of nursing homes, intermediate care facilities, board and care homes, and assisted-living facilities. Through acceptance and payment of a partial payment of claim, FHA pays the lender a portion of the unpaid principal balance and recasts a portion of the mortgage under terms and conditions determined by FHA, as an alternative to the lender assigning the entire mortgage to HUD. Partial payment of claim also allows FHA- insured healthcare projects to continue operating and providing services.

  7. 42 CFR 460.182 - Medicaid payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid payment. 460.182 Section 460.182 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) Payment § 460.182 Medicaid payment. (a) Under a PACE program agreement, the State administering agency...

  8. 42 CFR 412.535 - Publication of the Federal prospective payment rates.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.535 Publication of the Federal prospective... care hospital prospective payment system effective for each annual update in the Federal Register. (a...

  9. 42 CFR 412.20 - Hospital services subject to the prospective payment systems.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... payment systems. 412.20 Section 412.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Hospital Services Subject to and Excluded From the Prospective Payment Systems for Inpatient...

  10. 42 CFR § 414.1435 - Qualifying APM participant determination: Medicare option.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1435 Qualifying APM participant determination: Medicare option. (a) Payment amount method. The...

  11. 42 CFR § 414.1320 - MIPS performance period.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1320 MIPS performance period. (a) For purposes of the 2019 MIPS payment year, the performance period for all performance categories and...

  12. 42 CFR § 414.1415 - Advanced APM criteria.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1415 Advanced APM criteria. (a) Use... is responsible under an APM. For episode payment models, expected expenditures mean the episode...

  13. 42 CFR § 414.1330 - Quality performance category.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1330 Quality... comprise: (1) 60 percent of a MIPS eligible clinician's final score for MIPS payment year 2019. (2) 50...

  14. 45 CFR 1801.53 - Postponement of payment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Postponement of payment. 1801.53 Section 1801.53 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.53 Postponement of payment...

  15. 45 CFR 1801.53 - Postponement of payment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 4 2013-10-01 2013-10-01 false Postponement of payment. 1801.53 Section 1801.53 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.53 Postponement of payment...

  16. 45 CFR 1801.53 - Postponement of payment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Postponement of payment. 1801.53 Section 1801.53 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.53 Postponement of payment...

  17. 45 CFR 1801.53 - Postponement of payment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Postponement of payment. 1801.53 Section 1801.53 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.53 Postponement of payment...

  18. 45 CFR 1801.53 - Postponement of payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Postponement of payment. 1801.53 Section 1801.53 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.53 Postponement of payment...

  19. 5 CFR 1655.14 - Loan payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Loan payments. 1655.14 Section 1655.14 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD LOAN PROGRAM § 1655.14 Loan payments. (a) Loan payments must be made through payroll deduction in accordance with the loan agreement. Once loan...

  20. 42 CFR 414.313 - Initial method of payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... inpatients who were not admitted solely to receive maintenance dialysis. (iv) Administration of hepatitis B... (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Determination of Reasonable... of this subchapter. (b) Services for which payment is not included in the add-on payment. (1...

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