42 CFR 447.257 - FFP: Conditions relating to institutional reimbursement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false FFP: Conditions relating to institutional reimbursement. 447.257 Section 447.257 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for...

42 CFR 447.257 - FFP: Conditions relating to institutional reimbursement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false FFP: Conditions relating to institutional reimbursement. 447.257 Section 447.257 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for...

42 CFR 447.257 - FFP: Conditions relating to institutional reimbursement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false FFP: Conditions relating to institutional reimbursement. 447.257 Section 447.257 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for...

42 CFR 447.257 - FFP: Conditions relating to institutional reimbursement.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false FFP: Conditions relating to institutional reimbursement. 447.257 Section 447.257 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for...

42 CFR 447.257 - FFP: Conditions relating to institutional reimbursement.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false FFP: Conditions relating to institutional reimbursement. 447.257 Section 447.257 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for...

10 CFR 436.36 - Conditions of payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... baseline under the energy savings performance contract (adjusted if appropriate under § 436.37), multiplied... 10 Energy 3 2010-01-01 2010-01-01 false Conditions of payment. 436.36 Section 436.36 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methods and...

42 CFR § 512.510 - Downstream distribution arrangements under the EPM.

Code of Federal Regulations, 2010 CFR

2017-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL... distribution payment it receives from the EPM collaborator only in accordance with a downstream distribution... make or receive a downstream distribution payment must not be conditioned directly or indirectly on the...

42 CFR 410.172 - Payment for partial hospitalization services in CMHCs: Conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for partial hospitalization services in CMHCs: Conditions. 410.172 Section 410.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS...

42 CFR 495.316 - State monitoring and reporting regarding activities required to receive an incentive payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... quality measures data; and (v) A description and quantitative data on how its incentive payment program... conditions to use for quality improvement, reduction of disparities, research or outreach. (B) Capability to... specific conditions to use for quality improvement, reduction of disparities, research, or outreach. (B...

42 CFR 495.316 - State monitoring and reporting regarding activities required to receive an incentive payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... quality measures data; and (v) A description and quantitative data on how its incentive payment program... conditions to use for quality improvement, reduction of disparities, research or outreach. (B) Capability to... specific conditions to use for quality improvement, reduction of disparities, research, or outreach. (B...

42 CFR 495.316 - State monitoring and reporting regarding activities required to receive an incentive payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... quality measures data; and (v) A description and quantitative data on how its incentive payment program... conditions to use for quality improvement, reduction of disparities, research or outreach. (B) Capability to... specific conditions to use for quality improvement, reduction of disparities, research, or outreach. (B...

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.

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.

22 CFR 232.10 - Payment to USAID of excess amounts received by a Noteholder.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Payment to USAID of excess amounts received by a Noteholder. 232.10 Section 232.10 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT REPUBLIC... PROGRAMS APPROPRIATIONS ACT, 2012, DIV. I, PUB. L. 112-74-STANDARD TERMS AND CONDITIONS § 232.10 Payment to...

22 CFR 232.10 - Payment to USAID of excess amounts received by a Noteholder.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Payment to USAID of excess amounts received by a Noteholder. 232.10 Section 232.10 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT REPUBLIC... PROGRAMS APPROPRIATIONS ACT, 2012, DIV. I, PUB. L. 112-74-STANDARD TERMS AND CONDITIONS § 232.10 Payment to...

Medicare payment system for hospital inpatients: diagnosis-related groups.

PubMed

Baker, Judith J

2002-01-01

Diagnosis-Related Groups (DRGs) are categories of patient conditions that demonstrate similar levels of hospital resources required to treat the conditions. Each inpatient that is discharged from an acute care hospital can be classified into one of the 506 DRGs currently utilized by the Medicare program. The Medicare DRG prospective payment methodology has been in use for almost two decades and is used by hospital managers for planning and decisionmaking. The viability of DRGs for future prospective payment depends on the ability to keep up with the times through updates of the current methodology.

42 CFR 403.752 - Payment provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment provisions. 403.752 Section 403.752 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.752 - Payment provisions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Payment provisions. 403.752 Section 403.752 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.752 - Payment provisions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Payment provisions. 403.752 Section 403.752 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.752 - Payment provisions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Payment provisions. 403.752 Section 403.752 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.752 - Payment provisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Payment provisions. 403.752 Section 403.752 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 438.804 - Primary care provider payment increases.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Primary care provider payment increases. 438.804 Section 438.804 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Conditions for Federal Financial...

42 CFR 424.80 - Prohibition of reassignment of claims by suppliers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Limitations on Assignment and Reassignment of Claims § 424.80 Prohibition of reassignment of claims by suppliers. (a) Basic... the basic rule—(1) Payment to employer. Medicare may pay the supplier's employer if the supplier is...

Medicare program; End-Stage Renal Disease prospective payment system, quality incentive program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. Final rule.

PubMed

2014-11-06

This final rule will update and make revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2015. This rule also finalizes requirements for the ESRD quality incentive program (QIP), including for payment years (PYs) 2017 and 2018. This rule will also make a technical correction to remove outdated terms and definitions. In addition, this final rule sets forth the methodology for adjusting Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule payment amounts using information from the Medicare DMEPOS Competitive Bidding Program (CBP); makes alternative payment rules for certain DME under the Medicare DMEPOS CBP; clarifies the statutory Medicare hearing aid coverage exclusion and specifies devices not subject to the hearing aid exclusion; will not update the definition of minimal self-adjustment; clarifies the Change of Ownership (CHOW) and provides for an exception to the current requirements; revises the appeal provisions for termination of a CBP contract, including the beneficiary notification requirement under the Medicare DMEPOS CBP, and makes a technical change to the regulation related to the conditions for awarding contracts for furnishing infusion drugs under the Medicare DMEPOS CBP.

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...

Medicare's post-acute care payment: a review of the issues and policy proposals.

PubMed

Linehan, Kathryn

2012-12-07

Medicare spending on post-acute care provided by skilled nursing facility providers, home health providers, inpatient rehabilitation facility providers, and long-term care hospitals has grown rapidly in the past several years. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems and also includes broader payment reforms, such as bundled payment models. This issue brief describes Medicare's payment systems for post-acute care providers, evidence of problems that have been identified with the payment systems, and policies that have been proposed or enacted to remedy those problems.

7 CFR 760.500 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 2008 Farm Bill). (b) Eligible orchardists and nursery tree growers will be compensated as specified in... SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.500 Applicability. (a) This subpart establishes the terms and conditions under which the Tree Assistance Program (TAP) will be...

7 CFR 760.500 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 2008 Farm Bill). (b) Eligible orchardists and nursery tree growers will be compensated as specified in... SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.500 Applicability. (a) This subpart establishes the terms and conditions under which the Tree Assistance Program (TAP) will be...

7 CFR 760.500 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 2008 Farm Bill). (b) Eligible orchardists and nursery tree growers will be compensated as specified in... SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.500 Applicability. (a) This subpart establishes the terms and conditions under which the Tree Assistance Program (TAP) will be...

7 CFR 760.500 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 2008 Farm Bill). (b) Eligible orchardists and nursery tree growers will be compensated as specified in... SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.500 Applicability. (a) This subpart establishes the terms and conditions under which the Tree Assistance Program (TAP) will be...

42 CFR 424.350 - Replacement of checks that are lost, stolen, defaced, mutilated, destroyed, or paid on forged...

Code of Federal Regulations, 2010 CFR

2010-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Replacement and Reclamation of Medicare Payments § 424.350... investigation and settlement of claims in connection with Treasury checks issued on behalf of CMS. (2) Action by...

75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

... Respiratory Care Services; Medicaid Program: Accreditation for Providers of Inpatient Psychiatric Services... Conditions of Participation for Rehabilitation and Respiratory Care Services; Medicaid Program: Accreditation... Participation for Rehabilitation and Respiratory Care Services; Medicaid Program: Accreditation for Providers of...

The financial performance of rural hospitals and implications for elimination of the Critical Access Hospital program.

PubMed

Holmes, George M; Pink, George H; Friedman, Sarah A

2013-01-01

To compare the financial performance of rural hospitals with Medicare payment provisions to those paid under prospective payment and to estimate the financial consequences of elimination of the Critical Access Hospital (CAH) program. Financial data for 2004-2010 were collected from the Healthcare Cost Reporting Information System (HCRIS) for rural hospitals. HCRIS data were used to calculate measures of the profitability, liquidity, capital structure, and financial strength of rural hospitals. Linear mixed models accounted for the method of Medicare reimbursement, time trends, hospital, and market characteristics. Simulations were used to estimate profitability of CAHs if they reverted to prospective payment. CAHs generally had lower unadjusted financial performance than other types of rural hospitals, but after adjustment for hospital characteristics, CAHs had generally higher financial performance. Special payment provisions by Medicare to rural hospitals are important determinants of financial performance. In particular, the financial condition of CAHs would be worse if they were paid under prospective payment. © 2012 National Rural Health Association.

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...

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...

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...

Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNFs) for FY 2016, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and Staffing Data Collection. Final Rule.

PubMed

2015-08-04

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2016. In addition, it specifies a SNF all-cause all-condition hospital readmission measure, as well as adopts that measure for a new SNF Value-Based Purchasing (VBP) Program, and includes a discussion of SNF VBP Program policies we are considering for future rulemaking to promote higher quality and more efficient health care for Medicare beneficiaries. Additionally, this final rule will implement a new quality reporting program for SNFs as specified in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). It also amends the requirements that a long-term care (LTC) facility must meet to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or a nursing facility (NF) in the Medicaid program, by establishing requirements that implement the provision in the Affordable Care Act regarding the submission of staffing information based on payroll data.

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...

34 CFR 682.800 - Prohibition against discrimination as a condition for receiving special allowance payments.

Code of Federal Regulations, 2013 CFR

2013-07-01

... programs because of the borrower's race, sex, color, religion, national origin, age, disability status... borrower's education program, or the borrower's academic year in school. (b) The Secretary considers an...

34 CFR 682.800 - Prohibition against discrimination as a condition for receiving special allowance payments.

Code of Federal Regulations, 2012 CFR

2012-07-01

... programs because of the borrower's race, sex, color, religion, national origin, age, disability status... borrower's education program, or the borrower's academic year in school. (b) The Secretary considers an...

34 CFR 682.800 - Prohibition against discrimination as a condition for receiving special allowance payments.

Code of Federal Regulations, 2011 CFR

2011-07-01

... programs because of the borrower's race, sex, color, religion, national origin, age, disability status... borrower's education program, or the borrower's academic year in school. (b) The Secretary considers an...

24 CFR 888.202 - Manner of publication.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 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 CONTRACT RENT ANNUAL... published as market conditions indicate. In the case of revised factors applicable only to specific areas...

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...

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.

42 CFR 408.82 - Conditions for group billing.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Conditions for group billing. 408.82 Section 408.82... PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Group Payment § 408.82 Conditions for group billing. CMS agrees to a group billing arrangement only if the following conditions are met...

42 CFR 408.82 - Conditions for group billing.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Conditions for group billing. 408.82 Section 408.82... PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Group Payment § 408.82 Conditions for group billing. CMS agrees to a group billing arrangement only if the following conditions are met...

42 CFR 408.82 - Conditions for group billing.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Conditions for group billing. 408.82 Section 408.82... PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Group Payment § 408.82 Conditions for group billing. CMS agrees to a group billing arrangement only if the following conditions are met...

42 CFR 408.82 - Conditions for group billing.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Conditions for group billing. 408.82 Section 408.82... PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Group Payment § 408.82 Conditions for group billing. CMS agrees to a group billing arrangement only if the following conditions are met...

42 CFR 408.82 - Conditions for group billing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Conditions for group billing. 408.82 Section 408.82... PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Group Payment § 408.82 Conditions for group billing. CMS agrees to a group billing arrangement only if the following conditions are met...

Learning Together: How Families Responded to Education Incentives in New York City's Conditional Cash Transfer Program

ERIC Educational Resources Information Center

Greenberg, David; Dechausay, Nadine; Fraker, Carolyn

2011-01-01

In 2007, New York City's Center for Economic Opportunity launched Opportunity NYC-Family Rewards, an experimental, privately funded, conditional cash transfer (CCT) program to help families break the cycle of poverty. Family Rewards provided payments to low-income families in six of the city's poorest communities for achieving specific goals…

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...

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...

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...

7 CFR 760.818 - Marketing contracts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Marketing contracts. 760.818 Section 760.818... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS 2005-2007 Crop Disaster Program § 760.818 Marketing contracts. (a) A marketing contract must meet all of the conditions outlined in paragraphs (b), (c), and (d...

7 CFR 760.818 - Marketing contracts.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 7 2013-01-01 2013-01-01 false Marketing contracts. 760.818 Section 760.818... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS 2005-2007 Crop Disaster Program § 760.818 Marketing contracts. (a) A marketing contract must meet all of the conditions outlined in paragraphs (b), (c), and (d...

7 CFR 760.818 - Marketing contracts.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 7 2012-01-01 2012-01-01 false Marketing contracts. 760.818 Section 760.818... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS 2005-2007 Crop Disaster Program § 760.818 Marketing contracts. (a) A marketing contract must meet all of the conditions outlined in paragraphs (b), (c), and (d...

7 CFR 760.818 - Marketing contracts.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 7 2014-01-01 2014-01-01 false Marketing contracts. 760.818 Section 760.818... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS 2005-2007 Crop Disaster Program § 760.818 Marketing contracts. (a) A marketing contract must meet all of the conditions outlined in paragraphs (b), (c), and (d...

7 CFR 760.818 - Marketing contracts.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Marketing contracts. 760.818 Section 760.818... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS 2005-2007 Crop Disaster Program § 760.818 Marketing contracts. (a) A marketing contract must meet all of the conditions outlined in paragraphs (b), (c), and (d...

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

PubMed

2015-08-17

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.

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...

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...

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...

Learning Together: How Families Responded to Education Incentives in New York City's Conditional Cash Transfer Program. Executive Summary

ERIC Educational Resources Information Center

Greenberg, David; Dechausay, Nadine; Fraker, Carolyn

2011-01-01

In 2007, New York City's Center for Economic Opportunity launched Opportunity NYC-Family Rewards, an experimental, privately funded, conditional cash transfer (CCT) program to help families break the cycle of poverty. Family Rewards provided payments to low-income families in six of the city's poorest communities for achieving specific goals…

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...

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...

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...

77 FR 53257 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-31

... Electronic Device (CIED) Procedures c. New Candidate HAC Condition: Iatrogenic Pneumothorax With Venous Catheterization 6. RTI Program Evaluation Summary a. RTI Analysis of FY 2011 POA Indicator Reporting Across.... Hospital Inpatient Quality Reporting (IQR) Program 1. Background a. History of Measures Adopted for the...

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...

A Report On Eight Early-Stage State And Regional Projects Testing Value-Based Payment

PubMed Central

Conrad, Douglas; Grembowski, David; Gibbons, Claire; Marcus-Smith, Miriam; Hernandez, Susan E.; Chang, Judy; Renz, Anne; Lau, Bernard; Cruz, Erin dela

2014-01-01

To help contain health care spending and improve the quality of care, practitioners and policy makers are trying to move away from fee-for-service toward value-based payment, which links providers’ reimbursement to the value, rather than the volume, of services delivered. With funding from the Robert Wood Johnson Foundation, eight grantees across the country are designing and implementing value-based payment reform projects. For example, in Salem, Oregon, the Physicians Choice Foundation is testing “Program Oriented Payments,” which include incentives for providers who follow a condition-specific program of care designed to meet goals set jointly by patient and provider. In this article we describe the funding rationale and the specific objectives, strategies, progress, and early stages of implementation of the eight projects. We also share some early lessons and identify prerequisites for success, such as ensuring that providers have broad and timely access to data so they can meet patients’ needs in cost-effective ways. PMID:23650332

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...

20 CFR 627.300 - Scope and purpose.

Code of Federal Regulations, 2010 CFR

2010-04-01

... for benefits and working conditions for JTPA participants. These include requirements for: Compliance... there is no State workers' compensation coverage; and working conditions which are not detrimental to... PROGRAMS UNDER TITLES I, II, AND III OF THE ACT Payments, Supportive Services, and Benefits and Working...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... deficiencies. (e) The failure to meet one or more of the applicable conditions of participation is cause for...

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.

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...

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...

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...

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...

7 CFR 1951.871 - Post award requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... regulations, the loan agreement, the approved work program, security interests, and other conditions which Fm... programs must maintain separate ledgers and segregated accounts for RDLF funds at all times. (d) Reporting... such loan. (f) All loan payments that are due on RDLF loans will be made payable to the Farmers Home...

78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... develop and test innovative health care payment and service delivery models that show promise of reducing program expenditures, while preserving or enhancing the quality of care for Medicare, Medicaid, and... disease (ESRD). This population has complex health care needs, typically with comorbid conditions and...

76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-17

... under section 1903 of the Social Security Act for any amounts expended for providing medical assistance... (the Act) authorizes Federal grants to the States for Medicaid programs to provide medical assistance... all Federal requirements. The Federal government pays its share of medical assistance expenditures to...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... specified in § 442.105. (e) The failure to meet one or more of the applicable conditions of participation is...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... specified in § 442.105. (e) The failure to meet one or more of the applicable conditions of participation is...

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...

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...

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...

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...

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...

Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

PubMed

2017-01-03

This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

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...

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.

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...

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...

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...

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...

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...

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...

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...

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...

Statement of the Declaration of Istanbul Custodian Group Regarding Payments to Families of Deceased Organ Donors.

PubMed

Capron, Alexander Morgan; Delmonico, Francis L; Dominguez-Gil, Beatriz; Martin, Dominique Elizabeth; Danovitch, Gabriel M; Chapman, Jeremy

2016-09-01

Governmental and private programs that pay next of kin who give permission for the removal of their deceased relative's organs for transplantation exist in a number of countries. Such payments, which may be given to the relatives or paid directly for funeral expenses or hospital bills unrelated to being a donor, aim to increase the rate of donation. The Declaration of Istanbul Custodian Group-in alignment with the World Health Organization Guiding Principles and the Council of Europe Convention Against Trafficking in Human Organs-has adopted a new policy statement opposing such practices. Payment programs are unwise because they produce a lower rate of donations than in countries with voluntary, unpaid programs; associate deceased donation with being poor and marginal in society; undermine public trust in the determination of death; and raise doubts about fair allocation of organs. Most important, allowing families to receive money for donation from a deceased person, who is at no risk of harm, will make it impossible to sustain prohibitions on paying living donors, who are at risk. Payment programs are also unethical. Tying coverage for funeral expenses or healthcare costs to a family allowing organs to be procured is exploitative, not "charitable." Using payment to overcome reluctance to donate based on cultural or religious beliefs especially offends principles of liberty and dignity. Finally, while it is appropriate to make donation "financially neutral"-by reimbursing the added medical costs of evaluating and maintaining a patient as a potential donor-such reimbursement may never be conditioned on a family agreeing to donate.

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...

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

PubMed

2014-08-22

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Protecting Access to Medicare Act of 2014, and other legislation. These changes are applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2014. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014. In addition, we discuss our proposals on the interruption of stay policy for LTCHs and on retiring the "5 percent" payment adjustment for collocated LTCHs. While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revising requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers. We are aligning the reporting and submission timelines for clinical quality measures for the Medicare HER Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program. In addition, we provide guidance and clarification of certain policies for eligible hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions. In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.

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...

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals. Final rule.

PubMed

2016-08-22

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and making technical corrections and changes to regulations relating to costs to related organizations and Medicare cost reports; we are providing notice of the closure of three teaching hospitals and the opportunity to apply for available GME resident slots under section 5506 of the Affordable Care Act. We are finalizing the provisions of interim final rules with comment period that relate to a temporary exception for certain wound care discharges from the application of the site neutral payment rate under the LTCH PPS for certain LTCHs; application of two judicial decisions relating to modifications of limitations on redesignation by the Medicare Geographic Classification Review Board; and legislative extensions of the Medicare-dependent, small rural hospital program and changes to the payment adjustment for low-volume hospitals.

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...

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...

38 CFR 21.266 - Payment of subsistence allowance under special conditions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Vocational Rehabilitation and... rehabilitation program under Chapter 31 while hospitalized in a VA medical center or in any other hospital at VA... provided under § 21.264 that may be paid to a veteran pursuing a rehabilitation program for any month for...

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).

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...

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...

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...

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...

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.

Global Patterns in the Implementation of Payments for Environmental Services

PubMed Central

Ezzine-de-Blas, Driss; Wunder, Sven; Ruiz-Pérez, Manuel; Moreno-Sanchez, Rocio del Pilar

2016-01-01

Assessing global tendencies and impacts of conditional payments for environmental services (PES) programs is challenging because of their heterogeneity, and scarcity of comparative studies. This meta-study systematizes 55 PES schemes worldwide in a quantitative database. Using categorical principal component analysis to highlight clustering patterns, we reconfirm frequently hypothesized differences between public and private PES schemes, but also identify diverging patterns between commercial and non-commercial private PES vis-à-vis their service focus, area size, and market orientation. When do these PES schemes likely achieve significant environmental additionality? Using binary logistical regression, we find additionality to be positively influenced by three theoretically recommended PES ‘best design’ features: spatial targeting, payment differentiation, and strong conditionality, alongside some contextual controls (activity paid for and implementation time elapsed). Our results thus stress the preeminence of customized design over operational characteristics when assessing what determines the outcomes of PES implementation. PMID:26938065

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...

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...

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...

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 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...

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...

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...

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...

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...

Medicare program; FY 2015 hospice wage index and payment rate update; hospice quality reporting requirements and process and appeals for Part D payment for drugs for beneficiaries enrolled in hospice. Final rule.

PubMed

2014-08-22

This final rule will update the hospice payment rates and the wage index for fiscal year (FY) 2015 and continue the phase-out of the wage index budget neutrality adjustment factor (BNAF). This rule provides an update on hospice payment reform analyses, potential definitions of "terminal illness'' and "related conditions,'' and information on potential processes and appeals for Part D payment for drugs while beneficiaries are under a hospice election. This rule will specify timeframes for filing the notice of election and the notice of termination/revocation; add the attending physician to the hospice election form, and require hospices to document changes to the attending physician; require hospices to complete their hospice aggregate cap determinations within 5 months after the cap year ends, and remit any overpayments; and update the hospice quality reporting program. In addition, this rule will provide guidance on determining hospice eligibility; information on the delay in the implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM); and will further clarify how hospices are to report diagnoses on hospice claims. Finally, the rule will make a technical regulations text change.

Identifying hospitals that may be at most financial risk from Medicaid disproportionate-share hospital payment cuts.

PubMed

Cole, Evan S; Walker, Daniel; Mora, Arthur; Diana, Mark L

2014-11-01

Medicaid disproportionate-share hospital (DSH) payments are expected to decline by $35.1 billion between fiscal years 2017 and 2024, a reduction brought about by the Affordable Care Act (ACA) and recent congressional action. DSH payments have long been a feature of the Medicaid program, intended to partially offset uncompensated care costs incurred by hospitals that treat uninsured and Medicaid populations. The DSH payment cuts were predicated on the expectation that the ACA's expansion of health insurance to millions of Americans would bring about a decline in many hospitals' uncompensated care costs. However, the decision of twenty-five states not to expand their Medicaid programs, combined with residual coverage gaps, may leave as many as thirty million people uninsured, and hospitals will bear the burden of their uncompensated care costs. We sought to identify the hospitals that may be the most financially vulnerable to reductions in Medicaid DSH payments. We found that of the 529 acute care hospitals that will be particularly affected by the cuts, 225 (42.5 percent) are in weak financial condition. Policy makers should recognize that decreases in revenue may affect these hospitals' ability to give vulnerable populations access to care. Project HOPE—The People-to-People Health Foundation, Inc.

45 CFR 1801.51 - Report at the beginning of each term.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.51 Report at the beginning of each term. (a) To receive a Scholarship stipend, a Scholar must submit a current...

45 CFR 1801.51 - Report at the beginning of each term.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.51 Report at the beginning of each term. (a) To receive a Scholarship stipend, a Scholar must submit a current...

45 CFR 1801.51 - Report at the beginning of each term.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.51 Report at the beginning of each term. (a) To receive a Scholarship stipend, a Scholar must submit a current...

45 CFR 1801.51 - Report at the beginning of each term.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.51 Report at the beginning of each term. (a) To receive a Scholarship stipend, a Scholar must submit a current...

The impact of an online disease management program on medical costs among health plan members.

PubMed

Schwartz, Steven M; Day, Brian; Wildenhaus, Kevin; Silberman, Anna; Wang, Chun; Silberman, Jordan

2010-01-01

This study evaluated the economic impact of an online disease management program within a broader population health management strategy. A retrospective, quasi-experimental, cohort design evaluated program participants and a matched cohort of nonparticipants on 2003-2007 claims data in a mixed model. The study was conducted through Highmark Inc, Blue Cross Blue Shield, covering 4.8 million members in five regions of Pennsylvania. Overall, 413 online self-management program participants were compared with a matched cohort of 360 nonparticipants. The costs and claims data were measured per person per calendar year. Total payments were aggregated from inpatient, outpatient, professional services, and pharmacy payments. The costs of the online program were estimated on a per-participant basis. All dollars were adjusted to 2008 values. The online intervention, implemented in 2006, was a commercially available, tailored program for chronic condition self management, nested within the Blues on Call(SM) condition management strategy. General linear modeling (with covariate adjustment) was used. Data trends were also explored using second-order polynomial regressions. Health care costs per person per year were $757 less than predicted for participants relative to matched nonparticipants, yielding a return on investment of $9.89 for every dollar spent on the program. This online intervention showed a favorable and cost-effective impact on health care cost.

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...

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...

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...

78 FR 57800 - Medicare Program; Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-20

... of facilities or network(s); terror threats; strikes and similar labor actions; civil unrest... network(s). (3) Terror threats; strikes and similar labor actions. (4) Civil unrest, uprising or riot. (5...

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...

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...

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...

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...

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.

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...

42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payment system for inpatient rehabilitation facilities. 412.604 Section 412.604 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for payment under the prospective payment system for inpatient...

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 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...

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...

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...

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...

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...

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...

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.

Evaluation of the Permanence of Land Use Change Induced by Payments for Environmental Services in Quindío, Colombia.

PubMed

Pagiola, Stefano; Honey-Rosés, Jordi; Freire-González, Jaume

2016-01-01

The effectiveness of conservation interventions such as Payments for Environmental Services (PES) is often evaluated--if it is evaluated at all--only at the completion of the intervention. Since gains achieved by the intervention may be lost after it ends, even apparently successful interventions may not result in long-term conservation benefits, a problem known as that of permanence. This paper uses a unique dataset to examine the permanence of land use change induced by a short-term, asset-building PES program implemented in Quindío, Colombia, between 2003 and 2008. This the first PES program to have a control group for comparison. Under this program, PES had been found to have a positive and highly significant impact on land use. To assess the long-term permanence of these changes, both PES recipients and control households were re-surveyed in 2011, four years after the last payment was made. We find that the land use changes that had been induced by PES were broadly sustained in intervening years, with minor differences across specific practices and sub-groups of participants, indicating that these changes were in fact permanent. The patterns of change in the period after the PES program was completed also help better understand the reasons for the program's success. These results suggest that, at least in the case of productive land uses such as silvopastoral practices under conditions such as those at the study site, asset-building PES programs can be effective at encouraging land owners to adopt environmentally-beneficial land management practices and that the benefits will persist after payments cease.

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.

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.

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...

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...

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...

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...

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...

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...

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...

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...

Effects of payments for ecosystem services on wildlife habitat recovery.

PubMed

Tuanmu, Mao-Ning; Viña, Andrés; Yang, Wu; Chen, Xiaodong; Shortridge, Ashton M; Liu, Jianguo

2016-08-01

Conflicts between local people's livelihoods and conservation have led to many unsuccessful conservation efforts and have stimulated debates on policies that might simultaneously promote sustainable management of protected areas and improve the living conditions of local people. Many government-sponsored payments-for-ecosystem-services (PES) schemes have been implemented around the world. However, few empirical assessments of their effectiveness have been conducted, and even fewer assessments have directly measured their effects on ecosystem services. We conducted an empirical and spatially explicit assessment of the conservation effectiveness of one of the world's largest PES programs through the use of a long-term empirical data set, a satellite-based habitat model, and spatial autoregressive analyses on direct measures of change in an ecosystem service (i.e., the provision of wildlife species habitat). Giant panda (Ailuropoda melanoleuca) habitat improved in Wolong Nature Reserve of China after the implementation of the Natural Forest Conservation Program. The improvement was more pronounced in areas monitored by local residents than those monitored by the local government, but only when a higher payment was provided. Our results suggest that the effectiveness of a PES program depends on who receives the payment and on whether the payment provides sufficient incentives. As engagement of local residents has not been incorporated in many conservation strategies elsewhere in China or around the world, our results also suggest that using an incentive-based strategy as a complement to command-and-control, community- and norm-based strategies may help achieve greater conservation effectiveness and provide a potential solution for the park versus people conflict. © 2016 Society for Conservation Biology.

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

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.

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…

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...

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...

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...

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...

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...

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...

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...

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...

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...

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.

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...

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...

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.

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

7 CFR 786.104 - Eligibility.

Code of Federal Regulations, 2013 CFR

2013-01-01

... previous dairy disaster payment program, during the claim period applicable to a natural disaster... were incurred as a result of a disaster for which an applicable natural disaster declaration was issued... counties, specific to conditions resulting from the declared disaster as described in the natural disaster...

7 CFR 786.104 - Eligibility.

Code of Federal Regulations, 2012 CFR

2012-01-01

... previous dairy disaster payment program, during the claim period applicable to a natural disaster... were incurred as a result of a disaster for which an applicable natural disaster declaration was issued... counties, specific to conditions resulting from the declared disaster as described in the natural disaster...

7 CFR 786.104 - Eligibility.

Code of Federal Regulations, 2011 CFR

2011-01-01

... previous dairy disaster payment program, during the claim period applicable to a natural disaster... were incurred as a result of a disaster for which an applicable natural disaster declaration was issued... counties, specific to conditions resulting from the declared disaster as described in the natural disaster...

7 CFR 786.104 - Eligibility.

Code of Federal Regulations, 2014 CFR

2014-01-01

... previous dairy disaster payment program, during the claim period applicable to a natural disaster... were incurred as a result of a disaster for which an applicable natural disaster declaration was issued... counties, specific to conditions resulting from the declared disaster as described in the natural disaster...

42 CFR 441.13 - Prohibitions on FFP: Institutionalized individuals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... institution for mental diseases, except an individual who is under age 22 and receiving inpatient psychiatric... receiving inpatient psychiatric services), payments to institutions for the mentally retarded or persons with related conditions and to psychiatric facilities or programs providing inpatient psychiatric...

The Impact of the Medicaid Health Care-Associated Condition Program on Mediastinitis Following Coronary Artery Bypass Graft

PubMed Central

Hsu, Heather; Kawai, Alison Tse; Wang, Rui; Jentzsch, Maximilian S.; Rhee, Chanu; Horan, Kelly; Jin, Robert; Goldmann, Donald; Lee, Grace M.

2018-01-01

Objective In 2012, the Centers for Medicare and Medicaid Services expanded a 2008 program that eliminated additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) to include Medicaid. We aimed to evaluate the impact of this Medicaid program on mediastinitis rates reported by the National Healthcare Safety Network (NHSN) compared with rates of a condition not targeted by the program (deep space surgical site infection [SSI] after knee replacement). Design interrupted time series with comparison group. Methods We included surveillance data from non-federal acute care hospitals participating in NHSN and reporting CABG or knee replacement outcomes from 1/2009–6/2017. We examined the Medicaid program’s impact on NHSN-reported infection rates, adjusting for secular trends. Data analysis used generalized estimating equations with robust sandwich variance estimators. Results During the study period, 196 study hospitals reported 273,984 CABGs to NHSN, resulting in 970 mediastinitis cases (0.35%); 294 hospitals reported 555,395 knee replacements, with 1,751 resultant deep space SSIs (0.32%). There were no significant changes in incidence of either condition during the study. Mediastinitis models showed no effect of the 2012 Medicaid program on either secular trend during the post- vs. pre-program time periods (p-value=0.70) or immediate program effect (p-value=0.83). Results were similar in sensitivity analyses when adjusting for hospital characteristics, restricting to hospitals with consistent NHSN reporting, or incorporating a program implementation roll-in period. Knee replacement models also showed no program effect. Conclusions The 2012 Medicaid program to eliminate additional payments for mediastinitis following CABG had no impact on reported mediastinitis rates. PMID:29669607

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...

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...

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...

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...

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...

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...

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...

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...

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...

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.

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...

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...

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...

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...

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...

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.

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...

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.

42 CFR 442.14 - Effect of change of ownership.

Code of Federal Regulations, 2010 CFR

2010-10-01

....14 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... agreement is subject to all applicable statutes and regulations and to the terms and conditions under which...

34 CFR 280.40 - What costs are allowable?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION MAGNET SCHOOLS ASSISTANCE PROGRAM What Conditions Must Be Met by a... skills. (c) The payment or subsidization of the compensation of elementary and secondary school teachers...

34 CFR 280.40 - What costs are allowable?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION MAGNET SCHOOLS ASSISTANCE PROGRAM What Conditions Must Be Met by a... skills. (c) The payment or subsidization of the compensation of elementary and secondary school teachers...

45 CFR 1801.54 - Annual report.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.54 Annual report. (a) Scholars with remaining eligibility for scholarship stipends must submit no later than July 15 an annual report to the...

45 CFR 1801.54 - Annual report.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.54 Annual report. (a) Scholars with remaining eligibility for scholarship stipends must submit no later than July 15 an annual report to the...

45 CFR 1801.54 - Annual report.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.54 Annual report. (a) Scholars with remaining eligibility for scholarship stipends must submit no later than July 15 an annual report to the...

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...

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...

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...

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.

Does the benefits schedule of cash assistance programs affect the purchase of temptation goods? Evidence from Peru.

PubMed

White, Justin S; Basu, Sanjay

2016-03-01

A critique of cash assistance programs is that beneficiaries may spend the money on "temptation goods" such as alcohol and tobacco. We exploit a change in the payment schedule of Peru's conditional cash transfer program to identify the impact of benefit receipt frequency on the purchase of temptation goods. We use annual household data among cross-sectional and panel samples to analyze the effect of the policy change on the share of the household budget devoted to four categories of temptation goods. Using a difference-in-differences estimation approach, we find that larger, less frequent payments increased the expenditure share of alcohol by 55-80% and sweets by 10-40%, although the absolute magnitudes of these effects are small. Our study suggests that less frequent benefits scheduling may lead cash recipients to make certain types of temptation purchases. Copyright © 2016 Elsevier B.V. All rights reserved.

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Scholarship Program: 1979-80 Report to Congress. Report of the Secretary of Health and Human Services on the Administration of the National Health Service Corps Scholarship Program as Required by Section 751(i) of Title VII of the Public Health Service Act, as Amended, December 12, 1979.

ERIC Educational Resources Information Center

Health Resources Administration (DHHS/PHS), Hyattsville, MD.

The status of the National Health Service Corps Scholarship Program is examined in this third annual report with cumulative data from inception of the program. The scholarship award includes the payment of a monthly stipend, tuition and fees, and other educational expenses in a federal program of service-conditional awards for students of…

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...

48 CFR 13.402 - Conditions for use.

Code of Federal Regulations, 2011 CFR

2011-10-01

... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.402 Conditions for use. If the conditions in paragraphs (a) through (f) of this section are present, the fast payment... purchase. The conditions for use of the fast payment procedure are as follows: (a) Individual purchasing...

48 CFR 13.402 - Conditions for use.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.402 Conditions for use. If the conditions in paragraphs (a) through (f) of this section are present, the fast payment... purchase. The conditions for use of the fast payment procedure are as follows: (a) Individual purchasing...

48 CFR 13.402 - Conditions for use.

Code of Federal Regulations, 2013 CFR

2013-10-01

... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.402 Conditions for use. If the conditions in paragraphs (a) through (f) of this section are present, the fast payment... purchase. The conditions for use of the fast payment procedure are as follows: (a) Individual purchasing...

48 CFR 13.402 - Conditions for use.

Code of Federal Regulations, 2012 CFR

2012-10-01

... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.402 Conditions for use. If the conditions in paragraphs (a) through (f) of this section are present, the fast payment... purchase. The conditions for use of the fast payment procedure are as follows: (a) Individual purchasing...

48 CFR 13.402 - Conditions for use.

Code of Federal Regulations, 2014 CFR

2014-10-01

... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.402 Conditions for use. If the conditions in paragraphs (a) through (f) of this section are present, the fast payment... purchase. The conditions for use of the fast payment procedure are as follows: (a) Individual purchasing...

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

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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).

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...

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...

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...

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...

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...

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...

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...

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...

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...

42 CFR 415.102 - Conditions for fee schedule payment for physician services to beneficiaries in providers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... case of radiology or laboratory services, the additional requirements in § 415.120 or § 415.130... conditions for payment for radiology services) and 415.130 (concerning conditions for payment for physician...

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.

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...

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

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.

31 CFR 50.14 - Separate line item.

Code of Federal Regulations, 2010 CFR

2010-07-01

....14 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.14 Separate line item. An insurer is deemed to be in compliance with the requirement of providing disclosure on a “separate line item in the policy...

31 CFR 50.10 - General disclosure requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false General disclosure requirements. 50.10 Section 50.10 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.10 General disclosure requirements. (a...

38 CFR 21.9720 - Certification of enrollment.

Code of Federal Regulations, 2013 CFR

2013-07-01

... between school years. (3) When an eligible individual enrolls in a distance learning program leading to a... Certification of enrollment. Except as stated in § 21.9680, an institution of higher learning must certify an... higher learning must certify most enrollments. VA does not, as a condition of payment of tuition...

38 CFR 21.9720 - Certification of enrollment.

Code of Federal Regulations, 2012 CFR

2012-07-01

... between school years. (3) When an eligible individual enrolls in a distance learning program leading to a... Certification of enrollment. Except as stated in § 21.9680, an institution of higher learning must certify an... higher learning must certify most enrollments. VA does not, as a condition of payment of tuition...

38 CFR 21.9720 - Certification of enrollment.

Code of Federal Regulations, 2011 CFR

2011-07-01

... between school years. (3) When an eligible individual enrolls in a distance learning program leading to a... Certification of enrollment. Except as stated in § 21.9680, an institution of higher learning must certify an... higher learning must certify most enrollments. VA does not, as a condition of payment of tuition...

38 CFR 21.9720 - Certification of enrollment.

Code of Federal Regulations, 2014 CFR

2014-07-01

... between school years. (3) When an eligible individual enrolls in a distance learning program leading to a... Certification of enrollment. Except as stated in § 21.9680, an institution of higher learning must certify an... higher learning must certify most enrollments. VA does not, as a condition of payment of tuition...

31 CFR 50.11 - Definition.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false Definition. 50.11 Section 50.11 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.11 Definition. For purposes of this subpart, unless the...

31 CFR 50.10 - General disclosure requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false General disclosure requirements. 50.10 Section 50.10 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.10 General disclosure requirements. (a...

31 CFR 50.10 - General disclosure requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false General disclosure requirements. 50.10 Section 50.10 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.10 General disclosure requirements. (a...

31 CFR 50.11 - Definition.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Definition. 50.11 Section 50.11 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.11 Definition. For purposes of this subpart, unless the...

31 CFR 50.10 - General disclosure requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false General disclosure requirements. 50.10 Section 50.10 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.10 General disclosure requirements. (a...

31 CFR 50.11 - Definition.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Definition. 50.11 Section 50.11 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.11 Definition. For purposes of this subpart, unless the...

31 CFR 50.10 - General disclosure requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false General disclosure requirements. 50.10 Section 50.10 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.10 General disclosure requirements. (a...

31 CFR 50.11 - Definition.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Definition. 50.11 Section 50.11 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.11 Definition. For purposes of this subpart, unless the...

45 CFR 1801.50 - Acceptance of the scholarship.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Acceptance of the scholarship. 1801.50 Section 1801.50 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.50 Acceptance of the...

45 CFR 1801.50 - Acceptance of the scholarship.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 4 2011-10-01 2011-10-01 false Acceptance of the scholarship. 1801.50 Section 1801.50 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.50 Acceptance of the...

45 CFR 1801.50 - Acceptance of the scholarship.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 4 2014-10-01 2014-10-01 false Acceptance of the scholarship. 1801.50 Section 1801.50 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.50 Acceptance of the...

45 CFR 1801.50 - Acceptance of the scholarship.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false Acceptance of the scholarship. 1801.50 Section 1801.50 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.50 Acceptance of the...

45 CFR 1801.50 - Acceptance of the scholarship.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 4 2013-10-01 2013-10-01 false Acceptance of the scholarship. 1801.50 Section 1801.50 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.50 Acceptance of the...

42 CFR 423.871 - Contract terms and conditions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... following: (i) Costs. The entity contains costs to the Medicare Prescription Drug Account and to Part D... such as generic substitution and price discounts. (ii) Quality programs. The entity provides the... a fallback entity includes terms for payment for— (1) The actual costs of covered Part D drugs...

42 CFR 423.871 - Contract terms and conditions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... following: (i) Costs. The entity contains costs to the Medicare Prescription Drug Account and to Part D... such as generic substitution and price discounts. (ii) Quality programs. The entity provides the... a fallback entity includes terms for payment for— (1) The actual costs of covered Part D drugs...

45 CFR 1801.54 - Annual report.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false Annual report. 1801.54 Section 1801.54 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.54 Annual report. (a) Scholars with remaining eligibility for scholarship...

7 CFR 760.1104 - Application for payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... provided. (e) A minor child is eligible to apply for program benefits if all eligibility requirements are met and one of the following conditions exists: (1) The right of majority has been conferred upon the minor by court proceedings or statute; (2) A guardian has been appointed to manage the minor's property...

31 CFR 50.11 - Definition.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Definition. 50.11 Section 50.11 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.11 Definition. For purposes of this subpart, unless the...

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...

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...

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...

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...

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...

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...

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...

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.

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

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.

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices. Final rule.

PubMed

2017-08-14

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey reports and plans of correction of providers and suppliers; electronic signature and electronic submission of the Certification and Settlement Summary page of the Medicare cost reports; and clarification of provider disposal of assets.

Bundled payment and enhanced recovery after surgery.

PubMed

Huang, Jeffrey

2015-01-01

Medicare's fee-for-service (FFS) payment model may contribute to unsustainable spending growth. Payers are turning to alternative payment methods. The leading alternative payment model to the FFS problem is bundled payment. The Centers for Medicare & Medicaid Services (CMS) is taking another step to improve healthcare quality at lower cost. The CMS's Center for Medicare and Medicaid Innovation developed four models of bundled payments and 48 discrete clinical condition episodes. Many surgical care procedures are included in the 48 different clinical condition episodes.

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] ...

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...

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...

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...

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...

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...

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...

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...

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

42 CFR 415.130 - Conditions for payment: Physician pathology services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Conditions for payment: Physician pathology... Physician Services to Beneficiaries in Providers § 415.130 Conditions for payment: Physician pathology... of physician pathology services to fee-for-service Medicare beneficiaries who were hospital...

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.

The response of substance use disorder treatment providers to changes in macroeconomic conditions.

PubMed

Cantor, Jonathan; Stoller, Kenneth B; Saloner, Brendan

2017-10-01

To study how substance use disorder (SUD) treatment providers respond to changes in economic conditions. 2000-2012 National Survey of Substance Abuse Treatment Services (N-SSATS) which contains detailed information on specialty SUD facilities in the United States. We use fixed-effects regression to study how changes in economic conditions, proxied by state unemployment rates, impact treatment setting, accepted payment forms, charity care, offered services, special programs, and use of pharmacotherapies by specialty SUD treatment providers. Secondary data analysis in the N-SSATS. Our findings suggest a one percentage point increase in the state unemployment rate is associated with a 2.5% reduction in outpatient clients by non-profit providers and a 1.8% increase in the acceptance of private insurance as a form of payment overall. We find no evidence that inpatient treatment, the provision of charity care, offered services, or special programs are impacted by changes in the state unemployment rate. However, a one percentage point increase in the state unemployment rate leads to a 2.5% increase in the probability that a provider uses pharmacotherapies to treat addiction. Deteriorating economic conditions may increase financial pressures on treatment providers, prompting them to seek new sources of revenue or to change their care delivery models. Copyright © 2017 Elsevier Inc. All rights reserved.

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 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...

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. ...

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. ...

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. ...

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...

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...

38 CFR 21.9675 - Conditions that result in reduced rates or no payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... reduced rates or no payment. 21.9675 Section 21.9675 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF... Assistance § 21.9675 Conditions that result in reduced rates or no payment. The payment rates as established... the requirements for graduation. VA may pay educational assistance for a course from which the...

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...

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...

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...

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...

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...

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.

42 CFR 415.120 - Conditions for payment: Radiology services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions for payment: Radiology services. 415.120... Services to Beneficiaries in Providers § 415.120 Conditions for payment: Radiology services. (a) Services to beneficiaries. The carrier pays for radiology services furnished by a physician to a beneficiary...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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

48 CFR 552.270-31 - Prompt Payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Payment. As prescribed in 570.703, insert the following clause: Prompt Payment (JUN 2011) The Government will make payments under the terms and conditions specified in this clause. Payment shall be considered...

48 CFR 552.270-31 - Prompt Payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Payment. As prescribed in 570.703, insert the following clause: Prompt Payment (JUN 2011) The Government will make payments under the terms and conditions specified in this clause. Payment shall be considered...

48 CFR 552.270-31 - Prompt Payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Payment. As prescribed in 570.703, insert the following clause: Prompt Payment (JUN 2011) The Government will make payments under the terms and conditions specified in this clause. Payment shall be considered...

48 CFR 552.270-31 - Prompt Payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Payment. As prescribed in 570.703, insert the following clause: Prompt Payment (JUN 2011) The Government will make payments under the terms and conditions specified in this clause. Payment shall be considered...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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 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...

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...

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...

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...

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...

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...

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...

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...

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...

31 CFR 50.13 - Offer, purchase, and renewal.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 50.13 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.13 Offer, purchase, and renewal. An insurer is deemed to be in compliance with the requirement of providing disclosure “at the time of offer, purchase...

31 CFR 50.15 - Cap disclosure.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false Cap disclosure. 50.15 Section 50.15 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.15 Cap disclosure. (a) General. Under section 103(e)(2) of...

31 CFR 50.17 - Use of model forms.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Use of model forms. 50.17 Section 50.17 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.17 Use of model forms. (a) Policies in force on...

31 CFR 50.15 - Cap disclosure.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Cap disclosure. 50.15 Section 50.15 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.15 Cap disclosure. (a) General. Under section 103(e)(2) of...

31 CFR 50.15 - Cap disclosure.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Cap disclosure. 50.15 Section 50.15 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.15 Cap disclosure. (a) General. Under section 103(e)(2) of...

31 CFR 50.14 - Separate line item.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false Separate line item. 50.14 Section 50.14 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.14 Separate line item. An insurer is deemed to...

31 CFR 50.17 - Use of model forms.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Use of model forms. 50.17 Section 50.17 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.17 Use of model forms. (a) Policies in force on...

31 CFR 50.14 - Separate line item.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Separate line item. 50.14 Section 50.14 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.14 Separate line item. An insurer is deemed to...

31 CFR 50.15 - Cap disclosure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Cap disclosure. 50.15 Section 50.15 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.15 Cap disclosure. (a) General. Under section 103(e)(2) of...

31 CFR 50.17 - Use of model forms.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Use of model forms. 50.17 Section 50.17 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.17 Use of model forms. (a) Policies in force on...

31 CFR 50.14 - Separate line item.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Separate line item. 50.14 Section 50.14 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.14 Separate line item. An insurer is deemed to...

31 CFR 50.14 - Separate line item.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Separate line item. 50.14 Section 50.14 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.14 Separate line item. An insurer is deemed to...

31 CFR 50.17 - Use of model forms.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false Use of model forms. 50.17 Section 50.17 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.17 Use of model forms. (a) Policies in force on...

75 FR 21207 - Medicare Program; Ambulatory Surgical Centers, Conditions for Coverage

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-23

..., Department of Health and Human Services, Attention: CMS-3217-P, P.O. Box 8010, Baltimore, MD 21244-8010... for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-3217-P, Mail... under section 1833(i)(2) of the Act as full payment for services, and to accept assignment of benefits...

42 CFR 410.165 - Payment for rural health clinic services and ambulatory surgical center services: Conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for rural health clinic services and... (SMI) BENEFITS Payment of SMI Benefits § 410.165 Payment for rural health clinic services and ambulatory surgical center services: Conditions. (a) Medicare Part B pays for covered rural health clinic and...

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.

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...

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.

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 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...

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...

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...

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...

24 CFR 891.445 - Conditions for receipt of vacancy payments for assisted units.

Code of Federal Regulations, 2010 CFR

2010-04-01

... DISABILITIES Project Management § 891.445 Conditions for receipt of vacancy payments for assisted units. (a... project rental assistance payments set forth in this section are fulfilled. (b) Vacancies during rent-up...

24 CFR 891.445 - Conditions for receipt of vacancy payments for assisted units.

Code of Federal Regulations, 2012 CFR

2012-04-01

... DISABILITIES Project Management § 891.445 Conditions for receipt of vacancy payments for assisted units. (a... project rental assistance payments set forth in this section are fulfilled. (b) Vacancies during rent-up...

24 CFR 891.445 - Conditions for receipt of vacancy payments for assisted units.

Code of Federal Regulations, 2013 CFR

2013-04-01

... DISABILITIES Project Management § 891.445 Conditions for receipt of vacancy payments for assisted units. (a... project rental assistance payments set forth in this section are fulfilled. (b) Vacancies during rent-up...

24 CFR 891.445 - Conditions for receipt of vacancy payments for assisted units.

Code of Federal Regulations, 2014 CFR

2014-04-01

... DISABILITIES Project Management § 891.445 Conditions for receipt of vacancy payments for assisted units. (a... project rental assistance payments set forth in this section are fulfilled. (b) Vacancies during rent-up...

24 CFR 891.445 - Conditions for receipt of vacancy payments for assisted units.

Code of Federal Regulations, 2011 CFR

2011-04-01

... DISABILITIES Project Management § 891.445 Conditions for receipt of vacancy payments for assisted units. (a... project rental assistance payments set forth in this section are fulfilled. (b) Vacancies during rent-up...

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.

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...

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...

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...

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...

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...

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...

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...

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.

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...

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.

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...

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...

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...

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...

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...

Patient Protection and Affordable Care Act; standards related to reinsurance, risk corridors, and risk adjustment. Final rule.

PubMed

2012-03-23

This final rule implements standards for States related to reinsurance and risk adjustment, and for health insurance issuers related to reinsurance, risk corridors, and risk adjustment consistent with title I of the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. These programs will mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the Affordable Insurance Exchanges ("Exchanges") are implemented, starting in 2014. The transitional State-based reinsurance program serves to reduce uncertainty by sharing risk in the individual market through making payments for high claims costs for enrollees. The temporary Federally administered risk corridors program serves to protect against uncertainty in rate setting by qualified health plans sharing risk in losses and gains with the Federal government. The permanent State-based risk adjustment program provides payments to health insurance issuers that disproportionately attract high-risk populations (such as individuals with chronic conditions).

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Cost savings associated with an alternative payment model for integrating behavioral health in primary care.

PubMed

Ross, Kaile M; Gilchrist, Emma C; Melek, Stephen P; Gordon, Patrick D; Ruland, Sandra L; Miller, Benjamin F

2018-05-23

Financially supporting and sustaining behavioral health services integrated into primary care settings remains a major barrier to widespread implementation. Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) was a demonstration project designed to prospectively examine the cost savings associated with utilizing an alternative payment methodology to support behavioral health services in primary care practices with integrated behavioral health services. Six primary care practices in Colorado participated in this project. Each practice had at least one on-site behavioral health clinician providing integrated behavioral health services. Three practices received non-fee-for-service payments (i.e., SHAPE payment) to support provision of behavioral health services for 18 months. Three practices did not receive the SHAPE payment and served as control practices for comparison purposes. Assignment to condition was nonrandom. Patient claims data were collected for 9 months before the start of the SHAPE demonstration project (pre-period) and for 18 months during the SHAPE project (post-period) to evaluate cost savings. During the 18-month post-period, analysis of the practices' claims data demonstrated that practices receiving the SHAPE payment generated approximately $1.08 million in net cost savings for their public payer population (i.e., Medicare, Medicaid, and Dual Eligible; N = 9,042). The cost savings were primarily achieved through reduction in downstream utilization (e.g., hospitalizations). The SHAPE demonstration project found that non-fee-for-service payments for behavioral health integrated into primary care may be associated with significant cost savings for public payers, which could have implications on future delivery and payment work in public programs (e.g., Medicaid).

Under Pressure: Financial Impact of the Hospital-Acquired Conditions Initiative. A Statewide Analysis of Pressure Ulcer Development and Payment

PubMed Central

Meddings, Jennifer A.; Reichert, Heidi; Rogers, Mary A. M.; Hofer, Timothy P.; McMahon, Laurence F.; Grazier, Kyle L.

2017-01-01

OBJECTIVE To assess the financial impact of the 2008 Hospital-Acquired Conditions Initiative’s pressure ulcer payment changes on Medicare and other payors. DESIGN, SETTING AND PARTICIPANTS Retrospective before-and-after study of all-payor statewide administrative data for >2.4 million annual adult discharges from 311 nonfederal acute-care California hospitals in 2007 and 2009, using the Healthcare Cost and Utilization Project State Inpatient Datasets. We assessed how often and by how much the 2008 payment changes for pressure ulcers affected hospital payment. MEASUREMENTS Pressure ulcer rates and hospital payment changes RESULTS Hospital-acquired pressure ulcer rates were very low (0.28%) in 2007 and 2009; present-on-admission pressure ulcer rates increased from 2.35% in 2007 to 3.00% in 2009. By clinical stage of pressure ulcer (available in 2009), hospital-acquired stage III–IV ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for stage III–IV hospital-acquired ulcers reduced payment in 75 (0.003%) discharges for a statewide payment decrease of $310,444 (0.001%) for all payors and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital-Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present-on-admission ulcers) reducing statewide payment by $62,538,586 (0.21%) for all payors and $47,237,984 (0.32%) for Medicare. CONCLUSION The total financial impact of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than stages III–IV. The removal of payment for hospital-acquired stage III–IV ulcers was more than 200 times less than the removal of payment for other types of pressure ulcers that occurred in implementation of the Hospital-Acquired Conditions Initiative. PMID:26140454

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...

Optimizing claims payment for successful risk management.

PubMed

Frates, Janice; Ginty, Mary Jo; Baker, Linda

2002-05-01

Disputed claims and delayed payments are among the principal sources of provider and vendor dissatisfaction with managed care payment systems. Timely and accurate claims-payment systems are essential to ensure provider and vendor satisfaction, fiscal stability, and regulatory compliance. A focused analysis of conditions contributing to late payment of claims can disclose problems in provider, vendor, or payer operational and billing procedures, contracting processes, information systems, or human resources management. Resolution of these conditions equips claims-processing staff with tools to resolve problem claims promptly, thereby lowering costs.

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...

29 CFR 452.86 - Vote conditioned on payment of dues.

Code of Federal Regulations, 2010 CFR

2010-07-01

... where a member is laid off but desires to maintain his good standing and thus his membership rights by... AND DISCLOSURE ACT OF 1959 Right To Vote § 452.86 Vote conditioned on payment of dues. A labor organization may condition the exercise of the right to vote upon the payment of dues, which is a basic...

42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Conditions of payment: Assistants at surgery in... in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching hospitals. (a... schedule basis for the services of an assistant at surgery in a teaching hospital. This section is based on...

42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital. This...

42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital. This...

42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions of payment: Assistants at surgery in... in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching hospitals. (a... schedule basis for the services of an assistant at surgery in a teaching hospital. This section is based on...

42 CFR 415.190 - Conditions of payment: Assistants at surgery in teaching hospitals.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital. This...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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. ...

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. ...

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...

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...

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...