…-Time Prescription Benefit Criterion (d) New Certification Criteria for Modular API Capabilities (e) New Certification Criteria for Electronic Prior Authorization 3. Summary of Costs and Benefits B. Background Summary 1. Acute Care Hospital Inpatient Prospective Payment System (I…

…the IPPS for Operating Costs 4. Proposed FY 2021 Policy Governing the IPPS for Capital-Related Costs 5. Proposed Changes to the Payment Rates for Certain Excluded Hospitals: Rate-of-Increase Percentages 6. Proposed Changes to the LTCH PPS 7. Proposed Changes Relating to Quality D…

…the IPPS for Operating Costs 4. Proposed FY 2021 Policy Governing the IPPS for Capital-Related Costs 5. Proposed Changes to the Payment Rates for Certain Excluded Hospitals: Rate-of-Increase Percentages 6. Proposed Changes to the LTCH PPS 7. Proposed Changes Relating to Quality D…

…ical therapy services that are provided, in whole or in part, by a physical therapist assistant (PTA) or occupational therapy assistant (OTA). Section 1834(v)(2)(A) of the Act required CMS to establish modifiers to identify these services, which we did in the CY 2019 PFS final ru…

…ical therapy services that are provided, in whole or in part, by a physical therapist assistant (PTA) or occupational therapy assistant (OTA). Section 1834(v)(2)(A) of the Act required CMS to establish modifiers to identify these services, which we did in the CY 2019 PFS final ru…

… Analogous to Office/Outpatient E/M Visits (1) End-Stage Renal Disease Monthly Capitation Payment Services 2. TCM Services (CPT Codes 99495 and 99496) 3. Maternity Services 4. Assessment and Care Planning for Patients With Cognitive Impairment (CPT Code 99483) 5. Initial Preventi…

…ical therapy services that are provided, in whole or in part, by a physical therapist assistant (PTA) or occupational therapy assistant (OTA). Section 1834(v)(2)(A) of the Act required CMS to establish modifiers to identify these services, which we did in the CY 2019 PFS final ru…

…80504, 80505, and 80506) (29) Revaluing End-Stage Renal Disease (ESRD) Monthly Capitation Payment Services (MCP) (CPT Code 90954) (30) Colon Capsule Endoscopy (CPT Codes 91110, 91111, and 91113) (31) External Cardiovascular Device Monitoring (CPT Codes 93228 and 93229) (32) Elect…

…ed to New Technology APC Groups for CY 2024 a. Administration of Subretinal Therapies Requiring Vitrectomy (APC 1563) b. Bronchoscopy with Transbronchial Ablation of Lesion(s) by Microwave Energy (APC 1562) c. Cardiac Positron Emission Tomography (PET)/Computed Tomography (CT) St…

…ntions and Predictive Models vi. Synchronized Clocks Standard vii. Standardized API for Patient and Population Services viii. Patient Demographics and Observations Certification Criterion in § 170.315(a)(5) ix. Updates to Transitions of Care Certification Criterion in § 170.315(b…

…are services using a variety of care delivery systems (for example, FFS, fully-capitated managed care, partially capitated managed care, etc.), including through demonstrations and waiver programs. The volume of Medicaid beneficiaries enrolled in a managed care program in Medicai…

…urse Specialists, and Certified Registered Nurse Anesthetists (ii) Physical Therapists, Occupational Therapists, Clinical Social Workers, and Clinical Psychologists (6) APM Scoring Standard for MIPS Eligible Clinicians Participating in MIPS APMs (a) Overview (b) Summary of Propos…

…lizing the proposed methodology for benefit year 2016 and are finalizing a per capita risk adjustment user fee of $1.75 per enrollee per year, which we will apply as a per-enrollee-per-month risk adjustment user fee of $0.15. Comment: One commenter did not support the higher risk…

…ule), which established the rules governing the CO-OP program to make loans to capitalize eligible prospective CO-OPs. In the May 11, 2016 Federal Register ( 81 FR 29146 ), we amended several CO-OP standards related to governance requirements to provide greater flexibility, and t…

… information be updated at least annually if there are changes to report. More rapid updating is required for several data elements to help ensure that users of ClinicalTrials.gov have access to accurate, up-to-date information about important aspects of an applicable clinical tr…