What are measure specifications?
Measure specification provides the technical instructions for how the measure is to be collected and implemented consistently, reliably, and effectively. Both technical specification and harmonization define this phase; along with stakeholder engagement through public comment on the process.
What is a CMS review?
Medical reviews identify errors through claims analysis and/or medical record review activities. Contractors use this information to help ensure they provide proper Medicare payments (and recover any improper payments if the claim was already paid).
What is a CMS claim?
The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of ...
What are CMS penalties?
A CMP is a monetary penalty the Centers for Medicare & Medicaid Services (CMS) may impose against nursing homes for either the number of days or for each instance a nursing home is not in substantial compliance with one or more Medicare and Medicaid participation requirements for long-term care facilities.
What is a special needs plan?
A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following: An institutionalized individual, A dual eligible, or. An individual with a severe or disabling chronic ...
Why do SNPs need to provide Part D coverage?
All SNPs must provide Part D prescription drug coverage because special needs individuals must have access to prescription drugs to manage and control their special health care needs. SNPs should assume that, if no modification is contained in guidance, existing Part C and D rules apply.
Where to find SNP information?
Specific information about each of the three SNP types (C-SNPs, D-SNPs, and I-SNPs), as well as information on the SNP Application and the SNP Model of Care, can be found by clicking the appropriate links on the left-hand side of this page . In addition, there is a link below to the online Medicare Managed Care Manual, which contains Chapter 16b – CMS's current sub-regulatory guidance on SNPs.
Do SNPs have to follow Medicare?
SNPs are expected to follow existing MA program rules, including MA regulations at 42 CFR 422, as modified by guidance, with regard to Medicare- covered services and Prescription Drug Benefit program rules. All SNPs must provide Part D prescription drug coverage because special needs individuals must have access to prescription drugs to manage and control their special health care needs. SNPs should assume that, if no modification is contained in guidance, existing Part C and D rules apply.
What is SNP in healthcare?
A SNP may be any type of MA CCP, including either a local or regional preferred provider organization (i.e., LPPO or RPPO) plan, a health maintenance organization (HMO) plan, or an HMO Point-of-Service (HMO-POS) ...
Did CMS accept SNP applications in 2008?
Accordingly, CMS did not accept SNP applications in 2008 for contract year (CY) 2009. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) lifted the Medicare, Medicaid, and SCHIP Extension Act of 2007 moratorium on approving new SNPs.
What is a CMS hybrid measure?
A hybrid measure is a quality measure that uses both claims data and clinical data from electronic health records (EHRs) for calculating the measure. Please visit the Hybrid Measures page on the eCQI Resource Center to learn more. The hybrid measure value sets for use in the hybrid measures are available through the VSAC.
What is eCQI resource center?
CMS pre-rulemaking eCQMs include measures that are developed, but specifications are not finalized for reporting in a CMS program. These measures will not be eligible for CMS quality reporting until they are proposed and finalized through notice-and-comment rulemaking for each applicable program. Please visit the Pre-Rulemaking eCQM pages for Eligible Hospitals and CAHs and for Eligible Professionals and Eligible Clinicians to learn more.
What Is A Special Needs Plan?
- A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following: 1. An institutionalized individual, 2. A dual eligible, or 3. An individual with a severe or disabling chr...
Statutory and Regulatory History
- The Medicare Modernization Act of 2003 (MMA) established an MA CCP specifically designed to provide targeted care to individuals with special needs. In the MMA, Congress identified “special needs individuals” as: 1) institutionalized individuals; 2) dual eligibles; and/or 3) individuals with severe or disabling chronic conditions, as specified by CMS. MA CCPs established to provide se…
Requirements and Payment Procedures
- SNPs are expected to follow existing MA program rules, including MA regulations at 42 CFR 422, as modified by guidance, with regard to Medicare-covered services and Prescription Drug Benefit program rules. All SNPs must provide Part D prescription drug coverage because special needs individuals must have access to prescription drugs to manage and control their special health c…
Site Overview
- Specific information about each of the three SNP types (C-SNPs, D-SNPs, and I-SNPs), as well as information on the SNP Application and the SNP Model of Care, can be found by clicking the appropriate links on the left-hand side of this page. In addition, there is a link below to the online Medicare Managed Care Manual, which contains Chapter 16b – CMS's current sub-regulatory gu…