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About the Health FFRDC CMS

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

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› Url: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAMH/About-Health-FFRDC Go Now

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Health Plan Eligibility Benefit Inquiry and Response CMS

Details: Under HIPAA, HHS adopted standards for electronic transactions, including the health plan eligibility benefit inquiry and response. The eligibility/benefit inquiry transaction is used to obtain information about a benefit plan for an enrollee, including information on eligibility and coverage under the health plan. This inquiry can be sent from a health care provider to a health plan, or from

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› Url: https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Transactions/HealthPlanEligibilityBenefitInquiryandResponse Go Now

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Home Health Star Ratings CMS

Details: Apply to a substantial proportion of home health patients and have sufficient data to report for a majority of home health agencies. Show a reasonable amount of variation among home health agencies and it should be possible for a home health agency to show improvement in performance. Have high face validity and clinical relevance.

› Verified 8 days ago

› Url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings Go Now

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Home Health VBP CMS

Details: the Home Health Value-Based Purchasing (HHVBP) Model; The HHVBP Model is designed to give Medicare-certified home health agencies (HHAs) incentives to give higher quality and more efficient care.

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› Url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Other-VBPs/HHVBP Go Now

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Home Health Agencies CMS

Details: The existing CoPs are the minimum health and safety standards that home health agencies (HHAs) must comply with in order to qualify for reimbursement under the Medicare program. Related Links CONDITIONS OF PARTICIPATION: HOME HEALTH AGENCIES

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› Url: https://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/homehealth Go Now

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CMS Manual System

Details: CMS Manual System Department of Health & Human Services (DHHS) Pub 100-02 Medicare Benefit Policy Centers for Medicare & Medicaid Services (CMS) Transmittal 10438 Date: November 6, 2020 Change Request 12023

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› Url: https://www.cms.gov/files/document/r10438bp.pdf Go Now

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Home Health Services Fact Sheet

Details: The beneficiary requires home health services because the beneficiary is or was confined to the home. 2. The beneficiary needs or needed intermittent skilled nursing services (other than solely venipuncture for the purposes of obtaining a blood sample), or physical therapy, or speech-language pathology services. If a

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› Url: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ProviderComplianceTipsforHomeHealthServices-ICN909413.pdf Go Now

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Medicare Home Health Benefit

Details: Home health services defined in Section 1861(m) of the Act provided under arrangement at hospitals, Skilled Nursing Facilities, or rehabilitation centers when they involve equipment too cumbersome to bring to the home or furnished while the patient is at the facility to receive such services.

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› Url: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Home-Health-Benefit-Fact-Sheet-ICN908143.pdf Go Now

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State Operations Manual

Details: Medicaid patients, and patients utilizing any federally funded health plan options that are part of the Medicare program (e.g., Medicare Advantage (MA) plans). An HHA must also transmit an OASIS assessment for all Medicaid patients receiving services under a waiver program receiving services subject to the Medicare Conditions of Participation as

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› Url: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107ap_b_hha.pdf Go Now

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CMS Office of the Actuary Releases 2019 National Health

Details: Health care spending growth was faster in 2019 for the three largest goods and service categories – hospital care, physician and clinical services, and retail prescription drugs. Hospital spending (31% of total health care spending) growth accelerated in 2019, increasing 6.2% to $1.2 trillion compared to 4.2% growth in 2018. The faster growth

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› Url: https://www.cms.gov/newsroom/press-releases/cms-office-actuary-releases-2019-national-health-expenditures Go Now

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Home Health PPS CMS

Details: After a physician or allowed practitioner prescribes a home health plan of care, the HHA assesses the patient's condition and determines the skilled nursing care, therapy, medical social services and home health aide service needs, at the beginning of the 60-day certification period. The assessment must be done for each subsequent 60-day

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› Url: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS Go Now

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2021 Federal Health Insurance Exchange Weekly Enrollment

Details: To have their coverage effectuated, consumers generally need to pay their first month’s health plan premium. This release does not report the number of effectuated enrollments. New Consumers: A consumer is considered to be a new consumer if they did not have 2020 Exchange coverage through December 31, 2020, and had a 2021 plan selection.

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› Url: https://www.cms.gov/newsroom/fact-sheets/2021-federal-health-insurance-exchange-weekly-enrollment-snapshot-final-snapshot Go Now

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Home Health Patient-Driven Groupings Model CMS

Details: Home Health PPS Grouper Software (HHGS) Package (for claims starting 01-01-2021): The January 2021 release of the HH PPS Grouper software (v02.1.21) is now available in the “Downloads” section of the HH Grouper Software webpage. Included in the v02.1.21 HH PPS Grouper software update are the FY 2021 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM

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› Url: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/HH-PDGM Go Now

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Transparency in Coverage Final Rule Fact Sheet (CMS-9915-F)

Details: The Transparency in Coverage final rule released today by the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (the Departments) delivers on President Trump’s executive order on Improving Price and Quality Transparency in American Healthcare to Put Patients First.[1] This final rule is a historic step

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› Url: https://www.cms.gov/newsroom/fact-sheets/transparency-coverage-final-rule-fact-sheet-cms-9915-f Go Now

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Health Informatics and Interoperability Group CMS

Details: The Health Informatics and Interoperability Group (HIIG) (previously known as the Health Informatics Office (HIO)), within the Office of Burden Reduction and Health Informatics (OBRHI), oversees CMS’ interoperability efforts. Our Mission: To promote the secure exchange, access, and use of electronic health information to support better informed decision making and a more efficient healthcare

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› Url: https://www.cms.gov/About-CMS/Components/HIO/HIO-Landing Go Now

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Early Retirees and the Affordable Care Act CMS

Details: For millions of Americans, retiring early (ages 55-64) has meant losing the security and the peace of mind that come with employer-sponsored health insurance. Today, fewer and fewer employers offer coverage for workers who retire early. In fact, only 1 in 3 large employers offers retiree health coverage of any kind.

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› Url: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/early-retirees Go Now

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Health Disparites Guide

Details: the Health Research and Educational Trust to help health professionals understand the importance of collecting demographic data. A strong commitment to the collection of race, ethnicity, and language (REAL) data is essential to identifying and addressing disparities in quality of …

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› Url: https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Health-Disparities-Guide.pdf Go Now

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Medicare and Home Health Care

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

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› Url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/HHQIHHBenefits.pdf Go Now

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Telehealth Services

Details: evaluation and management visits (common office visits), mental health counseling, and preventive health screenings. Beneficiaries can get telehealth services in any health care facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.

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› Url: https://go.cms.gov/mln-telehealth-services-icn901705 Go Now

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Community Mental Health Centers CMS

Details: Community Mental Health Centers CMS established Conditions of Participation (CoPs) for the Community Mental Health Centers (CMHCs) effective October 29, 2014 (78 Fed. Reg. 64603, Oct. 29, 2013). The CMHC COPs are located at 42 CFR 485.904 through 42 CFR 485.918.

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› Url: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/CommunityHealthCenters Go Now

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Glossary of Health Coverage and Medical Terms

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

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› Url: https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/Uniform-Glossary-01-2020.pdf Go Now

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Medicare Home Health Benefit Booklet

Details: Medicare Home Health Benefit MLN Booklet Page 2 of 7. ICN MLN908143 November 2019 5. Had a face-to-face encounter related to the primary reason the patient requires home health services with a physician or an allowed NPP no more than 90 days prior to the home health start of care date or within 30 days of the start of the home health care

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› Url: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Medicare-Home-Health-Benefit-Text-Only.pdf Go Now

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Medicare Mental Health

Details: health risks (for the benefit of the Medicare patient) Chemical and electrical aversion therapy (therapy developed to condition a person to avoid undesirable behavior by pairing the behavior with unwanted stimuli) Cognitive Assessment and Care Planning (comprehensive evaluation of a new or existing patient

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› Url: https://www.cms.gov/files/document/medicare-mental-health.pdf Go Now

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Medicare Home Health Face-to-Face Requirement

Details: health care, or within the 30 days after the start of care •In situations when a physician orders home health care for the patient based on a new condition that was not evident during a visit within the 90 days prior to start of care, the certifying physician or NPP must see the patient within 30 days after admission

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› Url: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/Downloads/face-to-face-requirement-powerpoint.pdf Go Now

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Penalty for Delayed Request for Anticipated Payment (RAP

Details: under the Home Health Prospective Payment System (HH PPS) from 60 days to 30 days. • Under the HH PPS, Medicare makes a split-percentage payment for most 60-day episodes/30-day periods of care. • The first payment is made in response to a RAP submitted at the beginning of the

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› Url: https://www.cms.gov/files/document/mm11855.pdf Go Now

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Overview of the Patient Driven Groupings Model

Details: health plan of care, both of which still need to occur every 60-days (or in the case of updates to the plan of care, more often as the patient’s condition warrants). Physicians are separately paid by Medicare for certification and recertification for home health services.

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› Url: https://www.cms.gov/files/document/se19027.pdf Go Now

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MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET …

Details: HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA): Effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during

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› Url: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet Go Now

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Health Outcomes Survey (HOS) CMS

Details: Overview: The Medicare Health Outcomes Survey (HOS) is the first patient-reported outcomes measure used in Medicare managed care.The goal of the Medicare HOS is to gather valid, reliable, and clinically meaningful health status data from the Medicare Advantage (MA) program to use in quality improvement activities, pay for performance, program oversight, public reporting, and to improve health.

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› Url: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HOS Go Now

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Home Health Prospective Payment System

Details: Home Health Prospective Payment System MLN Booklet Page 6 of 15 For a patient to be eligible for Medicare home health services, he or she must meet all of these criteria: 1. Be confined to the home (that is, homebound) 2. Need skilled services 3. Be under the care of a physician 4.

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› Url: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Home-Health-PPS-Fact-Sheet-ICN006816.pdf Go Now

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Center for Clinical Standards and Quality/ Quality, Safety

Details: health-care decisions on the patient’s behalf. Evidence that there is a legal representative may include guardianship, a power of attorney for health care decision-making, or a designated health care agent. A patient-selected representative participates at the request of a patient in decisions related to the patient’s

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› Url: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/AdminInfo19-07-HHA.pdf Go Now

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Home Health Quality Measures CMS

Details: Measures based on home health claims data are calculated based on the first home health claim that starts an episode of care for a patient and end either 30 or 60 days after the initial claim, across an entire episode of care, or in the period of time following discharge (see …

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› Url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Measures Go Now

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Home Health Prospective Payment System (HH PPS) PC Pricer

Details: The Balanced Budget Act (BBA) of 1997 (Public Law 105-33) required the creation of a prospective payment system for home health services. The Omnibus Consolidated and Emergency Supplemental Appropriations Act for 1999 (Public Law 105-277) established the effective date of the system, using dates of service on or after October 1, 2000.

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› Url: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PCPricer/HH Go Now

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The Home Health Quality Reporting Program (HH QRP)

Details: Home Health Survey data. Data Submission A. fter July 1, 2020 For CAHPS ® Home Health Survey, what does that mean for CAHPS ® data collection? The CAHPS ® Home Health Survey will be required for the third quarter of 2020 and onward. The Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) requirements for the Annual

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› Url: https://www.cms.gov/files/document/hhqrp-covid19phetipsheet-july2020v2.pdf Go Now

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Overview of the Patient-Driven Groupings Model (PDGM)

Details: patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds. • PDGM will take effect January 1, 2020. • In conjunction with the implementation of the PDGM there will be a change in the unit of home health payment from a 60-day episode to a 30-day period.

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› Url: https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2019-02-12-PDGM-Presentation.pdf Go Now

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Improving Access to Maternal Health Care In Rural

Details: health workers; and doulas. Each of these health care professionals plays a critical role in providing maternal health care before, during, and after pregnancy. However, there is a shortage of maternal health care providers in rural and urban areas. By 2020, it is estimated that the US will have a shortage

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› Url: https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-Maternal-Health-Care-in-Rural-Communities.pdf Go Now

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Home Health Quality Reporting Requirements CMS

Details: Statutory Authority for Use of the OASIS Data Item Set and Home Health Quality Reporting The reporting of quality data by home health agencies (HHAs) is mandated by Section 1895(b)(3)(B)(v)(II) of the Social Security Act (“the Act”). This statute requires that ‘‘each home health agency shall submit to the Secretary such data that the Secretary determines are appropriate for the

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› Url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Reporting-Requirements Go Now

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Definition and Uses of Health Insurance Prospective

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

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› Url: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/Downloads/hippsuses.pdf Go Now

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Form Instructions for the HHCCN

Details: beneficiaries receiving the home health care benefits for notification of plan of care changes. Consistent with the Medicare Condition of Participation and the 2nd Circuit Court’s decision in Lutwin v. Thompson regarding notification procedures, home health agencies must provide the

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› Url: https://www.cms.gov/Medicare/Medicare-General-Information/BNI/Downloads/HHCCN-Form-Instructions.pdf Go Now

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Home Health Process Measures Table

Details: Home Health Process Measures OASIS-D (effective 01/01/201 9) Centers for Medicare & Medicaid Services Page 1 of 4 . Home Health Quality Measures – Process . Notes: 1. Risk Adjustment: Process measures are not risk adjusted to compensate for differences in the patient population. This is because the processes of care in the measures apply to

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› Url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/Home-Health-Process-Measures-Table_OASIS-D_11-2018c.pdf Go Now

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FEDERAL HEALTH INSURANCE EXCHANGE 2021 OPEN …

Details: The Federal Health Insurance Exchange (also known as the Marketplace) Open Enrollment Period runs from November 1, 2020 to December 15, 2020, for coverage starting on January 1, 2021. Similar to previous years, the Centers for Medicare & Medicaid Services (CMS) is taking a strategic and cost-effective approach to inform individuals about Open Enrollment, deliver a smooth …

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› Url: https://www.cms.gov/newsroom/fact-sheets/federal-health-insurance-exchange-2021-open-enrollment Go Now

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The Role of Therapy under the Home Health Patient-Driven

Details: Finally, the quality scores on Home Health Compare incorporate the use of therapy services in patient outcomes. Home Health Compare is a website for patients and their families where they can compare HHAs to help them choose a quality HHA that has the skilled home health …

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› Url: https://www.cms.gov/files/document/se20005.pdf Go Now

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National Health Expenditure Projections 2019-2028

Details: National health spending is projected to grow at an average annual rate of 5.4 percent for 2019-28 and to reach $6.2 trillion by 2028. Because national health expenditures are projected to grow 1.1 percentage points faster than gross domestic product per year on average over 2019–28, the health share of the economy is projected

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Federal Definitions for Health Insurance Products and Plans

Details: For purposes of the Federal Health Insurance Oversight System (HIOS), the identifier for a health insurance product sold in a State is the Product ID, and it is generated upon submission to HIOS. Plans, with respect to a product, are the pairing of the health insurance coverage benefits under the product with a particular cost

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› Url: https://www.cms.gov/CCIIO/Resources/Training-Resources/Downloads/product-vs-plan-ppt.pdf Go Now

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Disparities Impact Statement

Details: Health disparities—differences in health outcomes closely linked with social, economic, and environmental disadvantage—are often driven by the social conditions in which individuals live, learn, work, and play. Revised: Mar. 2021. Paid for by the U.S. Department of Health and Human Services. 1.

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› Url: https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Disparities-Impact-Statement-508-rev102018.pdf Go Now

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Center for Clinical Standards and Quality / Quality

Details: DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop C2-21-16 Baltimore, Maryland 21244-1850 . Center for Clinical Standards and Quality / Quality, Safety & Oversight Group . Ref: QSO-18-13-HHA DATE: January 12, 2018 . REVISED 01.16.18 TO: State Survey Agency Directors . FROM: Director

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› Url: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO-18-13-HHA-.pdf Go Now

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Prepare for a Behavioral Health Appointment CMS

Details: These tools can help you prepare for your behavioral health appointment. Each one includes a copy you can download and take with you to your appointment. Your Concerns The sample questions below can help prepare you for your first appointment with your behavioral health provider. There are lots of other questions you can ask to help determine what you want to cover, so this …

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