State Performance Standards System Evaluation and Subject Matter Expertise

State Performance Standards System Evaluation and Subject Matter Expertise

Project Overview The Centers for Medicare & Medicaid Services’ (CMS) Quality Safety and Oversight Group (QSOG) provides oversight and ensures compliance for providers serving Medicare and Medicaid beneficiaries. State survey agencies support QSOG by conducting facility surveys to verify compliance with Conditions of Participation or Requirements for Participation, and they complete the certification process and[...]

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Monitoring and Evaluation of Medicare Part C and D Plan Sponsors’ Customer Service and Pharmacy Call Centers

Project Overview The Centers for Medicare & Medicaid Services (CMS) has established arrangements with Medicare Advantage Organizations (MAOs), Medicare Advantage Prescription Drug Plans (MA-PDs), Prescription Drug Plans (PDPs), and Medicare-Medicaid Plans (MMPs) to provide Medicare coverage. Organizations that provide Part C (medical coverage) and/or Part D (prescription drug) benefits, including MMPs, must meet certain standards[...]

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Maternal Opioid Misuse (MOM) Model Evaluation

Project Overview To address the significant problem of opioid use in pregnancy and associated high numbers of babies born with neonatal abstinence syndrome or neonatal opioid withdrawal syndrome, the Centers for Medicare & Medicaid Services (CMS) awarded cooperative agreements to 10 state Medicaid agencies to implement the Maternal Opioid Misuse (MOM) Model. By supporting the[...]

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Research to Enhance Targeting Information for Medicare Audiences

Project Overview The Centers for Medicare & Medicaid Services (CMS) relies on rigorous, rapid-cycle research to understand its target audiences and develop compelling communications that inspire beneficiaries to take action. Such research becomes essential as Medicare audiences continue to change, along with their information needs and preferences. Insight is supporting CMS’s Office of Communications in[...]

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Evaluation of the Integrated Care for Kids Model

Overview The Centers for Medicare & Medicaid Services’ Integrated Care for Kids (InCK) is a child-centered local service delivery and state payment model. It aims to reduce expenditures and improve the quality of care for children under 21 covered by Medicaid through prevention, early identification, and treatment of behavioral and physical health needs. Model awardees[...]

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Long-Term Care Survey: Process, Operational Support, and Analysis

Project Overview The Centers for Medicare & Medicaid Services (CMS) developed and tested a new long-term care survey process for nationwide use that will replace the Quality Indicator Survey (QIS), previously used by 27 states and the District of Columbia for nursing home inspections. This project provides support to CMS in the implementation of the[...]

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CMS End-Stage Renal Disease Services Monitoring and Evaluation

Project Overview The Centers for Medicare & Medicaid Services (CMS) implemented the End-State Renal Disease (ESRD) Services Prospective Payment System (PPS) in 2011 and the ESRD Quality Incentive Program (QIP) in 2012 to improve the quality and efficiency of treatment for ESRD, a condition of permanent kidney failure. The most common treatment for ESRD is dialysis. In January[...]

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Evaluation of the Diffusion and Impact of the Chronic Care Management Fees

Project Overview In 2015, the Centers for Medicare & Medicaid Services (CMS) issued a new billing code to allow eligible professionals to be reimbursed for chronic care management (CCM) activities. The fee was designed to support primary care through financial investment in care management services. Under the program, eligible professionals can bill CMS and participating[...]

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