On March 9, CMS issued the Interoperability and Patient
Access final rule (CMS-9115-F). The final rule establishes policies that break
down barriers in the nation’s health system to enable better patient access to
their health information, improve interoperability and unleash innovation, while
reducing burden on payers and providers.
Two provisions will specifically affect dually eligible
individuals. The first requires daily state-CMS exchange of data to identify
who is enrolled in Medicare, and which party is liable for paying each beneficiary’s
Parts A and B premiums (commonly referred to as “buy-in” files). The second
requires daily state submission of Medicare Modernization Act (MMA) files,
which identify all full-benefit and partial-benefit dually eligible
beneficiaries. States and CMS currently exchange these data as infrequently as
monthly in many states. Moving to daily data exchange will expedite enrollment
status changes, improve customer experiences, and reduce the volume of payment
inaccuracies and recoupments. Improving the accuracy and timeliness of data on
dual eligibility status is an important step in improving how Medicare and
Medicaid work together for beneficiaries, providers, and payers. Both
provisions require daily exchange by April 1, 2022.
CMS will provide technical assistance to the 35 states that
currently submit monthly/weekly to shift to daily submission. Please
click here for more information on the MMA file and how to
contact us for assistance. For technical support on buy-in file exchange, state
staff should contact the CMS Office of Information Technology at MEPBSEDBSSStaff@cms.hhs.gov (and copy DPBCStateBuy-In@cms.hhs.gov).
The final rule is available on the CMS website. For the provisions specific to dually
eligible individuals, please see Section VII (Improving the Medicare-Medicaid
Dually Eligible Experience by Increasing the Frequency of Federal-State Data
Exchanges) and final changes to regulatory text in Parts 406, 407, and
423.
No comments:
Post a Comment