GNYHA has submitted comments in response to three Centers for Medicare & Medicaid Services (CMS) proposals to enhance oversight of Medicare Advantage (MA) plans through data collection and audit—an Annual Utilization Management (UM) Data Submission, a UM Audit Protocol Data Request, and a Service Level Data Collection for Initial Determinations and Appeals. These proposals focus...

As we have reported, the New York State Department of Health (DOH) recently adopted hospital cybersecurity regulations containing extensive requirements for hospitals. While most of the requirements do not go into effect until October 2025, the incident reporting requirements went into effect last month. GNYHA has received many questions about how and when hospitals must...

DOH recently issued the September 2024 Medicaid update, which includes updated guidance on licensure thresholds for providers that offer any combination of physical, behavioral health, and diagnostic and treatment services in an ambulatory setting. Licensure thresholds establish the percentage of these services that a licensed provider may furnish without requiring an additional license, certificate, or...

CMS has opened registration for clinicians seeking to report specialty-specific data under an alternative pathway to the Merit-based Incentive Payment System (MIPS) called MIPS Value Pathways (MVPs). Evaluations under the two programs focus on different measures. Traditional MIPS evaluates participating clinicians on quality, improvement activities, promoting interoperability, and cost relative to all other participants regardless...

The Centers for Medicare & Medicaid Services (CMS) recently released its calendar year (CY) 2025 Medicare outpatient prospective payment system (OPPS) and physician fee schedule (PFS) final rules. The final rules include provisions on social drivers of health (SDOH) and advanced primary care management (APCM). In the OPPS final rule, two measures—Screening for SDOH and...

The New York State Department of Health (DOH) recently opened applications for the State 30 program, which waives the two-year home residence requirement for physicians on J-1 visas in exchange for a service commitment in a federally designated underserved area of New York. Applications are due to DOH by December 12. J-1 Visa Waiver Program...

At its November meeting, the Medicare Payment Advisory Commission (MedPAC) presented a policy option to update the Physician Fee Schedule (PFS), raised concerns about the accuracy of PFS payment rates, analyzed the effect of Medicare’s coverage limits on stays in freestanding inpatient psychiatric facilities (IPFs), and reviewed a workplan on Medicare Advantage (MA) provider networks....

Staffing and Clinical Guidelines AWHONN Staffing Executive Summary ACOG Clinical Guidelines Simulation and Training CMS QAPI How to Guide AIM OB In-Situ Drill Program Manual Maternal Health Taskforce OB Emergency Drills Training Kit CMQCC OB Hemorrhage Tool Kit CMQCC OB Hypertensive Disorders of Pregnancy Tool Kit Emergency Supplies and Resource Kits AIM Obstetric Emergency Readiness...

The Centers for Medicare & Medicaid Services (CMS) recently released the Calendar Year (CY) 2025 Home Health (HH) Prospective Payment System (PPS) final rule. Rates under the CY 2025 HH PPS will increase by 0.5%, or about $85 million compared with the proposed -1.7% cut. CMS’s final rule payment rate update incorporated a more recent...

This GNYHA-developed resource contains enrollment figures across the following plan types: Medicare Advantage, Child Health Plus, Health & Recovery Plans (HARP), Medicaid Managed Care including HARP, Managed Long Term Care (MLTC), Medicaid Advantage, and HIV/SNP. The data is aggregated and compiled from the Department of Health and values are calculated on a rolling monthly and...