CMS’ RFP for new Workers Compensation Review Contractor

CMS posted a presolicitation notice for the Workers Compensation Review Contractor (WCRC) on February 22, 2016. The Request for Proposal ( RFP) should be released on or about March 8, 2016 with replies due by April 8, 2016. The one year contract, with four one year renewal options, is expected to be awarded by June 20, 2016. The WCRC is responsible for evaluating workers’ compensation Medicare set-aside proposals as “an impartial entity.” We will keep you advised of further developments.

Medicare and the Opioid Epidemic

Opioids are over prescribed in the U.S. Although they may provide effective pain relief when prescribed properly, increasing their dosage for chronic pain often results in a myriad of side effects as well as addiction, overdose and death. In response to the opioid epidemic, the Center for Medicare and Medicaid Services (CMS) developed an opioid overutilization policy designed to curb inappropriate prescribing of opioids.

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CMS posts “Frequently Asked Questions about the Commercial Repayment Center Non-Group Health Plan Recovery Workload Transition” on website

CMS transitioned a portion of its Non-Group Health Plan (NGHP) recovery work to its Commercial Repayment Center (CRC) on October 5, 2015. The CRC will now be responsible for pursuing conditional payment recovery directly from liability insurers (including self –insured entities), no-fault insurers or workers’ compensation entities. As part of CMS’ ongoing effort to provide information regarding the new process, CMS posted a “Frequently Asked Questions” (FAQ) document on its website today. The questions and answers are copied below.

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Recap of CMS’ September 17, 2015 webinar on the role of the Commercial Repayment Center (CRC) in the Non-Group Health Plan (NGHP) recovery process

CMS presented a second webinar on September 17, 2015 about the transition of the Non-Group Health Plan (NGHP) recovery process to the Commercial Repayment Center (CRC).. The majority of the material addressed was identical to that presented in the August 25, 2015 webinar, which is summarized in our earlier blog.

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A Review of CMS’ Comprehensive Care for Joint Replacement Model

According to the NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, over one million hip or knee replacement surgeries are performed each year in the United States. These procedures are generally the last resort for individuals afflicted with osteoarthritis, inflammatory arthritis, malignancies of the distal femur, proximal tibia and knee joint or avascular necrosis. In 2013, Medicare spent over $7 billion dollars for hip and knee replacement procedures. The reduction of these costs is behind the Center for Medicare and Medicaid Services (CMS) new “Comprehensive Care for Joint Replacement Model” proposed rule that was published in the July 14, 2015 Federal Register. The public comment period on this proposed rule closed on September 8, 2015.

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