Centers for Medicare & Medicaid Services

Transforming Opioid Prescribing Quality for Medicare Patients: The CMS OPS Program The opioid crisis exposed critical gaps in safe prescribing practices and pain management particularly for Medicare patients. In response, CMS designed and deployed the Opioid Prescriber Support (OPS) Program, a comprehensive, multi-stakeholder initiative built to drive evidence-based prescribing improvements at both the national and local levels. Here's what makes the OPS model unique: - National Command Center– Centralized coordination, data analytics, and TA infrastructure including a dedicated support helpline and national training summits. - Federal Partnership Network – Active collaboration with Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSAgov), HHS, The National Institutes of Health, U.S. Department of Veterans Affairs, and U.S. Department of Health and Human Services (HHS) - Local On-the-Ground Coverage – State health departments, academic institutions, and community leaders ensuring national strategies translate into real-world impact. - Data-Driven Framework– Using a Monitor-Analyze-Evaluate-Report methodology to continuously measure and improve prescribing quality outcomes. As healthcare professionals, policymakers, and advocates, we all have a role to play in supporting safe prescribing practices and reducing opioid-related harms. More information:https://go.cms.gov/3V8p2lS #OpioidCrisis #HealthcareLeadership #SafePrescribing #MedicarePatients #QualityImprovement #PublicHealth #HealthcarePolicy #OpioidAwareness #FederalHealthcare #PainManagement

Reminder: Register for the October 15 Short-Term Acute Care Hospital (STACH) PEPPER Webinar There's still time to register for the STACH PEPPER Webinar on October 15 at 1:00 p.m. EDT. Join us to learn how to access, interpret, and use your latest PEPPER report. Subject matter experts will review key PEPPER features, explain how to analyze your data, and answer participant questions. 🗓️ October 15 | 1:00 p.m. EDT 🔗 Register: https://lnkd.in/ef8yUACT We encourage STACHs to attend and take advantage of this opportunity to better understand their PEPPER data and support informed decision-making. #PEPPER #CMS #ShortTermAcuteCare

Join the Centers for Medicare & Medicaid Services (CMS) for a virtual info session on accounting career opportunities within the federal government.

🎉 What an incredible day at the University of Maryland, College Park Fall Career & Internship Fair! Our team had the opportunity to connect with talented Terps from across all academic backgrounds, sharing what it means to build a career at the Centers for Medicare & Medicaid Services. From conversations about public health to business administration, information science, and public policy, it was inspiring to see so much enthusiasm for public service careers. A huge thank you to UMD's University Career Center for hosting such a well-run event, and to our amazing team for representing CMS with energy and pride! Interested in joining a mission that impacts the lives of over 150 million Americans? Explore career opportunities with CMS today! CMS Careers job page: https://lnkd.in/gYpGMqtH #CMSCareers #PublicService #Recruiting #FederalCareers #UMD #TerpsAtWork

CMS brought together leaders from across federal agencies and all certified Independent Dispute Resolution (IDR) entities to address rising costs tied to out-of-network payment disputes and identify ways to strengthen the federal IDR process. We’re working together to improve the fairness and efficiency of the program while continuing to protect patients from surprise medical bills. Learn more: https://go.cms.gov/47DRUoV

Skilled Nursing Facilities (SNF): Reminder to Download Your FY 2025 PEPPER CMS released the FY 2025 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for Skilled Nursing Facilities (SNFs) in September 2026. Download your PEPPER today. Your PEPPER helps you review your billing data to make sure claims are accurate. Use it to: - Spot billing patterns that may need improvement - Identify areas that may need audits or closer monitoring - Find diagnosis-related groups that may be under-coded or over-coded - Track areas where patient stays are getting longer How to Get Your PEPPER: Authorized Officials (AOs), Access Managers (AMs), and Staff End Users (SEUs) can download their organization’s report from the PEPPER Portal: https://go.cms.gov/4nUZ1kt How to Become an SEU: - Sign in to the CMS Identity & Access (I&A) Management System using your existing National Plan and Provider Enumeration System (NPPES) or Provider Enrollment, Chain, and Ownership (PECOS) credentials: https://go.cms.gov/4dxGjua - Request the PEPPER business function under your organization. The Comparative Billing Report business function is also available and can be requested at the same time. - Your AO or AM must approve your request. More Information: - Visit the Training & Resources webpage for more information: https://go.cms.gov/3RbLCZj - See the I&A Quick Reference Guide and FAQs for step-by-step - Contact the External User Services Help Desk: https://go.cms.gov/4uiMjxp

Innovation Insight: Final CJR Evaluation Report Shows $180M in Savings Ahead of Nationwide Expansion What’s new: The final evaluation report for the CMS Innovation Center’s Comprehensive Care for Joint Replacement (CJR) Model shows the model generated $180 million in Medicare savings while preserving care quality for lower extremity joint replacements. Why it matters: Joint replacements are some of the most common and expensive Medicare procedures, and fragmented post-acute care has historically driven up costs without delivering better outcomes for patients. What to expect: The Innovation Center has already announced the nationwide expansion of the CJR Model and will launch the mandatory CJR Expanded (CJR-X) Model in 2028 to expand proven savings and improve the recovery experience for joint replacements for people with Medicare across the country. The big picture: CJR’s evaluation results prove that episode-based payment models can simultaneously lower costs and sustain quality, while advancing the Innovation Center’s strategy to scale effective models that empower people to achieve their health goals and deliver value for taxpayers. Additional details: The model also increased hospitals’ awareness of the costs and quality of post-acute care, informing discharge destination decisions and increasing focus on patient recovery. The model held hospitals accountable for surgical costs and the 90-day recovery period that followed to help spur a meaningful shift in how hospitals approach discharge planning. Lessons learned from CJR have been applied to the Transforming Episode Accountability Model (TEAM) Model. Find out more: Links to evaluation report: https://go.cms.gov/4ymii2h CMS Innovation Center Strategic Direction: https://go.cms.gov/4plCQV8 Value-Based Care Spotlight: https://go.cms.gov/4dTGAc9 Innovation Insights: https://go.cms.gov/4hnyARp

CMS released new 2025 Medicaid & Children's Health Insurance Program Child and Adult Core Set data & products, plus new external quality review summary tables with performance-related information about states' Medicaid & CHIP managed care programs. More: https://go.cms.gov/4rYGRQR

The Q2 FY 2026 Short-Term Acute Care Hospital PEPPER is Now Available CMS released the Q2 FY 2026 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for short-term acute care hospitals. Your PEPPER helps you review your billing data to make sure claims are accurate. Use it to: - Spot billing patterns that may need review or improvement - Identify areas that may need closer monitoring or internal audits - Find services that may be under-coded or over-coded - Track trends like longer patient stays How to Get Your PEPPER Authorized officials (AOs), access managers (AMs), and staff end users (SEUs) can download their organization’s report from the PEPPER Portal: https://lnkd.in/gRe59G3W How to become an SEU: - Sign in to the CMS Identity & Access (I&A) Management System using your existing NPPES or PECOS credentials: https://lnkd.in/e9A9m6y3 - Request the PEPPER business function for your organization. The Comparative Billing Report business function is also available, and you can request it at the same time. - Our AO or AM must approve your request. More Information: - Visit the Training & Resources webpage for more information about the release and the User Guide: https://lnkd.in/ef8yUACT - See the I&A Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs - Contact the External User Services Help Desk: https://eus.cms.gov/home Turn insights into action – drive compliance smarter and outcomes higher. #PEPPER #CMS #STACH #HealthcareQuality #MedicareProviders

Caring for a loved one with dementia can be hard. This #WorldAlzheimersMonth, learn how CMS is helping support caregivers as they care for loved ones with dementia through the Guiding an Improved Dementia Experience (GUIDE) Model. GUIDE connects families with a dedicated care navigator and respite support, so caregivers can also take care of themselves. Watch a new video featuring CMS Administrator Oz and hospice nurse Manal M.: go.cms.gov/GUIDE-video “I’ve seen firsthand, both as a nurse and in my own life, what a difference it makes when families have the kind of support we’re providing through the GUIDE model.” – Manal M., nurse and GUIDE team member Learn more at go.cms.gov/GUIDE or call 1-800-MEDICARE to see if GUIDE is available in your area.