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Rural Health Information Hub

Rural Health
News by Topic: Reimbursement and payment models

May 26, 2023 - Notice of proposed rule from the Centers for Medicare & Medicaid Services (CMS) that seeks to implement policies in the Medicaid Drug Rebate Program (MDRP) related to the new legislative requirements in the Medicaid Services Investment and Accountability Act of 2019 (MSIAA), which are needed to address drug misclassification, as well as drug pricing and product data misreporting by Manufacturers. Among other things, this proposed rule clarifies and establishes requirements for State fee-for-service (FFS) pharmacy reimbursement; codifies conditions relating to States claiming FFP for physician-administered drugs (PADs); designates drug price verification and transparency through data collection; and proposes two new contracting requirements between States and their Medicaid managed care plans. Includes information about the potential impact of this proposed rule on small rural hospitals. Comments are due by July 25, 2023.
Source: Federal Register
May 24, 2023 - Rural Mississippi hospitals are increasingly endangered, as poverty, declining populations, and dwindling inpatient revenue chip away at profits. Federal aid appropriated during the pandemic seemed to slow the rate of closures, but now some are in worse shape than before, as they struggle with ongoing staff shortages and rising costs.
Source: Roll Call
May 19, 2023 - The Centers for Medicare and Medicaid Services (CMS) is proposing a policy change for the rural floor wage index in 2024 that could have profound financial effects on urban and rural hospitals. Under this proposal CMS would treat hospitals with rural classifications the same as geographically rural hospitals when calculating the wage index.
Source: HealthLeaders
May 17, 2023 - U.S. Senators Joe Manchin, Joni Ernst, Jeanne Shaheen, and Jerry Moran reintroduced the Protecting Rural Telehealth Access Act. This legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024.
Source: Office of Senator Joe Manchin
May 16, 2023 - A group of industry leaders, advocates, and state officials gathered at the University of Connecticut in Storrs to discuss barriers to care in rural areas. Discussion topics included transportation, workforce, and reimbursement rates.
Source: Journal Inquirer
May 11, 2023 - Notice from the Centers for Medicare & Medicaid Services (CMS) seeking comments on the extension of the Home Health Agency Cost Report, Form CMS–1728–20. The cost report is used to determine a provider's reasonable cost incurred in furnishing medical services to Medicare beneficiaries and reimbursement due to or from a provider and for annual rate setting and payment refinement activities, including developing a home health market basket. Comments are due by July 10, 2023.
Source: Federal Register
May 9, 2023 - Describes anticipated nursing home closures in Iowa due to financial challenges from rising medical care costs and static Medicaid reimbursement rates. Notes that fewer long-term care facilities means other long-term care facilities and rural hospitals must absorb the communities served by the closed facilities. Iowa's aging population means that the strain of fewer long-term care facilities will impact the healthcare system far into the future.
Source: N'West Iowa REVIEW
May 1, 2023 - Notice of proposed rule from the Centers for Medicare & Medicaid Services (CMS) regarding changes to the hospital inpatient prospective payment system (IPPS) for operating and capital-related costs of acute care hospitals for fiscal year 2024. Contains details of changes impacting Medicare graduate medical education (GME) for teaching hospitals and inpatient hospital services provided by long-term care hospitals, among other things. This proposed rule also includes information and updates on the Rural Emergency Hospital (REH) designation. Comments are due by June 9, 2023.
Source: Federal Register
May 1, 2023 - Describes the oral healthcare shortages in Florida where 66 of the 67 counties do not have enough dentists to treat all patients. Workforce distribution problems stem from the challenge to recruit dentists to rural areas as well as low Medicaid reimbursement rates. Discusses proposed legislation to improve access to oral healthcare.
Source: KFF Health News, Tampa Bay Times
Apr 18, 2023 - Notice from the Centers for Medicare & Medicaid Services (CMS) seeking comments on revisions to the Minimum Data Set 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) for the collection of data related to the Patient-Driven Payment Model and the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). CMS uses the MDS 3.0 PPS Item Set to collect the data used to reimburse skilled nursing facilities for SNF-level care furnished to Medicare beneficiaries and to collect information for quality measures and standardized patient assessment data under the SNF QRP. Comments are due by May 18, 2023.
Source: Federal Register
Apr 14, 2023 - Notice from the Centers for Medicare & Medicaid Services (CMS) announcing the final federal share (FS) Disproportionate Share Hospital (DSH) allotments for fiscal years (FY) 2020 and 2021, and the preliminary FS DSH allotments for FY 2022 and FY 2023. This notice also announces the final FY 2020 and FY 2021 and the preliminary FY 2022 and FY 2023 limitations on aggregate DSH payments that states may make to institutions for mental disease and other mental health facilities. The allotments are effective May 15, 2023.
Source: Federal Register
Apr 11, 2023 - Notice from the Department of Veterans Affairs (VA) making technical corrections to the April 4, 2023, final rule. This correction is effective April 11, 2023.
Source: Federal Register
Apr 10, 2023 - Notice of proposed rule from the Centers for Medicare & Medicaid Services (CMS) that would update the skilled nursing facility (SNF) payment rates for fiscal year 2024 and implement the second phase of the Patient-Driven Payment Model (PDPM) parity adjustment recalibration. Includes proposals to update the diagnosis code mappings used under PDPM, the SNF Quality Reporting Program (QRP), and the SNF Value-Based Purchasing (VBP) Program. Comments are due by June 5, 2023.
Source: Federal Register
Apr 7, 2023 - The Centers for Medicare and Medicaid Services (CMS) recently released guidance on proper billing practices, designations, and conversion processes for Critical Access Hospitals (CAHs) and Rural Emergency Hospitals (REHs). CMS updated the location requirement for CAHs, detailed the optional payment method for CAHs, and included information on the REH provider type,
Source: HealthLeaders Media
Apr 4, 2023 - Notice of a proposed rule from the Centers for Medicare and Medicaid Services (CMS) updating the hospice wage index, payment rates, and aggregate cap amount for fiscal year 2024. Includes updates to the Hospice Quality Reporting Program; discusses the Hospice Outcomes and Patient Evaluation tool; provides an update on Health Equity and future quality measures; and provides updates on the Consumer Assessment of Healthcare Providers and Systems, Hospice Survey Mode Experiment. Among other things, this rule also includes information on hospice utilization trends and solicits comments regarding information related to the provision of higher levels of hospice care; ownership transparency; and ways to examine health equity under the hospice benefit. Includes rural considerations throughout. Comments are due by May 30, 2023.
Source: Federal Register
Apr 4, 2023 - Notice of final rule from the Department of Veterans Affairs (VA) implementing a statute exempting Indian and urban Indian veterans from copayment requirements for the receipt of hospital care or medical services, including all urgent care visits. The rule is effective April 4, 2023.
Source: Federal Register