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Rural Health Information Hub
Rural Health Information Hub

Rural Health
News by Topic: Reimbursement and payment models

Aug 1, 2025 - Announcement of the application process for the 340B Rebate Model Pilot Program and call for comments related to the structure and application process of the program. This program is voluntary and aims to test a rebate model on a select group of drugs for the purpose of understanding the merits and shortcomings of the rebate model. Drug manufacturers interested in participating should email 340BPricing@hrsa.gov by September 15, 2025. The program will start January 1, 2026 and run for 1 year. Comments are due September 2, 2025.
Source: Federal Register
Aug 1, 2025 - Pre-publication notice of final rule from the Centers revising the hospital inpatient prospective payment system (IPPS) for operating and capital-related costs of acute care hospitals for fiscal year 2026. This rule also makes changes related to Medicare graduate medical education (GME) for teaching hospitals; updates payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals; updates and make changes to requirements for certain quality programs; and finalizes certain updates to the ONC Health Information Technology (IT) Certification Program among other things. These final rules are effective October 1, 2025.
Source: Federal Register
Aug 1, 2025 - Pre-publication notice of final rule from the Centers for Medicare & Medicaid Services (CMS) updating the skilled nursing facility (SNF) prospective payment system (PPS) payment rates for fiscal year 2026. Among other things, this rule updates the requirements for the SNF Quality Reporting Program and the SNF Value-Based Purchasing Program. These regulations are effective October 1, 2025.
Source: Federal Register
Jul 30, 2025 - Advisory notice from the Centers for Medicare and Medicaid Services to alert certain clinicians who are Qualifying APM participants (QPs) and have earned an Alternative Payment Model (APM) Incentive Payment that CMS does not have the current information needed to disburse the payment. Provides information to QPs on how to update their Medicare billing information so that CMS can disburse payments. All information should be sent to CMS by September 1, 2025.
Source: Federal Register
Jul 28, 2025 - The Centers for Medicare and Medicaid Services is seeking comments on the following information collections: 1) Medicare Geographic Classification Review Board Procedures and Criteria; 2) Part C and Part D Medicare Prescription Payment Plan Model Documents; and 3) Applicable Integrated Plan Coverage Decision Letter. Comments are due by August 27, 2025.
Source: Federal Register
Jul 25, 2025 - Highlights the Rural Health Transformation Program, part of the One Big Beautiful Bill Act.
Source: The White House
Jul 17, 2025 - Notice of a proposed rule from the Centers for Medicare & Medicaid Services (CMS) making changes to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2026, including changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment systems. Among other updates, this rule also proposes updates related to the requirements for the Hospital Outpatient Quality Reporting Program, Rural Emergency Hospital Quality Reporting Program, Ambulatory Surgical Center Quality Reporting Program, Overall Hospital Quality Star Rating, and hospitals to make public their standard charge information and enforcement of hospital price transparency. Comments are due September 15, 2025.
Source: Federal Register
Jul 17, 2025 - The Centers for Medicare & Medicaid Services (CMS) will hold a virtual meeting of the Advisory Panel on Hospital Outpatient Payment on August 25, 2025. The purpose of the Panel is to advise the Secretary on the clinical integrity of the Ambulatory Payment Classification groups and their associated weights, which are major elements of the Medicare Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center payment system, and supervision of hospital outpatient therapeutic services. The agenda and information on how to join the meeting will be posted on the Panel's website. Presentations and comment letters are due by August 1, 2025.
Source: Federal Register
Jul 15, 2025 - Notice of a proposed rule from the Centers for Medicare & Medicaid Services (CMS) addressing: 1) changes to the Physician Fee Schedule and Medicare Part B payment policies; 2) policies for the Medicare Prescription Drug Inflation Rebate Program under the Inflation Reduction Act of 2022; 3) the Ambulatory Specialty Model; 4) updates to the Medicare Diabetes Prevention Program expanded model; 5) updates to drugs and biological products paid under Part B; 6) Medicare Shared Savings Program requirements; 7) updates to the Quality Payment Program; 8) updates to policies for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs); 9) updates to the Ambulance Fee Schedule regulations; 10) codification of the Inflation Reduction Act and Consolidated Appropriations Act, 2023 provisions; and 11) updates to the Medicare Promoting Interoperability Program. Comments are due on September 12, 2025.
Source: Federal Register
Jul 14, 2025 - The Centers for Medicare and Medicaid Services is seeking comments on the following information collections: 1) Medicare Current Beneficiary Survey; and 2) Review Choice Demonstration for Home Health Services. Comments are due by September 12, 2025.
Source: Federal Register