Rural Health
News by Topic: Reimbursement and payment models
CMS: Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model
Federal Register
Dec 4, 2024 - Notice of a final rule from the Centers for Medicare & Medicaid Services (CMS) describing a new mandatory Medicare payment model, the Increasing Organ Transplant Access Model (IOTA Model). The IOTA Model would test whether performance-based upside risk payments or downside risk payments paid to or owed by participating kidney transplant hospitals increase access to kidney transplants for patients with end-stage renal disease (ESRD) while preserving or enhancing the quality of care and reducing Medicare expenditures. This proposed rule also describes standard provisions for the Radiation Oncology Model, the End-Stage Renal Disease (ESRD) Treatment Choices Model, and mandatory Innovation Center models, including the IOTA Model, whose first performance period begins on or after January 1, 2025. Includes comments regarding rural-specific concerns. This rule is effective January 3, 2025.
Source: Federal Register
Nov 27, 2024 - Notice of final rule with comment period from the Centers for Medicare & Medicaid Services (CMS) revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2025. This rule also updates the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, Rural Emergency Hospital Quality Reporting (REHQR) Program, Ambulatory Surgical Center Quality Reporting (ASCQR) Program, and Hospital Inpatient Quality Reporting Program and finalizes updates to the Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services. Among other things, this rule summarizes comments received in response to an information request on potential modifications to the Safety of Care measure group in the Overall Hospital Quality Star Rating methodology. This rule also finalizes exceptions to the Medicaid clinic services benefit four walls requirement for Indian Health Service and Tribal clinics, and, at state option, for behavioral health clinics and clinics located in rural areas. The provisions of this rule are effective January 1, 2025. Comments are due by December 31, 2024.
Source: Federal Register
CMS: Agency Information Collection Activities: Proposed Collection; Comment Request
Federal Register
Nov 25, 2024 - Notice from the Centers for Medicare & Medicaid Services (CMS) seeking comments on revisions to an information collection titled "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 Quality Reporting Program (QRP)." Revisions include four new items as standardized patient assessment data elements, one modified item collected as a standardized patient assessment data element, and twenty-two removed items that are not needed for case-mix adjusting the SNF per diem payment for PDPM. Comments are due by January 24, 2025.
Source: Federal Register
Nov 13, 2024 - Outlines current and projected funding challenges for Federally Qualified Health Centers. Discusses common sources of revenue, reimbursement rates, the 340B program, and policy opportunities for federal and state government. Notes that rural residents are a significant user base for Community Health Centers.
Source: The Commonwealth Fund
Nov 13, 2024 - Provides overview of recent research on rural medical debt. Notes that rural residents are more likely than urban residents to have problems paying medical bills, and identifies gender and racial disparities within rural survey respondents. Discusses the potential impacts of medical debt on the viability of rural hospitals.
Source: The Daily Yonder
Nov 12, 2024 - Notice of final rule from the Centers for Medicare & Medicaid Services (CMS) updating and revising the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2025 and updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also updates the requirements for the Conditions for Coverage for ESRD facilities, the ESRD Quality Incentive Program, and the ESRD Treatment Choices Model. These regulations are effective January 1, 2025.
Source: Federal Register
Nov 7, 2024 - Notice of final rule from the Centers for Medicare & Medicaid Services (CMS) updating the home health payment rates for calendar year (CY) 2025. This rule also finalizes changes to the Home Health Quality Reporting Program (HH QRP) requirements and provides an update on potential approaches for integrating health equity in the Expanded Health Value-Based Purchasing (HHVBP) Model. Among other things, this rule also finalizes a new standard for acceptance to service policy in the home health conditions of participation (CoPs) and provides updates to provider and supplier enrollment requirements and changes to the long-term care reporting requirements for acute respiratory illnesses, among other things. These regulations are effective January 1, 2025.
Source: Federal Register
Nov 4, 2024 - Highlights the growth of community health worker (CHW)
programs across the country. Notes that CHW programs in
rural areas can help connect low-income and minority
communities to health systems and navigate common barriers
to care. Describes the impacts of a CHW program in Huron,
South Dakota, which was created through a federal grant
program and is now funded by Medicaid reimbursements.
Source: South Dakota Searchlight, KFF Health News
Nov 4, 2024 - Discusses telehealth and remote monitoring tool solutions for improving rural healthcare access. Highlights the role the COVID-19 pandemic played in increasing telehealth adoption and access barriers that remain in spite of wider telehealth adoption. Discusses workforce shortages, broadband challenges, and reimbursement for telehealth.
Source: TechTarget
Nov 1, 2024 - Announcement of new policies included in the 2025 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center final rule. Describes updated health and safety requirements for hospitals and Critical Access Hospitals (CAHs) to improve and expand access to quality maternal and behavioral health care. Notes policy changes including updated payment rates, staffing standards, quality assessments, training requirements, and expanded coverage for services provided outside the "four walls" of behavioral health clinics and clinics located in rural areas.
Source: Centers for Medicare & Medicaid Services