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Rural Health
News by Topic: Reimbursement and payment models

CMS: Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs Federal Register
Nov 21, 2018 - Notice from the Centers for Medicare and Medicaid Services of a final rule with comment period to revise the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2019. Among other things, this final rule updates the requirements for the Hospital Outpatient Quality Reporting (OQR) program and the ASC Quality Reporting program, as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey to remove communication about pain questions. The final rule is effective on January 1, 2019 and comments are due by December 3, 2018.
Source: Federal Register
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CMS: Agency Information Collection Activities: Proposed Collection; Comment Request Federal Register
Nov 20, 2018 - The Centers for Medicare and Medicaid Services is seeking comment on the following information collections: 1) Medicare Coverage of Items and Services in FDA Investigational Device Exemption Clinical Studies - Revision of Medicare Coverage; 2) Generic Clearance for the Health Care Payment Learning and Action Network; and 3) Hospitals and Health Care Complex Cost Report. Comments are due by January 22, 2019.
Source: Federal Register
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Washington Managed Fee-for-Service Demonstration: 2015 and 2016 Medicare Actuarial Savings Report
Nov 16, 2018 - The Centers for Medicare and Medicaid Services (CMS) released a report summarizing the final Medicare Parts A and B actuarial savings analysis of the Washington managed fee-for-services (MFFS) demonstration. This model seeks to align the financial incentives of the state-run Medicaid program and the federal Medicare program when working with dually eligible enrollees to improve care and save money for both programs.
Source: Centers for Medicare and Medicaid Services
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CMS May Allow Hospitals to Pay for Housing Through Medicaid
Nov 14, 2018 - U.S. Department of Health and Human Services (HHS) Secretary Alex Azar said in a speech that Medicaid may soon allow hospitals and health systems to directly pay for housing, healthy food, and more to improve the overall health of enrollees. Azar expressed that including social determinants of health in overall health considerations could allow the U.S. to spend less on healthcare while improving health. (May require subscription to view article.)
Source: Modern Healthcare
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CMS Strengthens Federal Support to California Residents Affected by Wildfires
Nov 14, 2018 - The Centers for Medicare and Medicaid Services (CMS) announced waivers and modifications to certain Medicare, Medicaid, and Children's Health Insurance Program (CHIP) requirements in response to the wildfires in California and the resulting declaration of a public health emergency by the U.S. Department of Health and Human Services (HHS). These include a blanket Skilled Nursing Facility waiver, a Special Enrollment Period, and dialysis care.
Source: Centers for Medicare and Medicaid Services
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CMS: Medicare Program: End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) and Fee Schedule Amounts, and Technical Amendments to Correct Existing Regulations Related to the CBP for Certain DMEPOS Federal Register
Nov 14, 2018 - Notice of final rule from the Centers for Medicare and Medicaid Services to update the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2019. Also updates requirements for the ESRD Quality Incentive Program and makes technical amendments to correct existing regulations for the Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), among other things.
Source: Federal Register
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CMS Announces New Medicaid Demonstration Opportunity to Expand Mental Health Treatment Services
Nov 13, 2018 - The Centers for Medicare and Medicaid Services (CMS) announced existing and new opportunities for states to design innovative service delivery systems for adults with serious mental illness (SMI) and children with serious emotional disturbance (SED). This includes the ability for states to receive authority to pay for short-term resident treatment services in an institution for mental disease (IMD).
Source: Centers for Medicare and Medicaid Services
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CMS: Medicare and Medicaid Programs: CY 2019 Home Health Prospective Payment System Rate Update and CY 2020 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; Home Health Quality Reporting Requirements; Home Infusion Therapy Requirements; and Training Requirements for Surveyors of National Accrediting Organizations Federal Register
Nov 13, 2018 - The Centers for Medicare and Medicaid Services has issued a final rule with comment period to update the home health prospective payment system (HH PPS) rates effective for services provided beginning January 1, 2019. Among many other things, the rule also finalizes the methodology for determining rural add-on payments for calendar years 2019-2022 and finalizes the definition of "remote patient monitoring" and recognizes it as an allowable administrative cost. Comments on the final rule are due by December 31, 2018.
Source: Federal Register
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For Some Rural Tennessee Hospitals, Sustainability Means Avoiding Repeat Customers
Nov 13, 2018 - Discusses how one rural Tennessee hospital has worked with home health agencies in the community to reduce readmissions. Also touches on the difficult balance of trying to keep patients out of the hospital without losing volume, especially because many rural hospitals are operating on a thin margin.
Source: Nashville Public Radio
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Quality Payment Program (QPP) Year 1 Performance Results
Nov 8, 2018 - Blog post from the Centers for Medicare and Medicaid Services on the performance results of the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program (QPP). Touches on the Small, Underserved, and Rural Support initiative.
Source: Centers for Medicare and Medicaid Services Blog
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