Feb 1, 2023 - Notice of final rule from the Centers for Medicare & Medicaid Services (CMS) announcing policies to improve program integrity and payment accuracy in the Medicare Advantage (MA) program. This final rule codifies that, as part of the MA Risk Adjustment Data Validation (RADV) program audit methodology, CMS will extrapolate RADV audit findings beginning with payment year (PY) 2018 and will not extrapolate RADV audit findings for PYs 2011 through 2017. A policy is also being finalized whereby CMS will not apply an adjustment factor in RADV audits. This final rule is effective April 3, 2023.
Jan 20, 2023 - Arkansas House Bill 1127, or the Rural Emergency Hospital Act, would give the Arkansas Department of Health authority to license hospitals as "Rural Emergency Hospitals." This designation would allow qualifying rural hospitals to be reimbursed at a higher rate for outpatient services and procedures, and would support acute care emergency care in communities where other types of care might not be available.
Jan 16, 2023 - A bill introduced in the Iowa House is the first step in setting up a state licensing process for Rural Emergency Hospitals (REHs). If approved, the REH license would increase reimbursement rates for Medicare and Medicaid patients treated in an emergency room, and could be a financial lifeline for more than 30 small Iowa hospitals .
Jan 12, 2023 - Notice of interim final rule with comment request from the Department of Defense modifying the TRICARE regulation by adding freestanding End Stage Renal Disease (ESRD) facilities as institutional providers within the TRICARE program and establishing reimbursement for such facilities. This interim final rule also temporarily adopts Medicare's New Coronavirus Disease 2019 (COVID-19) Treatments Add-on Payments (NCTAPs) for COVID-19 cases that meet Medicare's criteria. This interim final rule is effective January 12, 2023. Comments are due by March 13, 2023.
Jan 12, 2023 - Notice of proposed rule from the Department of Veterans Affairs (VA) proposing changes to its medical regulations to implement a statute exempting Indian and urban Indian veterans from copayment requirements for the receipt of hospital care or medical services, including the initial three urgent care visits in a calendar year. Comments are due by February 13, 2022.
Jan 10, 2023 - Describes new two Kaiser Family Foundation (KFF) studies, with findings drawn from KFF's Behavioral Health Survey of state Medicaid programs. The first study explores expansion of telehealth and of the types of providers who may be reimbursed for telehealth delivery of behavioral health services. The second examines strategies some state Medicaid programs are implementing to address the behavioral health workforce shortage.
Jan 5, 2023 - Announces new guidance that allows state Medicaid and Children's Health Insurance Programs (CHIPs) to pay specialists directly when a beneficiary's primary healthcare provider asks for advice. This links routine care with specialty care, allowing more people to benefit from practitioners with specialized knowledge.
Dec 29, 2022 - Notice from the U.S. Department of Health and Human Services (HHS) announcing the 2023 meetings of the Physician-Focused Payment Model Technical Advisory Committee (PTAC), which will include discussion and voting on proposals for physician-focused payment models (PFPMs). The 2023 meeting dates are: March 2-3, June 12-13, September 18-19, and December 4-5.