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Rural Health Information Hub
Rural Health Information Hub

Rural Health
News by Topic: Reimbursement and payment models

Aug 22, 2025 - Notice from the U.S. Department of Health and Human Services (HHS) announcing its intent to establish the Healthcare Advisory Committee, which will advise the Secretary of HHS and Administrator of the Centers for Medicare & Medicaid Services (CMS) on issues related to improving the operations and outcomes of federally administered healthcare insurance and payment programs. HHS is also requesting nominations for membership on the committee. Nominations are due by September 22, 2025.
Source: Federal Register
Aug 14, 2025 - Notice from the Centers for Medicare & Medicaid Services (CMS) making technical and typographical corrections to the July 16, 2025, proposed rule.
Source: Federal Register
Aug 7, 2025 - Notice from the Health Resources and Services Administration (HRSA) correcting the August 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. Drug manufacturer plans for participation in the 340B Rebate Model Pilot Program should be submitted 340BPricing@hrsa.gov by September 15, 2025. The program will start January 1, 2026, and run for 1 year. Comments are due September 8, 2025.
Source: Federal Register
Aug 7, 2025 - Notice from the Health Resources and Services Administration (HRSA) seeking comments on an information collection request titled "Enrollment and Re-Certification of Entities in the 340B Drug Pricing Program, OMB No. 0915-0327—Revision." HRSA requires covered entities to submit administrative information, certifying information, and attestation from appropriate grantee-level or entity-level authorizing officials and primary contacts in order to enroll and certify the eligibility of federally funded grantees and other safety net health care providers. Comments are due by October 6, 2025.
Source: Federal Register
Aug 5, 2025 - Notice of a final rule from the Centers for Medicare & Medicaid Services (CMS) updating the FY 2026 prospective payment rates, outlier threshold, and wage index for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPF), including psychiatric hospitals and excluded psychiatric units of an acute care hospital or Critical Access Hospital. Includes a revision to the payment adjustment factors for teaching status and for IPFs in rural areas. These changes will be effective for IPF discharges occurring during the fiscal year beginning October 1, 2025, through September 30, 2026. This final rule also includes changes to measures used in the Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program and changes to update and codify the Extraordinary Circumstances Exception policy. These changes are effective October 1, 2025.
Source: Federal Register
Aug 5, 2025 - Notice of a final rule from the Centers for Medicare & Medicaid Services (CMS) seeking comments on updates to the prospective payment system for inpatient rehabilitation facilities (IRFs) for fiscal year 2026. Among other things, this rule proposes classification and weighting factors for the IRF prospective payment system's case-mix groups, continues the second year of the 3-year phase-out of the rural adjustments, and includes proposals for the IRF Quality Reporting Program. This final rule is effective October 1, 2025.
Source: Federal Register
Aug 4, 2025 - 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 4, 2025 - 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
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
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