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Rural Health Information Hub

Rural Health
News by Topic: Reimbursement and payment models

Jul 22, 2024 - Notice of proposed rule 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 proposed rule would also update and refine the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, Rural Emergency Hospital Quality Reporting (REHQR) Program, ASC Quality Reporting (ASCQR) Program, and Hospital Inpatient Quality Reporting Program and proposes Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services. Among other things, this rule would request information on options being considered for future changes to the Overall Hospital Quality Star Rating methodology and further information related to a Tribal Technical Advisory Group request to apply the Indian Health Service encounter rate to all outpatient tribal clinics. This proposed rule would also provide 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. Comments are due by September 9, 2024.
Source: Federal Register
Jul 17, 2024 - 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, 2024.
Source: Federal Register
Jul 16, 2024 - The Centers for Medicare and Medicaid Services is seeking comment on the following information collections: 1) Medicare Current Beneficiary Survey (MCBS); 2) Implementation of the Medicare Prescription Drug Plan (PDP) and Medicare Advantage (MA) Plan Disenrollment Reasons Survey; and 3) New Technology Services for Ambulatory Payment Classifications Under Outpatient Prospective Payment System. Comments are due August 15, 2024.
Source: Federal Register
Jul 15, 2024 - The Centers for Medicare & Medicaid Services (CMS) will hold a virtual meeting of the Advisory Panel on Hospital Outpatient Payment on August 26-27, 2024. The purpose of the Panel is to advise the Secretary of the Department of Health and Human Services and the Administrator of CMS concerning the clinical integrity of the Ambulatory Payment Classification groups and their associated weights, as well as 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 2, 2024.
Source: Federal Register
Jul 15, 2024 - Discusses rural healthcare viability challenges including telehealth and broadband access, reimbursement rates, and an end of pandemic-era funding.
Source: Health Leaders Media
Jul 15, 2024 - Highlights declines in birth rates across time and the associated impact on rural labor and delivery services. Discusses the impact of low service volume on maintaining labor and delivery services and offering high quality healthcare.
Source: KFF Health News, NPR
Jul 11, 2024 - The Centers for Medicare & Medicaid Services' proposed calendar year 2025 physician fee schedule rule includes new payments and coverage for digital health and telehealth services. The draft rule contains significant provisions for Rural Health Clinics and Federally Qualified Health Centers and gives opioid treatment programs more flexibility in their use of telehealth services.
Source: Fierce Healthcare
Jul 11, 2024 - Pre-publication 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) updates to the Medicare Diabetes Prevention Program expanded model; payment for dental services inextricably linked to specific covered medical services; 4) updates to drugs and biological products paid under Part B including immunosuppressive drugs and clotting factors; 5) Medicare Shared Savings Program requirements; 6) updates to the Quality Payment Program; 7) Medicare coverage of opioid use disorder services furnished by opioid treatment programs; 8) updates to policies for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs); 9) electronic prescribing for controlled substances for a covered Part D drug under a prescription drug plan or an MA-PD plan; 10) updates to the Ambulance Fee Schedule regulations; 11) updates to Clinical Laboratory Fee Schedule regulations; 12) updates to the diabetes payment structure and COVID-19 public health emergency (PHE) flexibilities; 13) expansion of colorectal cancer screening and Hepatitis B vaccine coverage and payment; 14) establishing payment for drugs covered as additional preventive services; and 15) Medicare Parts A and B Overpayment Provisions of the Affordable Care Act. Comments are due by September 9, 2024.
Source: Federal Register
Jul 5, 2024 - Notice of proposed rule from the Centers for Medicare & Medicaid Services (CMS) making changes related to End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2025 and proposing updates to the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). Among other things, this rule also proposes updated requirements for the Conditions for Coverage for ESRD facilities, the ESRD Quality Incentive Program, and the ESRD Treatment Choices Model. Comments are due by August 26, 2024.
Source: Federal Register
Jul 3, 2024 - Notice of proposed rule from the Centers for Medicare & Medicaid Services (CMS) updating the home health payment rates for calendar year (CY) 2025. This rule also proposes changes to the Home Health Quality Reporting Program (HH QRP) requirements; provides an update on potential approaches for integrating health equity in the Expanded Health Value-Based Purchasing (HHVBP) Model; proposes a new standard for acceptance to service policy in the home health conditions of participation (CoPs); proposes rebasing and revising the home health market basket; and proposes updates to provider and supplier enrollment requirements and changes to the long-term care reporting requirements for acute respiratory illnesses, among other things. Also includes requests for information seeking input on permitting rehabilitative therapists to conduct the initial and comprehensive assessment and the factors that may influence the patient referral and intake processes. Comments are due by August 26, 2024.
Source: Federal Register