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Rural Health
News by Topic: Reimbursement and payment models

CMS: Agency Information Collection Activities: Submission for OMB Review; Comment Request Federal Register
Sep 19, 2018 - Notice from the Centers for Medicare and Medicaid Services seeking comment on a potential demonstration project called the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration. If approved, the demonstration would test whether exempting clinicians who participate in certain payment arrangements with Medicare Advantage Organizations (MAOs) with Medicare Fee-for-Service from the Merit-based Incentive Payment System (MIPS) reporting requirements and payment adjustment will increase or maintain participation in MAOs similar to Advanced Alternative Payment Models (APMs). Comments are due by October 19, 2018.
Source: Federal Register
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AHA, Hospital Leaders Announce 340B Good Stewardship Principles
Sep 18, 2018 - Press release from the American Hospital Association (AHA) announcing new principles for ensuring good stewardship of the 340B program on behalf of leaders from both the AHA and individual 340B hospitals. These principles are designed to help 340B hospitals strengthen the program as well as communicating the value of the program directly.
Source: American Hospital Association
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This Social Worker Goes Where Her Clients Are - Even out Behind a Gas Station.
Sep 10, 2018 - Discusses the impact that providing mental healthcare through house calls can have in rural areas and among people with severe mental illnesses, focusing on rural Idaho in particular. There has been a push in the state to make this option more widespread and accessible. Even so, existing providers using this model say they struggle to make ends meet because of the expense, despite how helpful their clients find it.
Source: Idaho Statesman
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Medicaid To Introduce Value-Based Drug Pricing
Sep 4, 2018 - Details Oklahoma's Medicaid drug pricing initiative, approved by the Centers for Medicare and Medicaid Services (CMS), as well as Massachusetts' prescription drug waiver request, which CMS rejected. Touches on Michigan and Colorado, which appear to be planning similar moves. Discusses the broader push, nationally, towards value-based pricing and its application to prescription drugs.
Source: Forbes
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CMS Announces New Model to Address Impact of the Opioid Crisis for Children
Aug 23, 2018 - The Centers for Medicare and Medicaid Services (CMS) announced the Integrated Care for Kids (InCK) as a new Innovation Center payment and service delivery model. As part of the larger strategy to address the opioid epidemic, this model aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children's Health Insurance Program (CHIP) through prevention, early identification, and treatment of behavioral and physical health needs.
Source: Centers for Medicare and Medicaid Services
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CMS: Medicare Program; Certain Changes to the Low-Volume Hospital Payment Adjustment Under the Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals for Fiscal Years 2011 Through 2017 Federal Register
Aug 23, 2018 - Notice from the Centers for Medicare and Medicaid Services (CMS) announcing changes to the low-volume hospital payment adjustment under the hospital inpatient prospective payment systems (IPPS) for acute care hospitals for fiscal years 2011-2017 relating to the application of mileage criterion for Indian Health Service (IHS) and non-IHS hospitals.
Source: Federal Register
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Demographic Shifts And Inadequate Cost Reimbursements Spell Trouble For Rural Hospitals
Aug 21, 2018 - Discusses rural hospital closures in Texas, which is the state with the most closures in the country. Texas has had at least 18 hospitals that serve rural people close since 2013. Also discusses causes for these closures, like Medicare and Medicaid reimbursements, lack of insurance or insurance with deductibles too high for patients to pay, and more.
Source: Texas Standard
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Still Grappling With Provider Access Issues, State Pours More Money Into Denti-Cal
Aug 20, 2018 - Discusses efforts to improve Denti-Cal, California's low-income dental program. Only just over 15% of the state's dentists accept Denti-Cal patients, although the program is trying to improve those rates. Discusses some of the reasons why dentists are reluctant to accept Denti-Cal and the specific efforts to improve them. Also touches on the high demand for dentists in rural areas.
Source: California Health Report
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CMS Proposes “Pathways to Success,” an Overhaul of Medicare’s ACO Program
Aug 9, 2018 - The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would overhaul the Medicare Shared Savings Program. This program, established by the Affordable Care Act, is the program through which most of Medicare's Accountable Care Organizations (ACOs) operate. Presently, for the first six years ACOs receive a shared savings payment from CMS when they keep costs down, but do not have to pay taxpayers back when costs are high, allowing them to transition to a new service delivery model without risk. The proposed rule would reduce the amount of time that an ACO can remain in the program without taking on risk in an effort to discourage market consolidation which may reduce choices for patients and increase costs. Comments are being accepted through October 16, 2018.
Source: Centers for Medicare and Medicaid Services
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CMS: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program; Correction Federal Register
Aug 9, 2018 - Notice from the Centers for Medicare and Medicaid Services making corrections to Figure A, as filed in the July 27, 2018 proposed rule to revise payment policies under the Physician Fee Schedule.
Source: Federal Register
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