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Rural Healthcare Payment and Reimbursement – News

News stories from the past 60 days.

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 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 8, 2024 - Discusses challenges faced by Maine rural hospitals and describes facilities' creative solutions to staffing shortages, reduced reimbursements, and lower margins. Includes statistics on operating margins at select Maine hospitals.
Source: Mainebiz
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) proposing policies for assessing performance year (PY) 2023 financial performance of Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs) in light of significant, anomalous, and highly suspect (SAHS) billing activity for selected intermittent urinary catheters on Medicare Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) claims. Among other things, rule proposes benchmarks for ACOs starting agreement periods in 2024, 2025, and 2026; and financial calculations used in the application cycle for ACOs applying to enter a new agreement period beginning on January 1, 2025, and the change request cycle for ACOs continuing their participation in the program for PY 2025. Comments are due by July 29, 2024.
Source: Federal Register
Jun 17, 2024 - Announces the conclusion of the Center for Medicare & Medicaid Services (CMS) Accelerated and Advance Payment (AAP) Program, which launched in March to address payment disruptions resulting from the Change Healthcare cyberattack. Notes that over $2.55 billion has been distributed to Part A providers as a result of the program, which will conclude on July 12.
Source: Center for Medicare & Medicaid Services
Jun 12, 2024 - The Government Accountability Office (GAO) is accepting nominations for appointment to the Physician-Focused Payment Model Technical Advisory Committee (PTAC), which provides comments and recommendations to the Secretary of Health and Human Services on physician payment models. Nominations are due by July 10, 2024.
Source: Federal Register
Jun 4, 2024 - Notice from the Centers for Medicare & Medicaid Services (CMS) making technical and typographical corrections to the May 2, 2024, proposed rule regarding changes to the hospital inpatient prospective payment system (IPPS) for operating and capital-related costs of acute care hospitals for fiscal year 2025.
Source: Federal Register

Last Updated: 7/15/2024