Rural Healthcare Payment and Reimbursement – News

CMS: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments Federal Register

Dec 9, 2024 - Notice of final 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; 4) payment for dental services inextricably linked to specific covered medical services; 5) updates to drugs and biological products paid under Part B including immunosuppressive drugs and clotting factors; 6) Medicare Shared Savings Program requirements; 7) updates to the Quality Payment Program; 8) Medicare coverage of opioid use disorder services furnished by opioid treatment programs; 9) updates to policies for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs); 10) electronic prescribing for controlled substances for a covered Part D drug under a prescription drug plan or an MA-PD plan; 11) updates to the Ambulance Fee Schedule regulations; 12) updates to Clinical Laboratory Fee Schedule regulations; 13) updates to the diabetes payment structure and COVID-19 public health emergency (PHE) flexibilities; 14) expansion of colorectal cancer screening and Hepatitis B vaccine coverage and payment; 15) establishing payment for drugs covered as additional preventive services; and 15) Medicare Parts A and B Overpayment Provisions of the Affordable Care Act and Medicare Parts C and D Overpayment Provisions of the Affordable Care Act. These regulations are effective January 1, 2025.

view details

CMS: Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model Federal Register

Dec 4, 2024 - Notice of a final rule from the Centers for Medicare & Medicaid Services (CMS) describing a new mandatory Medicare payment model, the Increasing Organ Transplant Access Model (IOTA Model). The IOTA Model would test whether performance-based upside risk payments or downside risk payments paid to or owed by participating kidney transplant hospitals increase access to kidney transplants for patients with end-stage renal disease (ESRD) while preserving or enhancing the quality of care and reducing Medicare expenditures. This proposed rule also describes standard provisions for the Radiation Oncology Model, the End-Stage Renal Disease (ESRD) Treatment Choices Model, and mandatory Innovation Center models, including the IOTA Model, whose first performance period begins on or after January 1, 2025. Includes comments regarding rural-specific concerns. This rule is effective January 3, 2025.

view details

Study: Rural Residents More Likely to Struggle With Medical Debt

Nov 13, 2024 - Provides overview of recent research on rural medical debt. Notes that rural residents are more likely than urban residents to have problems paying medical bills, and identifies gender and racial disparities within rural survey respondents. Discusses the potential impacts of medical debt on the viability of rural hospitals.

view details

CMS: Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, Conditions for Coverage for End-Stage Renal Disease Facilities, End-Stage Renal Disease Quality Incentive Program, and End-Stage Renal Disease Treatment Choices Model Federal Register

Nov 12, 2024 - Notice of final rule from the Centers for Medicare & Medicaid Services (CMS) updating and revising the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2025 and updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also updates the requirements for the Conditions for Coverage for ESRD facilities, the ESRD Quality Incentive Program, and the ESRD Treatment Choices Model. These regulations are effective January 1, 2025.

view details