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Medicare and Rural Health News

News stories from the past 60 days.

CMS: Medicare Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs Federal Register
Dec 14, 2017 - Corrected republication of a final rule from the Centers for Medicare and Medicaid Services (CMS) revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) Payment System for calendar year 2018. Included in the rule is a provision that reduces Medicare Part B payments to Disproportionate Share Hospitals (DSHs) and Rural Referral Centers (RRCs) for drugs acquired through the 340B Drug Pricing Program. Effective January 1, 2018, payments to affected facilities will be reduced from average sales price (ASP) plus 6 percent, to ASP minus 22.5 percent. Among others, Critical Access Hospitals (CAHs) and rural Sole Community Hospitals (SCHs) are excluded from this payment adjustment. Comments regarding provisions of the rule must be submitted no later than 5:00 p.m. Eastern on December 31, 2017.
Source: Federal Register
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Rural Hospitals Feel the Squeeze as Medicare Extender Funding in Flux
Dec 13, 2017 - Discusses the impact of Medicare extender provisions supporting rural hospitals that expired on September 30, 2017. If Congress doesn't delay cuts to these programs by December 31st, reduced payments for rural hospitals could begin at the start of the year. (May require registration for full article.)
Source: Modern Healthcare
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CMS Office of the Actuary Releases 2016 National Health Expenditures
Dec 6, 2017 - The Centers for Medicare and Medicaid Services (CMS) Office of the Actuary has released a study on overall national health spending. The study includes spending growth trends for private health insurance, Medicare, Medicaid, prescription drugs, and out-of-pocket consumer costs.
Source: Centers for Medicare and Medicaid Services
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CMS: Medicare Program; Cancellation of Advancing Care Coordination Through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model: Extreme and Uncontrollable Circumstances Policy for the Comprehensive Care for Joint Replacement Payment Model Federal Register
Dec 1, 2017 - Final rule from the Centers for Medicare and Medicaid Services (CMS) cancelling the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) Incentive Payment Model. The rule also finalizes revisions to the Comprehensive Care for Joint Replacement (CJR) Model, making participation in CJR voluntary for all low-volume and rural hospitals, regardless of geographic location. Additionally, the included interim final rule provides flexibility when determining episode costs for providers located in areas affected by extreme circumstances, such as hurricanes, in 2017. Comments regarding provisions of the interim final rule must be submitted no later than 5:00 p.m. Eastern on January 30, 2018. Additional information is available on the November 30, 2017, CMS fact sheet.
Source: Federal Register
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CMS Finalizes Changes to the Comprehensive Care for Joint Replacement Model, Cancels Episode Payment Models and Cardiac Rehabilitation Incentive Payment Model
Nov 30, 2017 - The Centers for Medicare and Medicaid Services (CMS) implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model. CMS also finalized the cancellation of the mandatory hip fracture and cardiac bundled payment models that were to be operated by the CMS Innovation Center. A fact sheet is available.
Source: Centers for Medicare and Medicaid Services
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CMS Releases Its Measures Under Consideration List for 2018 Pre-Rulemaking
Nov 30, 2017 - Blog post from the Centers for Medicare and Medicaid Services (CMS) announcing that they have released the annual list of quality and cost measures that are under consideration for Medicare quality reporting and value-based purchasing programs. CMS collaborates with the National Quality Forum (NQF) to get input from stakeholders on this list in order to provide more high quality care and achieve better individual outcomes.
Source: Centers for Medicare & Medicaid Services Blog
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Updated Medicare Part D Opioid Drug Mapping Tool Unveiled
Nov 29, 2017 - The Centers for Medicare and Medicaid Services (CMS) released an updated version of their interactive Medicare opioid prescribing mapping tool. This tool provides geographic comparisons of Medicare Part D opioid prescribing rates and includes county-level hot spots and outliers.
Source: Centers for Medicare and Medicaid Services
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CMS: Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program Federal Register
Nov 28, 2017 - Proposed rule from the Centers for Medicare and Medicaid Services (CMS) that would revise Medicare Advantage (Part C) and Prescription Drug Benefit (Part D) regulations to implement certain provisions contained in the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act. The proposed rule also clarifies the "any willing pharmacy" requirement, which may work to support independent community pharmacies often found in rural areas, and improve rural beneficiaries' access to specialty drugs. Comments regarding provisions of the rule must be submitted no later than 5:00 p.m. Eastern on January 16, 2018. Additional information is available on the November 16, 2017, CMS fact sheet.
Source: Federal Register
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CMS Updates Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019
Nov 22, 2017 - The Centers for Medicare and Medicaid Services (CMS) announced updates to the Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019 to expand into an additional fifteen states, allow Chronic Condition Special Needs Plans to participate, and allow participants to propose their own systems or methods for identifying eligible enrollees.
Source: Centers for Medicare and Medicaid Services
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CMS: Medicare Program; CY 2018 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts Federal Register
Nov 21, 2017 - Notice from the Centers for Medicare and Medicaid Services (CMS) announcing the inpatient hospital deductible, and hospital and extended care services coinsurance amounts for services furnished under Medicare Part A during calendar year (CY) 2018. The updated deductible and coinsurance amounts take effect January 1, 2018.
Source: Federal Register
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CMS: Medicare Program; CY 2018 Part A Premiums for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement Federal Register
Nov 21, 2017 - Notice from the Centers for Medicare and Medicaid Services (CMS) announcing the calendar year (CY) 2018 Medicare Hospital Insurance (Part A) premium for uninsured enrollees who are not otherwise eligible and for certain individuals who have exhausted other entitlement. Effective January 1, 2018, the CY 2018 monthly premium for the uninsured aged and certain disabled individuals is $422, and the reduced premium for certain eligible individuals is $232.
Source: Federal Register
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CMS: Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rates, and Annual Deductible Beginning January 1, 2018 Federal Register
Nov 21, 2017 - Presents the calendar year 2018 monthly actuarial rates for aged and disabled beneficiaries enrolled in part B of the Medicare Supplementary Medical Insurance (SMI) program. Also announces the monthly premium for aged and disabled beneficiaries, the deductible for 2018, and the income-related monthly adjustment amounts to be paid by beneficiaries with modified adjusted gross income above certain threshold amounts. Rates become effective on January 1, 2018.
Source: Federal Register
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2018 Medicare Parts A & B Premiums and Deductibles Announced
Nov 17, 2017 - The Centers for Medicare and Medicaid Services (CMS) announced the 2018 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs. There is a fact sheet on these premiums and deductibles available.
Source: Centers for Medicare & Medicaid Services
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CMS Proposes Policies to Lower the Cost of Prescription Drugs and Combat the Opioid Crisis
Nov 16, 2017 - The Centers for Medicare and Medicaid Services (CMS) have issued a proposed rule intended to provide more affordable prescription drugs to Medicare Part D enrollees and to allow Medicare to combat overprescribing and abuse of opioid medications. A fact sheet on this proposed rule is available.
Source: Centers for Medicare and Medicaid Services
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CMS Releases Proposed Rule to Increase Choices and Lower Premiums for Medicare Advantage Enrollees
Nov 16, 2017 - The Centers for Medicare and Medicaid Services (CMS) released a proposed rule to allow Medicare Advantage beneficiaries more flexibility with customized benefit designs to address their specific health needs. The proposed rule would also work to reduce regulatory burdens. There is a fact sheet available.
Source: Centers for Medicare and Medicaid Services
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CMS: Medicare Program; CY 2018 Updates to the Quality Payment Program; and Quality Payment Program: Extreme and Uncontrollable Circumstance Policy for the Transition Year Federal Register
Nov 16, 2017 - Final rule and interim final rule providing updates for the second and future years of the Quality Payment Program (QPP), and establishing guidelines for MIPS-eligible clinicians who may face uncontrollable circumstances due to widespread catastrophic events, such as hurricanes, during calendar year 2017. Also finalizes the low-volume threshold, which exempts clinicians and groups providing care to fewer than 200 Medicare Part B beneficiaries annually, or submitting $90,000 or less to Medicare Part B annually. Comments regarding provisions of the rule, which take effect January 1, 2018, must be submitted no later than 5:00 p.m. Eastern on January 1, 2018.
Source: Federal Register
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CMS: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program Federal Register
Nov 15, 2017 - Final rule from the Centers for Medicare and Medicaid Services (CMS) addressing changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies. Also includes policies necessary to begin offering the expanded Medicare Diabetes Prevention Program model, and information about new care coordination services and payments for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQCHs). Provisions of the rule take effect January 1, 2018. Additional information is available on the November 2, 2017, CMS fact sheet.
Source: Federal Register
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HHS: Meetings Announcement for the Physician-Focused Payment Model Technical Advisory Committee Required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Federal Register
Nov 15, 2017 - Announces the next meeting of the Physician-Focused Payment Model Technical Advisory Committee, which will be held on December 18-20, 2017, from 9:00 a.m. to 5:00 p.m. Eastern each day at the Hubert H. Humphrey Building in Washington, D.C. The meeting is open to the public and will include deliberations and voting on proposals for physician-focused payment models submitted by members of the public. Those wishing to participate may attend in person, over teleconference, or via livestream. Pre-registration is requested.
Source: Federal Register
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Ways & Means Committee Leaders Announce Bipartisan Medicare Extenders Package
Nov 15, 2017 - The U.S. House of Representatives Committee on Ways and Means announced a bipartisan agreement to extend several expiring Medicare payment policies, including the Medicare Dependent Hospital Program and the Low-Volume Adjustment Program. The agreement includes offsetting the cost of these extensions with funding from other programs, including payments for Critical Access Hospital swing beds.
Source: U.S. House of Representatives Committee on Ways and Means
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CMS: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs Federal Register
Nov 13, 2017 - Final rule from the Centers for Medicare and Medicaid Services (CMS) revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) Payment System for calendar year 2018. Included in the rule is a provision that reduces Medicare Part B payments to Disproportionate Share Hospitals (DSHs) and Rural Referral Centers (RRCs) for drugs acquired through the 340B Drug Pricing Program. Effective January 1, 2018, payments to affected facilities will be reduced from average sales price (ASP) plus 6 percent, to ASP minus 22.5 percent. Among others, Critical Access Hospitals (CAHs) and rural Sole Community Hospitals (SCHs) are excluded from this payment adjustment. Comments regarding provisions of the rule must be submitted no later than 5:00 p.m. Eastern on December 31, 2017.
Source: Federal Register
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CMS: Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements Federal Register
Nov 7, 2017 - Final rule from the Centers for Medicare and Medicaid Services (CMS) updating several payment parameters within the home health prospective payment system (HH PPS). The rule also finalizes the sunset of the rural add-on provision, effective for episodes of care ending on or after January 1, 2018. Provisions of the rule take effect January 1, 2018.
Source: Federal Register
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CMS Finalizes Policies that Reduce Provider Burden, Lower Drug Prices
Nov 2, 2017 - The Centers for Medicare and Medicaid Services (CMS) highlights two final rules, to be published in the Federal Register on November 15 and 16th respectively. The 2018 Physician Fee Schedule final rule will modernize the Medicare payment system to create greater competition in the biopharmaceutical market to lower costs. The Quality Payment Program final rule allows clinicians in small and rural practices to join together and share the responsibility of participating in value-based payments. This rule also decreases the number of clinicians required to participate, provides additional detail on clinician participation in Advanced Alternative Payment Models (APMs), and includes a new hardship exception for small practices affected by the recent hurricanes.
Source: Centers for Medicare and Medicaid Services
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CMS Finalizes Policies that Lower Out-of-Pocket Drug Costs and Increase Access to High-Quality Care
Nov 1, 2017 - The Centers for Medicare and Medicaid Services (CMS) announced two Medicare payment rules. The Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System and Quality Reporting Programs Changes for 2018 rule is using the 340B Program to reduce the cost of Medicare Part B drugs for hospitals in order to pass those savings on to beneficiaries. It also places a two-year moratorium on the direct physician supervision requirements for rural hospitals and Critical Access Hospitals. The Home Health Prospective Payment System rule will move towards a more patient-centered model.
Source: Centers for Medicare & Medicaid Services
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CMS: Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, and End-Stage Renal Disease Quality Incentive Program Federal Register
Nov 1, 2017 - Final rule from the Centers for Medicare and Medicaid Services (CMS) updating and revising the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year 2018. This rule also sets forth requirements for the ESRD Quality Incentive Program (QIP) and updates payment rates for renal dialysis services furnished by ESRD facilities to individuals with acute kidney injury (AKI). Provides information specific to small rural hospitals and treatment facilities located in rural areas. Provisions of the rule take effect January 1, 2018.
Source: Federal Register
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CMS Administrator Verma Announces New Meaningful Measures Initiative and Addresses Regulatory Reform; Promotes Innovation at LAN Summit
Oct 30, 2017 - The Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma announced a new approach to quality measurement called "Meaningful Measures," which involves only assessing the core issues that are vital to providing high-quality care and improving patient outcomes. This outcome-based approach is part of an effort to streamline quality measures, reduce regulatory burden, and promote innovation.
Source: Centers for Medicare & Medicaid Services
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CMS Offers Medicare Enrollment Relief for Americans Affected by Recent Disasters
Oct 30, 2017 - The Centers for Medicare and Medicaid Services (CMS) is giving individuals who have been impacted by the wildfires in California and the recent hurricanes additional time to enroll in Medicare Part B and premium-Part A if they were unable to make a request during the initial and special enrollment periods.
Source: Centers for Medicare & Medicaid Services
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CMS: Medicare and Medicaid Programs: Approval of an Application From the Joint Commission (TJC) for Continued CMS Approval of Its Critical Access Hospital (CAH) Accreditation Program Federal Register
Oct 27, 2017 - Announces the Centers for Medicare and Medicaid Services' (CMS) decision to approve the Joint Commission's application for continued recognition as a national accrediting organization for Critical Access Hospitals (CAHs) that wish to participate in the Medicare and/or Medicaid programs. The Joint Commission's new term takes effect November 21, 2017, and runs through November 21, 2023.
Source: Federal Register
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CMS: Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-July Through September 2017 Federal Register
Oct 27, 2017 - Quarterly listing of Centers for Medicare and Medicaid Services (CMS) manual instructions, substantive and interpretive regulations, and Federal Register notices published from July through September, 2017. Also includes contact information for general questions or additional information about a specific section.
Source: Federal Register
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CMS: Medicare and Medicaid Programs; Application by Community Health Accreditation Partner for Continued CMS Approval of Its Home Health Agency Accreditation Program Federal Register
Oct 20, 2017 - Acknowledges the receipt of an application from the Community Health Accreditation Partner (CHAP) for continued recognition as a national accrediting organization for home health agencies (HHAs) that wish to participate in the Medicare or Medicaid programs. Comments regarding the continued recognition of CHAP must be submitted no later than 5:00 p.m. Eastern on November 20, 2017.
Source: Federal Register
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Medicare Open Enrollment – New Features make Shopping for 2018 Coverage Easier!
Oct 20, 2017 - Blog post from the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma on Medicare Open Enrollment, which began on October 15, 2017 and will remain open through December 7, 2017. Post emphasizes that Medicare is offering more health coverage choices and lower premiums to improve the affordability of care for participants. Also touches on some updates including digital features on Medicare.gov.
Source: Centers for Medicare & Medicaid Services Blog
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Last Updated: 12/14/2017