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CMS Rules

CMS Rules

Home Health Agencies Receive $125 Million Pay Boost

Although budget cuts are still coming,  home health agencies will receive a 0.7% pay increase, equaling $125 million, rather than the proposed $810 million budget cut, under the finalized rule for the Home Health Prospective Payment System Rate...
Biden Administration Announces Push for Oversight on Nursing Homes, Special Focus Facility Program CMS Rules

Biden Administration Announces Push for Oversight on Nursing Homes, Special Focus Facility Program

Last Friday, the Biden administration announced it will immediately increase enforcement for nursing home requirements and tighten quality requirements for poor-performing facilities. The Centers for Medicare and Medicaid Services (CMS) said that it would provide resources for poorly-performing nursing homes but maintains the threat...
CMS Rules

CMS Extends Bundle Payments for Care Improvement Advanced Model for 2 Years

The Centers for Medicare and Medicaid Services (CMS) announced the extension of the BPCI program to December 2025 along with the agency’s plans to release a 2023 RFA for Medicare ACOs interested in applying for the model, which was expected to end next year. In 2018, the Bundled Payments for Care Improvement Advanced (BPCI...
CMS Rules

CMS Proposed Rule Would Streamline Enrollment for CHIP and Medicaid

Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would streamline the application and renewal process for enrollees in Medicaid and the Children's Health Insurance Program (CHIP). The overhaul aims to "reduce red tape" and simplify the application and verification process for children,...
CMS Drops Surprise Draft of MDS 3.0, Dropping Section G of Skilled Nursing Data CMS Rules

CMS Drops Surprise Draft of MDS 3.0, Dropping Section G of Skilled Nursing Data

Well ahead of the expected publication, the Centers for Medicare and Medicaid Services (CMS) posted a draft of updated Minimum Data Set specifications (MDS 3.0) last Friday. The comprehensive item set version 1.18.11 is expected to radically transform the future of nursing home reimbursements by states. CMS said that the final version...
Rural Hospitals Respond to CMS's Designation for Rural Emergency Hospitals and Critical Access Hospitals CMS Rules

Rural Hospitals Respond to CMS's Designation for Rural Emergency Hospitals and Critical Access Hospitals

On July 26, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that included new payment model for rural emergency hospitals (REH). The designation seeks to alleviate financial disturbance in the continuity of care provided in areas with limited medical resources by shifting from an inpatient bed model to...
COVID-19 Update August 25, 2022: CMS Signals End of PHE Waivers and Flexibilities CMS Rules

COVID-19 Update August 25, 2022: CMS Signals End of PHE Waivers and Flexibilities

The Centers for Medicare and Medicaid Services (CMS) are signaling that the end of the COVID-19 public health emergency (PHE) is near. Last week, CMS published a blog post called "Creating a Roadmap for the End of the COVID-19 Public Health Emergency," to help providers prepare for the end of the waivers and flexibilities that arrived...
Biden Administration Issues Final Rule on No Surprises Act CMS Rules

Biden Administration Issues Final Rule on No Surprises Act

Last Friday, the U.S. Departments of Health and Human Services, Labor and Treasury issued a joint final rule that rectifies issues with the implementation of the No Surprises Act, a law that aims to curb surprise billing practices. The rule defines the processes for payers and providers to settle payment for services provided that...
CMS Rules

Medicaid: Quality Metrics Reporting, Georgia Work Requirements & Another Case of Medicaid Fraud

Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that aims to improve quality reporting for Medicaid and the Children's Health Insurance Program (CHIP). According to the CMS press release, the rule would include mandatory annual state reporting of three new quality measures, called "Core Sets,"...
CMS Rules

No Surprises Act: Providers Need More Time to Comply, Insurers Using NSA in Rate Negotiations

The No Surprises Act has been a hot-button point of contention among insurers and providers as physician groups feel threatened by the leverage that insurers are given through the Act's enforcement. The Medical Group Management Association (MGMA) sent a letter to the U.S. Department of Health and Human Services (HHS) and the Centers for...
CMS Rules

FY 2023 SNF PPS Final Rule: CMS Increases Reimbursement for Nursing Homes

In a surprising turn of events, the Centers for Medicare and Medicaid Services issued the FY 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule which contains a 2.7% increase in Medicare rates to nursing homes. When the proposed payment rule was published in April, the agency had proposed cutting Medicare Part...
CMS Requests Public Comment on Medicare Advantage CMS Rules

CMS Requests Public Comment on Medicare Advantage

Last week, the Centers for Medicare and Medicaid Services (CMS) released a Request for Information (RFI), seeking comment on ways to improve Medicare Advantage and make the program more equitable, affordable and sustainable. Medicare Advantage (MA) has been under great scrutiny lately, for policies on prior authorization, the adequacy...
CMS Rules

CMS Final Rule: 4.3% Payment Increase Announced in FY 2023 Hospital IPPS and 2.4% Boost to LTCH PPS

The rule updates Medicare fee-for-service payment rates and policies for inpatient hospitals and long-term care hospitals (LTCH) and builds on key priorities to advance health equity, including better measurements for healthcare quality disparities and improving the safety and quality of maternity care by establishing a...
CMS Rules

CMS Unveils HCBS Quality Metrics for Patient Outcomes

The Centers for Medicare and Medicaid Services (CMS) published a set of quality metrics for home and community-based services (HCBS) to assess patient health outcomes. According to CMS, the ratings will provide insight into HCBS programs and will enable states to determine the success of long-term services and support programs offered...
CMS Rules

CMS Final Rule Provides $825M YOY Bump in Hospice Payments

In 2023 hospice payments will increase by 3.8% and the most Medicare will pay per hospice patient in FY 2023 will be $32,486.92, this year the cap amount is $31,297.61. Hospices that don't meet quality reporting requirements get a 2% point reduction to the annual hospice payment update percentage increase for the year.  The rule also...
 CMS Final Rule: 2023 Medicare Inpatient Psychiatric Facility PPS CMS Rules

 CMS Final Rule: 2023 Medicare Inpatient Psychiatric Facility PPS

No new changes yet to the Inpatient Psychiatric Facility (IPF) Quality Reporting Program, but payments to facilities are expected to increase 2.5% ($90 million) over FY 2022. The Centers for Medicare & Medicaid Services (CMS) said the IPF prospective payment system (PPS) rates in FY 2023 will be updated by 3.8%. The agency also...
CMS Issues Final Rule: Inpatient Rehabilitation Facility PPS & QRP CMS Rules

CMS Issues Final Rule: Inpatient Rehabilitation Facility PPS & QRP

The agency had proposed a more modest 2% increase ($170 million) but the FY 2023 Inpatient Rehabilitation Facility (IRF)  payments will increase by 3.2% ($275 million) relative to payments in FY 2022. The IRF Quality Reporting Program (QRP) is a pay-for-reporting program. IRFs that do not meet reporting requirements are subject to a 2%...
CMS Rules

AHA Review of CMS Hospital Star Ratings Finds Volatility for Smaller Hospitals

In 2020, the Centers for Medicare and Medicaid Services (CMS) reevaluated and revised the Hospital Overall Star Ratings methodology to streamline the ratings process and improve equitable ratings throughout a highly-varied industry. The American Hospital Association (AHA) reviewed the changes and found that they provide some stability...
PFS Proposed Rule includes MSSP Changes Benchmarks to Encourage Participation, Advance Equity CMS Rules

PFS Proposed Rule includes MSSP Changes Benchmarks to Encourage Participation, Advance Equity

Last Thursday, the Centers for Medicare and Medicaid Services (CMS) published the proposed 2023 physician fee schedule (PFS) which included an overhaul to the agency's strategies on accountable care organizations (ACOs) through the Medicare Shared Savings Program (MSSP). In February, CMS pulled the Accountable Care Organizations...
CMS Rules

CMS Unveils New Nursing Home Star Rating System for Staffing

It's no secret that the Biden administration is planning to implement mandatory staffing levels in nursing facilities that are reimbursed through Medicare and Medicaid. In the most recent step to announcing this measure last Thursday, the Centers for Medicare and Medicaid Services (CMS) published new guidance on staffing measures tied to...
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