December 20, 2024

Medicare Advantage Value-Based Insurance Design (VBID) Model to End after Calendar Year 2025

The Centers for Medicare & Medicaid Services (CMS) announced the Medicare Advantage (MA) Value-Based Insurance Design Model (VBID) is ending on December 31, 2025.

CMS is ending the model due to negative financial performance. Through the model, participating MA plans have had greater flexibility in serving high needs and underserved beneficiaries, and many of the lessons learned from the model have been incorporated into the MA program as a whole. Upon the model’s end, some beneficiaries in VBID MA plans may need to select a new MA plan or go back to traditional Medicare in 2026.

Click Here to Learn More

December 20, 2024

CMS Guidance on Co-location Arrangements in CAHs

The Centers for Medicare & Medicaid Services (CMS) has released guidance providing clarity on how Critical Access Hospitals (CAHs) may leverage space sharing arrangements with other healthcare entities, such as private physician practices, to increase access to care and services within the community, while maintaining independent compliance with all applicable Conditions of Participation (CoPs).

Because CAHs must maintain a specified distance from another hospital or CAH, they cannot share space with these types of facilities. This guidance explains how a CAH may share space with other types of health care providers through either a ‘time share’ arrangement or a ‘leased space’ arrangement and meet requirements of their CoPs.

Click Here to Learn More

December 20, 2024

Rural Health Clinic CY 2025 All-Inclusive Rate

The Centers for Medicare & Medicaid Services (CMS) updated the Rural Health Clinic (RHC) all-inclusive rate for calendar year (CY) 2025. The payment limit per visit for independent and provider based RHCs in hospitals with 50 or more beds is $152.00.

The payment limit per visit for specified provider based RHCs, with an April 1, 2021, established payment limit, that continue to meet the qualifications in section 1833(f)(3)(B) of the Social Security Act is the greater of these amounts:

• Your payment limit per visit starting January 1, 2024, increased by 3.5 percent;
• The national statutory CY 2025 payment limit per visit of $152.00.

For more information see:

• Medicare Claims Processing Manual, Chapter 9, section 20.2, and
• Instruction to your Medicare Administrative Contractor.

December 20, 2024

CMS Seeking Input to Protect Medicare Beneficiary Identifiers

The Centers for Medicare & Medicaid Services (CMS) is soliciting comments to inform future decision-making regarding how the agency can best protect Medicare Beneficiary Identifiers (MBIs) and Medicare beneficiaries.

MBIs have been targeted by individuals seeking to commit Medicare fraud, including the use of MBI lookup tools to commit MBI theft. CMS is seeking input and information related to the following topic areas:

• Organizations that operate an externally controlled MBI lookup tool;
• Users of MBI lookup tools, both CMS-operated and externally controlled;
• Potential benefit or impact of prohibiting or restricting externally controlled MBI lookup tools;
• Safeguards or best practices from inside or outside healthcare that CMS should consider for preventing MBI theft and misuse.

Click Here for more information and the full list of questions.

To provide comments, Click Here and fill out and submit the survey by Monday, February 17.

December 6, 2024

CMS Finalizes New Model to Improve Access to Kidney Transplants

On November 26, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized a rule establishing a new, six-year mandatory model aimed at increasing access to kidney transplants.

Starting in July 2025, selected transplant hospitals will receive financial incentives to perform more kidney transplants.

The final rule also includes standard provisions for all mandatory CMS innovation center models starting after January 1, 2025.

Click Here to Read CMS New Model

Click Here to Read Final Rule

December 6, 2024

CMS Proposed Changes to Medicare Part C and D

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise the Medicare Advantage (MA) Program and Medicare Prescription Drug Benefit Program (Part D).

Proposals include:

• Permitting Medicare and Medicaid coverage of anti-obesity medications,
• Further clarifications to the rules on what MA plans must cover,
• Limits on enrollee cost-sharing for behavioral health,
• Expanded topics that agents/brokers must cover when assisting beneficiaries,
• Parameters around the use of debit cards for supplemental MA benefits,
• Codifying requirements for the Medicare Prescription Payment Plan, and
• Integrating member identification cards for individuals dually eligible for Medicare and Medicaid.

As of January 2023, about 45 percent of rural Medicare beneficiaries were enrolled in an MA plan.

Click Here to Learn More

Click Here to Read Proposed Rule

Click Here to Go to Medicare Prescription Payment Plan

December 6, 2024

CMS Seeks Feedback on Quality Measures for Medicare Hospitals, including REHs, Comment by December 30

The Centers for Medicare & Medicaid Services (CMS) would like public feedback on 41 measures under consideration for quality reporting and value-based programs before the measures are formally proposed through the rulemaking process.

Categories of quality measures for hospitals receiving payment through Medicare, including CMS-designated Rural Emergency Hospitals (REHs) are:

• Post-acute care/long-term care measures
• Clinician Measures
• Hospital Measures

For example, CMS would like early feedback on including the measure Median Time to Pain Medication for Patients with a Diagnosis of Sickly Cell Disease with Vaso-Occlusive Episode in the Rural Emergency Hospital Quality Reporting Program, and the measure Proportion of Patients who Died from Cancer Admitted to Hospice for less than 3 Days in the Hospital Quality Reporting Program.

CMS will hold three listening sessions, one for each of these categories, December 17-19. Register to make live comments or ask questions during these sessions:

Click on the topic, below to learn more and register for the listening session:

• Tuesday, December 17, 1:00 p.m. – 4 p.m. ET: Clinician Listening Session
• Wednesday, December 18, 1:00 p.m. – 4:00 p.m. ET: Hospital Listening Session
• Thursday, December 19, 1:00 p.m. – 2:00 p.m.: Post-Acute Care/Long-term Care (PAC/LTC) Listening Sessions

Click Here for Instructions on Submitting a Comment