Category: Current Affairs

CMS Innovation Center Ending Four Models Early

March 21, 2025

CMS Innovation Center Ending Four Models Early

Last week the Innovation Center at the Centers for Medicare & Medicaid Services (also known as CMMI) announced they are terminating four models early to align with its statutory obligation and strategic goals.

Innovation Center Models are intended to be time-limited experiments to determine what approaches should be:

  • expanded nationwide,
  • what components need further testing, and
  • what approaches are not viable for expansion.

The models are ending early are:

Termination of the ETC model will be proposed through rulemaking. Subject to discussions with State authorities, Maryland will transition to the AHEAD model and begin its implementation period in January 2026.

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CMS Rescinds Medicaid Guidance on Health-Related Social Needs

March 13, 2025

CMS Rescinds Medicaid Guidance on Health-Related Social Needs

Last week, the Centers for Medicare & Medicaid Services (CMS) announced rescission of previous guidance for Center Information Bulletins (CIBs) related to services and supports addressing health-related social needs (HRSN) for Medicaid and state Children Health Insurance Programs (CHIPs). The rescinded guidance includes:

Rescinding this guidance does not negate programs that are currently approved. Rather, it informs States and the public that CMS will review applications to cover HRSN services on a case-by-case basis.

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Where the Physician Shortage is Headed – and What it Means

March 7, 2025

Where the Physician Shortage is Headed – and What it Means

According to a recent report, the shortfall of physicians could reach as high as 86,000 by the year 2036. NRHA COO Brock Slabach says rural areas are already affected by workforce shortages, with primary care in especially high demand. Subspecialties already experiencing a shortage are bracing for impact as demand for eye care and other categories exacerbate shortfalls.

Act soon to share your perspective in Stroudwater’s physician compensation survey.

Click Here to access the survey

Article: The Other Physician Pipeline Problem

March 4, 2025

Article: The Other Physician Pipeline Problem

The Association of American Medical Colleges reported in 2021 that physicians aged 65 and older accounted for 20% of the active patient care workforce, and those between 55 and 64 years old made up 22%. In 2023, physicians 65 and older were 23.4% of the active clinical workforce.

These data show that more than a third of currently active physicians will reach retirement age within the next decade – if they have not already.

This spells a problem not only for patients but also hospitals, many of which are already operating within tight margins. Failing to replace a vacant physician role can heavily cost an organization.

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DEA & HHS Delay Implementation of Final Rules

February 25, 2025

DEA & HHS Delay Implementation of Final Rules

The Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) have announced a delay in the effective date for the recently issue final rules regarding the telemedicine prescribing of buprenorphine and telemedicine for Veterans Affairs Patients. Originally scheduled to become effective February 18, the rules will now take effect on March 21, 2025.

This decision aligns with the White House memorandum issued on January 20, which called for “A Regulatory Freeze Pending Review” to allow agencies further review of any fact, law, and policy considerations prior to proposing, issuing, or finalizing any regulatory activities. In particular, the DEA/HHS announcement cites the third paragraph of the Freeze Memo, which ordered agencies to consider postponing the effective dates for any recently published rules that have yet to take effect.

The DEA and HHS have also confirmed that the waiver provisions established in the third extension of telemedicine flexibilities for prescribing controlled substances will remain in effect through December 31, 2025, ensuring that in-person visit requirements continue to be waived for the remainder of 2025.

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Click Here to Read Buprenorphine Rule

Click Here to Read Veterans Affair Rule

Click Here to Read Telemedicine Special Registration Rule

CMS Provides Billing Instructions for Opioid Treatment Programs (OTP) Telecommunications Add-On Codes

February 18, 2025

CMS Provides Billing Instructions for Opioid Treatment Programs (OTP) Telecommunications Add-On Codes

In the 2025 Final Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) finalized important updates for Opioid Treatment Programs (OTPs) aligning with regulations previously adopted by the Substance Abuse and Mental Health Services Administration (SAMHSA). These changes aim to enhance access to care for individuals with opioid use disorder (OUD) by expanding telehealth options.

Key Updates include:

  • Periodic assessments may now be conducted via audio-only technology on a permanent basis if live video is unavailable, as long as they meet all applicable SAMHSA and DEA requirements.
  • The OTPs intake add-on code (G2076) can now be billed when using live video for the initiation of methadone treatment.

As a result of these changes, CMS has updated its Opioid Treatment Program (OTP) webpage to reflect proper billing practices. OTPs should use the following HCPCS add-on codes when treating eligible patients:

  • G2076 – Used to initiate buprenorphine or methadone treatment via two-way interactive audio-video or audio-only technology when video is unavailable.
  • G2077 – covers periodic patient assessments via audio-only technology when video is unavailable.
  • G2080 – Applies to additional counseling or therapy provided via audio-only technology when video is unavailable.

For more details on the finalized policy, review the 2025 Final Physician Fee Schedule.

To learn more about billing and G-codes for OTPs, visit the CMS Opioid Treatment Program webpage.

Click Here to go to 2025 Final Physician Fee Schedule

Click Here to go to CMS Opioid Treatment Program webpage.

HHS Proposes Major Updates to HIPAA Security Rule to Strengthen Cybersecurity, Comments due March 7

February 18, 2025

HHS Proposes Major Updates to HIPAA Security Rule to Strengthen Cybersecurity, Comments due March 7

For the first time in two decades, the Department of Health and Human Services (HHS) has proposed significant updates to the HIPAA Security Rule to better protect electronic protected health information (ePHI) from increasing cyber threats. The Notice of Proposed Rulemaking (Proposed Rule) seeks to modernize security safeguards in response to a significant increase in large-scale healthcare breaches caused by hackers and ransomware between 2018 and 2023.

If enacted, the rule would require all HIPAA-regulated entities to:

  • Enhance cybersecurity practices, including maintaining an up-to-date inventory of technology assets,
  • Conducting annual risk analyses,
  • Implementing stronger patch management policies, and
  • Using multi-factor authentication.

Additionally, covered entities would be obligated to:

  • Encrypt ePHI,
  • Perform vulnerability scans and penetration testing, and
  • Ensure more rigorous oversight of business associates handling sensitive health data.

As remote care platforms manage vast amounts of ePHI, these new cybersecurity rules could significantly impact telehealth services.

The Proposed Rule also emphasizes stricter compliance documentation and monitoring, including mandating a 72-hour disaster recovery plan, annual compliance audits, and stronger incident response protocols. Notably, business associates would be required to notify covered entities of any contingency plan activation within 24 hours.

The proposed rule also seeks comments on emerging technologies such as artificial intelligence, quantum computing, virtual and augmented reality, and HIPAA’s role in regulating these emerging technologies.

Comments are due by March 7, 2025 and can be submitted through the federal register.

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New Fact Sheets from USDA

February 18, 2025

New Fact Sheets from USDA

The Economic Research Service (ERS) at the U.S. Department of Agriculture (USDA) regularly updates data on population, income, poverty, food security, education, employment/unemployment, farm characteristics, farm financial indicators, and agricultural exports for all states and includes breakouts for rural and metropolitan areas.

County-level Data Sets include poverty estimates, unemployment, and median household income. A separate ERS report examines the Trends and Patterns of Job Quality in the United States, including wages, employer sponsored health insurance coverage, and retirement benefits between 2000 and 2022.

Click Here to see County-level data sets

Click Here to see Trends and Patterns of Job Quality in the United States

DEA, HHS Finalize Expansion of Buprenorphine Treatment via Telemedicine

February 18, 2025

DEA, HHS Finalize Expansion of Buprenorphine Treatment via Telemedicine

The Drug Enforcement Administration (DEA) and the U.S. Department of Health & Human Services (HHS) are amending their regulations to expand the circumstances under which practitioners registered by the DEA are authorized to prescribe schedule III-V controlled substances approved by the FDA for the treatment of opioid use disorder via telemedicine, including an audio-only telemedicine encounter.

Under these new regulations, after a practitioner reviews the patient’s prescription drug monitoring program data for the state in which the patient is located, the practitioner may prescribe an initial six-month supply of such medications (split amongst several prescriptions totaling six calendar months) through audio-only means.

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HIPAA Security Rule Notice of Proposed Rulemaking to Strengthen Cybersecurity for Electronic Protected Health Information, Comment by March 7

January 10, 2025

HIPAA Security Rule Notice of Proposed Rulemaking to Strengthen Cybersecurity for Electronic Protected Health Information, Comment by March 7

On January 6, 2025, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) issued a proposed rule to modify the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule to strengthen cybersecurity protections for electronic protected health information.

The proposal will strengthen the Security Rule’s standards and implementation specifications with new proposals and clarifications. This rule will impact hospitals, providers, health plans, and any other entity that use or transmit electronic protected health information. Comments are due by March 7, 2025.

Click Here to Read More and Make Comment