Category: Current Affairs

CMS Wasteful and Inappropriate Service Reduction (WISeR) Model – Apply by July

July 15, 2025

CMS Wasteful and Inappropriate Service Reduction (WISeR) Model – Apply by July

Last week, the Centers for Medicare & Medicaid Services (CMS) announced the new Wasteful and Inappropriate Service Reduction (WISeR) Model. CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes.

The WISeR Model will test a new process on whether enhanced technologies, including artificial intelligence (AI), can expedite the prior authorization processes for select items and services that have been identified as particularly vulnerable to fraud, waste, and abuse, or inappropriate use.

Companies selected to participate in the model must have clinicians with appropriate expertise to conduct medical reviews and validate coverage determinations. CMS has issued a Request for Applications for companies interested in participating in the WISeR Model.

Additional information is available in the Model Overview Fact Sheet and on the Federal Register.

Click here to Learn More

Click Here to see Request for Applications

Click Here to view Model Overview Fact Sheet

Click Here to go to Federal Register

CMS Updates Mental Health & Substance Use Disorder Telehealth Coverage Guidance

July 8, 2025

CMS Updates Mental Health & Substance Use Disorder Telehealth Coverage Guidance

The Centers for Medicare and Medicaid Services (CMS) released a revised version of its Medicare & Mental Health Coverage booklet, incorporating several important updates related to telehealth and digital mental health services.

Notable changes include notating telehealth coverage for:

  • Caregiver training,
  • Depression screening, and
  • Tobacco cessation counseling.

In addition, CMS added new HCPCS/CPT codes eligible for telehealth and outlined coverage criteria for digital mental health treatment (DHMT) devices when used “incident to” behavioral health services. Due to the possibility that the current Medicare telehealth waivers are not extended or changed, the guidance confirms that starting October 1, 2025, Medicare will require:

  • An in-person visit within six months before initiating telehealth-based mental health services, and
    • Follow-up in-person visits every 12 months.
      • For rural health clinics (RHCs) and federally qualified health centers (FQHCs), this requirement is delayed until January 1, 2026, for services delivered to patients in their homes.

CMS does not mention in the document that current permanent federal law still allows Medicare mental health services to be delivered without an in-person visit if the patient is located at an eligible facility in a geographically rural area or a rural health professional shortage area. Providers can check geographic eligibility using HRSA’s telehealth tool.

In-person visit exemptions also remain in place for patients with substance use disorder and co-occurring mental health conditions.

Finally, an exception to the subsequent 12 month in-person requirement described in the 2022 Final Physician Fee Schedule is also not explicitly addressed by CMS in the booklet-specifically that the requirement can be waived if the patient and practitioner agree that the risks and burdens associated with an in-person service outweigh the benefits of an in person visit.

Click Here to Access Medicare & Mental Coverage booklet

Click Here to Use HRSA’s Telehealth Tool

Click Here to View 2022 Final Physician Fee Schedule

Request for Information: Inviting Comments on the NIH Artificial Intelligence (AI) Strategy, Comment by July 15

June 23, 2025

Request for Information: Inviting Comments on the NIH Artificial Intelligence (AI) Strategy, Comment by July 15

The National Institutes of Health (NIH) is crafting an ambitious institute-wide strategy to guide its use and development of artificial intelligence (AI) technologies – and they are now seeking public input. Through its recently issued Request for Information (RFI): Inviting Comments on the NIH Artificial Intelligence Strategy, the NIH is calling on researchers, health systems, developers, and stakeholders across sectors to help shape the direction of biomedical AI over the coming decade.

Information Requested

NIH welcomes input on any relevant topic, especially the areas below:

  • Strategic Architecture
  • Research & Innovation Actions
  • Intramural-Extramural Synergy
  • Operational Excellence
  • Facilitating & Validating AI in Healthcare Delivery
  • Reproducibility & Trust
  • Partnerships & Ecosystem Building

The deadline for submitting comments is July 15, 2025.

How to Submit a Response

  • Email: ai-rfi@nih.gov
  • Subject Line: “RIF Response – NIH AI Strategy”
  • Format: 7 pages (PDF, Word, or plain-text); include section headers that correspond to the bullets, such as those above, when feasible.

Responses must be received by 11:59 p.m. ET on July 15, 2025. All submissions are voluntary; do not include proprietary, classified, or personally identifiable information you do not wish to make public. NIH may post anonymized summaries or use content to inform future solicitations or policy documents.

Click Here to Learn More

DHSS Recognizes World Elder Abuse Awareness Day

June 9, 2025

DHSS Recognizes World Elder Abuse Awareness Day

June 15 is World Elder Abuse Awareness Day, an event that seeks to unite communities around the world to raise awareness about elder abuse. In Missouri, the Department of Health and Senior Services (DHSS) receives and investigates reports of abuse, neglect, bullying and exploitation of some of the state’s most vulnerable individuals – the elderly and disabled. Last year, DHSS received and investigated 41,929 reports, an average of about 115 each day. That number is on the rise, though the crimes are vastly underreported.

“As people age, it can become increasingly difficult for them to stay involved and connected to their communities and families. As a result, older people are more likely to experience social isolation, which increases the likelihood of abuse, neglect and exploitation,” said Sarah Willson, director of DHSS.

Elder abuse is widespread. Every year an estimated 1 in 10 older Americans are victims of elder abuse, neglect or exploitation.

“This all-too-common tragedy impacts aging adults wherever they call home and in communities throughout Missouri,” says Willson.

Despite its prevalence, experts believe that elder abuse is significantly underreported, in part because so many communities lack the social supports that would make it easier for those who experience abuse to report it. Sadly, research estimates that for every reported adult abuse or neglect case, 23 go unreported to the authorities.

Together, communities can address the issue of elder abuse and help prevent it by strengthening education and social support and by reducing social isolation.

Anyone who suspects a senior or disabled Missourian is being abused, neglected, bullied or exploited, should report to the Missouri Adult Abuse and Neglect Hotline at 1-800-392-0210, which is operational from 7 a.m. through 8 p.m., 365 days a year. Online reporting is also available 24/7 at Health.Mo.Gov/abuse.

Everyone is encouraged to wear purple and communities across Missouri are encouraged to display World Elder Abuse Awareness Day banners, posters and yard signs along with purple ribbons, flags or pinwheels to bring awareness to this public health issue.

For more information about how to make a difference, visit Health.Mo.Gov/weaad.

New Guidance for Hospital Price Transparency

May 29, 2025

New Guidance for Hospital Price Transparency

The Centers for Medicare & Medicaid Services (CMS) released new guidance on how hospitals should calculate the estimated allowed amount values for their online machine-readable files as part of the Hospital Price Transparency requirements.

Whenever possible, hospitals should:

  • Use electronic remittance data to determine the average dollar amount received over the last 12-month period.
    • If there is no historic data, hospitals should use the expected payment amount, encoded as a dollar figure.
  • Hospitals will no longer be able to use a code of nine number nines to signify that there was not sufficient historic data for that item or service over the last year.

Click Here to View Entire Guidance Document

Missouri DHSS Issues Emergency Waiver to Assist Missourians Impacted by Severe Weather

May 22, 2025

Missouri DHSS Issues Emergency Waiver to Assist Missourians Impacted by Severe Weather

The Missouri Department of Health and Senior Services (DHSS) has issued an emergency waiver to assist Missourians in need of critical prescription medications following the devastating tornadoes and sever weather that struck Missouri on May 16.

The action comes after Governor Mike Kehoe issued Executive Order 25-24 authorizing DHSS to temporarily waive or suspend any statutory or administrative rule under its purview to allow medical professionals to better assist those affected by storms.

The provisions of §195.010-195.100 and their attendant regulations and 195.060, RSMo, are partially waived to allow pharmacists to fill controlled substance prescriptions for patients in disaster-impacted areas without the presentation of a written prescription and if the pharmacist determines within his or her professional judgment that an extended supply is needed to avoid interruptions to patient care.

This will ensure that individuals whose prescriptions or prescription records were lost or destroyed, or whose original prescribing physician is unavailable, can continue to receive needed medications even if the pharmacy has not previously dispensed or refilled the prescription.

Click Here to View the Waiver

Policy Update: CMS Proposes Updates for FY 2026 Hospice Payment Rates, Comment by June 10

May 22, 2025

Policy Update: CMS Proposes Updates for FY 2026 Hospice Payment Rates, Comment by June 10

This week, the Centers for Medicare & Medicaid Services (CMS) updated the deadline for comments on their proposed rule for Medicare Hospice Payment Rates from June 30 to June 10.

Click Here to see the CMS Fact Sheet for the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Update Proposed Rule for a summary. When commenting, refer to file code CMS-1835-P.

Healthcare Award Nominations – Annual MOCAN Healthcare Professional and Student Awards, Deadline June 6

May 19, 2025

Healthcare Award Nominations – Annual MOCAN Healthcare Professional and Student Awards, Deadline June 6

Know a healthcare professional or healthcare student who promotes healthy eating and active living in their community?

Please nominate them for the MOCAN award for Excellence in Connecting Health to the Community. The winner in each category will be recognized and share their work at the annual MOCAN Summit.

Deadline for application and supporting materials is Friday, June 6, 2025.

Click Here to Learn More

Click Here to Nominate Healthcare Professional

Click Here to Nominate Healthcare Student

An Expanded Look at Recent State Developments in CCHP’s Telehealth Policy Finder

May 16, 2025

An Expanded Look at Recent State Developments in CCHP’s Telehealth Policy Finder

The Center for Connected Health Policy (CCHP) closely monitors federal telehealth developments through the Telehealth Policy Finder, which is updated year-round, as CCHP ensures that each state undergoes three rounds of comprehensive policy review annually.

Each fall, CCHP compiles a full snapshot of the telehealth policy landscape in their 50-State Summary Report, covering all 50 states, Washington, DC, Puerto Rico, and the U.S. Virgin Islands. This report includes:

  • Medicaid reimbursement status for live video,
  • Store-and-forward,
  • RPM, and
  • Audio-only services, as well as
  • State-level requirements related to patient consent, cross-state licensing, and private payer laws.

To view the most recent version, visit: Fall 2024 State Telehealth Laws and Reimbursement Policies Report.

July 2025 Public Reporting Preview Data Available

May 16, 2025

July 2025 Public Reporting Preview Data Available

The Centers for Medicare & Medicaid Services (CMS) created the Care Compare website to allow consumers to compare health care providers based on quality and other information and to make more informed choices when choosing a health care provider. Users of the site can compare providers in several categories of care settings.

Today through June 13, 2025, on the CMS Hospital Quality Reporting (HQR) page (https://hqr.cms.gov/hqrng/login), you can preview:

  • Your hospital,
  • Overall Hospital Quality Star Rating, or
  • Inpatient psychiatric facility’s quality data

This information will publicly appear in the July 2025 release on the Compare tool on Medicare.gov and the Provider Data Catalog at data.cms.gov/provider-data/. Medicare beneficiaries and the public can use these tools to view quality measure data for participating hospitals and facilities.

Questions about the information listed?

  • Submit questions to the Inpatient and Outpatient Healthcare Quality Systems Development and Program Support Contract Team via the QualityNet Question and Answer Tool or phone assistance:
    • For inpatient questions call (844) 472-4477 or (866) 800-8765 weekdays from 8 a.m. to 8 p.m. Eastern Time (ET).
    • For outpatient questions call (866) 800-8756 weekdays from 7 a.m. to 6 p.m. ET.