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

November 8, 2024

Medicare Finalizes New Standards for Hospital Obstetric Care

The Centers for Medicare & Medicaid Services (CMS) released the Medicare Outpatient Hospital Prospective Payment System (OPPS) Final Rule for Calendar Year 2025.

In addition to annual updates in outpatient hospital Medicare payment rates, this rule finalizes new standards for hospitals and Critical Access Hospitals (CAHs) with obstetric (OB) units regarding maternal quality assessment and performance improvement, the organization, staffing, and delivery of OB care, and staff training on evidence-based maternal health practices.

For hospitals and CAHs with emergency services, it adds standards on facility readiness in caring for emergency services’ patients, including pregnant, birthing, and postpartum women.

The rule also finalizes new transfer policies for hospitals that mirror the current CAH and Rural Emergency Hospital standards. These Conditions of Participation (CoPs) will be phased in over two years.

Click Here to Read Final Rule

November 8, 2024

Policy Update: Medicare Finalizes Changes to Medicare Home Health Program, Effective January 1, 2025

On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which updates the Medicare payment policies and rates for home health agencies (HHAs).

CMS projects an increase in aggregate payments by 0.5 percent, and finalizes a permanent prospective adjustment of 1.975% to the CY 2025 home health payment rate.

CMS finalized a new standard for acceptance to service policy in the Home Health Conditions of Participation (HH CoPs) and their proposal with modification to require ongoing respiratory illness reporting for Long-Term Care (LTC) facilities. The rule is effective January 1, 2025.

Click Here to see 2025 Home Health Prospective Payment System Rate Update final rule

October 17, 2024

OSHA Request for Information: Extending COVID-19 Recordkeeping and Reporting for Employees in Healthcare Settings – respond by December 9

The federal Occupational Safety and Health Administration (OSHA) seeks comments on their request to extend requirements for collecting information specified in OSHA’s COVID-19 Recordkeeping and Reporting in Healthcare Standard, which applies to settings where any employee provides healthcare services.

The requirements include:

• Establishing and maintaining a log of each instance identified by the employer that an employee is COVID-19 positive;
• Make the individual log entry available upon request for examination and copying, and
• Reporting to OSHA each work-related COVID-19 fatality and each work-related COVID-19 in-patient hospitalization within specific timeframes of the employer learning of them.

OSHA would like to hear from the public:

• Whether the information collection requirements are necessary for the proper performance of the agency’s function to protect workers;
• If OSHA’s estimate of the burden (time and costs) of collecting the information is accurate; and
• What are some ways to minimize the burden on employers who much comply.

OSHA will summarize responses when they submit their request to the Office of Management and Budget to extend the requirements.

Click Here to Comment

October 17, 2024

Request for Information: Medicare $2 Drug List Model – Respond by December 9

In response to an Executive Order to lower prescription drug costs, the Centers for Medicare & Medicaid Services (CMS) developed a model to test whether a simpler approach to offering low-cost, clinically important generic drugs can improve medication adherence, lead to better health outcomes, and improve satisfaction with the Part D prescription drug benefit for people with Medicare and for prescribers.

This RFI aims to obtain input from a broad range of interested parties to support continued development of the model. CMS’ primary areas of interest include:

• Drug List Development Process;
• Maximizing Plan Participation;
• CMS Outreach Efforts;
• Part D Sponsor Outreach and Education Efforts for Beneficiaries;
• Assessment of Model Impact;
• Drug List Modifications.

CMS is interested in hearing from all stakeholders, including, but not limited to:

• Medicare beneficiaries
• Advocates
• Medicare Part D plan sponsors
• Pharmacy benefit managers
• Prescribers
• Pharmacists
• Pharmacies
• Policy experts
• Researchers
• Drug manufacturers
• Wholesalers
• Distributors
• All other interested parties

Click Here to Read More

Click Here to Read Executive Order

Process for Submitting Response:

• Deadline to respond: December 9, 2024, 11:59 p.m. PST
• Comments can be submitted here