Category: Regulations

Webinar: Preparing for Pricing Transparency

Date: July 20, 2020

Time: 2:00 PM Central

Register

In this webinar, we will review the background, intent, and final rule surrounding Price Transparency. We will also cover the requirements, consider the challenges, and evaluate strategies to meet the hospital transparency mandates that will become effective January 2021.

Telepharmacy Rules and Statutes: A 3-Year Update for all 50 States

A new rural policy brief is available from the RUPRI Center for Rural Health Policy Analysis:

Telepharmacy Rules and Statutes: A 3-Year Update for all 50 States

Jason Semprini, MPP; Fred Ullrich, BA; Keith Mueller, PhD

This policy brief analyzed administrative rules and legislative statutes governing each state’s pharmacy practice. Key features of telepharmacy regulations were investigated for comparative analysis. Twenty-one states currently authorize retail telepharmacy, but between these states the regulatory activity varies considerably.

Please click here to read the brief.

Web site: www.public-health.uiowa.edu/rupri

Follow us on Twitter! @RUPRIhealth

ESRD PPS CY 2021 Proposed Rule; COVID-19: New and Expanded Flexibilities for RHCs & FQHCs

July 6, 2020

On July 6, CMS issued a proposed rule that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2021. This rule also proposes updates to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI and proposes changes to the ESRD Quality Incentive Program (QIP).

In addition to the annual technical updates for the ESRD PPS, the proposed rule proposes the following:

  • An addition to the ESRD PPS base rate to include calcimimetics in the ESRD PPS bundled payment
  • Changes to the eligibility criteria and determination process for the Transitional add-on Payment adjustment for New and Innovative Equipment and Supplies (TPNIES)
  • Expansion of the TPNIES to include new and innovative capital-related assets that are home dialysis machines
  • A change to the low-volume adjustment eligibility criteria and attestation requirement to account for the COVID-19 public health emergency
  • An update to the ESRD PPS wage index to adopt the new Office of Management and Budget delineations with a transition period
  • Information received from two manufacturers whose products, a dialyzer and a cartridge for a home dialysis machine, are being considered for TPNIES in CY 2021

Additionally, the proposed rule proposes the following updates to the ESRD QIP:

  • Scoring methodology changes to the ultrafiltration rate reporting measure
  • Updates to the National Healthcare Safety Network validation study

The proposed CY 2021 ESRD PPS base rate is $255.59, an increase of $16.26 to the current base rate of $239.33. This proposed amount reflects the application of the proposed wage index budget-neutrality adjustment factor (.998652), the proposed addition to the base rate of $12.06 to include calcimimetics, and a proposed productivity-adjusted market basket increase as required by section 1881(b)(14)(F)(i)(I) of the Act (1.8 percent), equaling $255.59 (($239.33 x .998652) + $12.06) x 1.018 = $255.59).

The proposed rule also includes:

  • Annual update to the wage index
  • Update to the outlier policy
  • Low-volume eligibility criteria and attestation requirement
  • Impact analysis

For More Information:

See the full text of this excerpted CMS Fact Sheet (issued July 6).

Webinar: Preparing for Price Tansparency

Date: June 20, 2020

Time: 2:00 PM – 3:00 PM Central

Register!

In this webinar, we will review the background, intent, and final rule surrounding Price Transparency. We will also cover the requirements, consider the challenges, and evaluate strategies to meet the hospital transparency mandates that will become effective January 2021.

New Brief: Provision of Mental Health Services by Critical Access Hospital-Based Rural Health Clinics

Residents of rural communities face longstanding access barriers to mental health (MH) services due to chronic shortages of specialty MH providers, long travel distances to services, increased likelihood of being uninsured or under-insured, limited choice of providers, and high rates of stigma. As a result, rural residents rely more heavily on primary care providers and local acute care hospitals to meet their MH needs than do urban residents. This reality highlights the importance of integrating primary care and MH services to improve access to needed care in rural communities. Critical Access Hospitals (CAHs) are ideally positioned to help meet rural MH needs as 60 percent manage at least one Rural Health Clinic (RHC). RHCs receive Medicare cost-based reimbursement for a defined package of services including those provided by doctoral-level clinical psychologists (CPs) and licensed clinical social workers (LCSWs).

This policy brief explores the extent to which CAH-based RHCs are employing CPs and/or LCSWs to provide MH services, describes models of MH services implemented by CAH-based RHCs, examines their successes and challenges in doing so, and provides a resource to assist CAH and RHC leaders in developing MH services. It also provides a resource for State Flex Programs to work with CAH-based RHCs in the development of MH services.

**The report may accessed on the Flex Monitoring Team website.

 

CMS Announces Plans to End the Blanket Waiver Requiring Nursing Homes to Submit Staffing Data

June 25, 2020

Today, the Centers for Medicare & Medicaid Services (CMS) announced plans to end the emergency blanket waiver requiring all nursing homes to resume submitting staffing data through the Payroll-Based Journal (PBJ) system by August 14, 2020. The PBJ system allows CMS to collect nursing home staffing information which impacts the quality of care residents receive. The blanket waiver was intended to temporarily allow the agency to concentrate efforts on combating COVID-19 and reduce administrative burden on nursing homes so they could focus on patient health and safety during this public health emergency.

The memorandum released today also provides updates related to staffing and quality measures used on the Nursing Home Compare website and the Five Star Rating System.

To view the memorandum to states and nursing home stakeholders, visit: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/changes-staffing-information-and-quality-measures-posted-nursing-home-compare-website-and-five-star

 

Medicare Care Choices Model One-Year Model Extension Announcement

June 25, 2020

The Centers for Medicare & Medicaid Services (CMS) will extend the Medicare Care Choices Model (MCCM) by one calendar year, through December 31, 2021, allowing more Medicare beneficiaries to access supportive care.

MCCM tests a new option for Medicare beneficiaries to receive supportive care services from selected hospice providers. It evaluates whether those services can improve the quality of life and care received by Medicare beneficiaries, increase patient satisfaction, and reduce Medicare expenditures.

Under the extension, participating MCCM hospices will be able to enroll eligible beneficiaries through June 30, 2021 and provide MCCM services for them through December 31, 2021. The extension will not affect the model’s other existing operations or policies.

The extension will apply to hospices already participating in the model; no new hospices will be enrolled. CMS will contact hospices participating in the model in the coming days and invite them to apply for the voluntary extension.

For more information on the model, please see its webpage.

Questions or Feedback?

If you have questions or feedback, please email the MCCM model team at CareChoices@cms.hhs.gov.