The Federal Office of Rural Health Policy provides these updates in Rural Route, the monthly newsletter published by the Technical Assistance and Services Center (TASC). Contact Nicole Clement at if you would like to subscribe to receive the newsletter.

Updates include: Opportunities for Medicaid 1115 waiver demonstrations addressing serious mental illness, comments requested on ONC Draft Strategy on Reducing Burden, RFI on how to improve HIPAA, FORHP funding opportunity for VB care TA. Proposed changes to: Medicaid and CHIP Managed Care, Medicare Advantage (MA) and Part D Plans.

Updates include: Calendar Year (CY) 19 Home Health PPS Final Rule, CY 19 Physician Fee Schedule and Quality Payment Program Final Rule, Interim final rule implementing provisions of the SUPPORT Act, CY 19 Medicare Outpatient PPS Final Rule and Proposed Policy and Technical Changes to Medicare Advantage, among other programs.

Regulatory updates for October include: Proposed Regulatory Provisions to Promote Program Efficiency, Transparency and Burden Reduction.

Updates include: ONC Request for Information (RFI) on EHR Reporting Program and Office of Inspector General (OIG) Request for Information on Safe Harbors.

Updates include CMS proposed rules: Hospital Outpatient Prospective Payment System, Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs), Medicare Physician Fee Schedule (PFS) and QPP, as well as final rules updating payment rates and rules on PPS facilities.

Updates include: CMS publishes durable medical equipment fee schedule adjustments, and HRSA’s 340B Drug Pricing Program ceiling price and manufacturer civil monetary penalties regulation.

Updates include: CMS Direct Provider Contracting Model Request for Information, Fiscal Year (FY) 2019 Medicare Hospital IPPS Proposed Rule (PR), FY19 Medicare SNF PR, FY19 Medicare Inpatient Rehabilitation Facility PPS PR, FY19 Medicare Inpatient Psychiatric Facilities PPS PR, FY19 Medicare Hospice Wage Index and Payment Rate Update PR, VA Telehealth Final Rule

Updates include: HHS Notice of Benefit and Payment Parameters final rule 2019, Hardship Exemptions Guidance for Insurance, Medicare Advantage and Prescription Drug Benefit final rule 2019, Methods for Assuring Access to Covered Medicaid Services, Exemptions for States With High Managed Care Penetration Rates and Rate Reduction Threshold proposed rule

Updates include: Proposed changes to short-term, limited duration health insurance and Veterans Administration (VA) revises policy for emergency treatment payment.

Updates include: RHC and FQHC Policy Manual Updated, Advisory Panel on Hospital Outpatient Payment, Medicare Advantage/Prescription Drug Plan Updates, New Medicare Episode Payment Model, Updated APMs List, EHR Incentive Program Payment Adjustment for CAHs, Annual Call for EHR Incentive Program Measures, New Medicaid Guidance and 2019 Essential Community Providers List

Updates include: HHS seeks input on how to improve health care choice and competition, Department of Labor Association Health Plans proposed rule and FCC Promoting Telehealth in Rural America proposed rule

Updates include: hospital-based Bundled Payment Programs, Medicare Advantage and the Prescription Drug Benefit Program, Rural Community Hospital demonstration, hospital policy for inpatient services, Essential Community Provider (ECP) Petition, new Medicare cards, updates to the Rural Health Care (RHC) program

Updates include: Calendar Year (CY) 2018 Final Rule for QPP, New Medicare Physician Payment Model Proposals, CY 2018 Final Rule for Physician Fee Schedule (PFS), CY 2018 Final Rule for Hospital OPPS and Ambulatory Surgical Center Payment System, CY 2018 Final Rule for Home Health PPS, CY 2018 Final Rule for End-Stage Renal Disease (ESRD) PPS, 2019 Proposed Notice of Benefit and Payment Parameters for Health Insurance Marketplace, State Medicaid Directors’Letter on Strategies to Address the Opioid Epidemic

Updates include: Veterans Administration (VA) publishes telehealth proposed rule, the Centers for Medicare and Medicaid Services (CMS) revises instructions for Medicare cost report Worksheet S-10 

Updates include: CMS proposes cancellation of Cardiac Bundled Payment Program, Medicare-dependent Hospital Expiration, CMS clarifies statutory definition of “hospital”, CMS reveals new Medicare cards

Updates include: QPP Hardship Exception for Meaningful Use, Fiscal year (FY) 2018 Final Rule Medicare Hospital IPPS, FY 2018 Final Rule for Long-Term Care Hospitals (LTCH) payment, FY 2018 Final Rule for SNF, FY 2018 Final Rule for Inpatient Rehabilitation Facilities (IRF), FY 2018 Final Rule for Hospice

Updates include: Calendar Year (CY) 2018 Proposed Rule for QPP, CY 2018 Proposed Rule for Physician Fee Schedule, CY 2018 Proposed Rule for Hospital OPPS and Ambulatory Surgical Center Payment System, CY 2018 Proposed Rule for End-Stage Renal Disease PPS, CMS Delays Rules for Home Health Agencies, Skilled Nursing Facilities Now Eligible for FCC Rural Health Care Program

Updates include: CMS delays bundled payment programs to 2018, Review skilled nursing quality measures, CMS expands Comprehensive Primary Care Plus (CPC+), CMS publishes request for information for Affordable Care Act market improvements

Updates include: Fiscal Year (FY) 2018 Proposed Rule Medicare Hospital Inpatient Prospective Payment System (IPPS), Federal Communications Commission (FCC) Seeks Public Comment, Quality Payment Program (QPP) Update, The Joint Commission CAH Accreditation Program

Updates include: Centers for Medicare and Medicaid Services (CMS) Delays Update to Rules for Home Health Agencies, 2018 Medicare Advantage and Part D Plan Payment and Policy Updates, Request for Information on How to Improve Medicare Advantage and Part D, CMS Selects Accountable Health Communities (AHC)

Updates include: Chronic Care Management Payment Correction for Rural Health Clinics and Federally Qualified Health Centers, New Broadband Advisory Committee, Secretary Price Highlights State Innovation Waivers, New Bundled Payment Programs Delayed, CMS Issues Emergency Information Collection for Home Health Beneficiaries, Government Accountability Office Issues Preliminary Observations on Veterans' Access to Choice Program Care

Updates include: Fact Sheet: New Accountable Care Organization (ACO) Model Opportunity: Medicare ACO Track 1+ Model, Proposed Rule: 2018 Medicare Advantage and Part D Advance Notice and Draft Call Letter, Request for Letters of Intent for Two New Beneficiary Engagement and Incentive Models, Medicare and Medicaid Conditions of Participation for Home Health Agencies, Extension of Data and Meaningful Use Deadlines, Centers for Medicare and Medicaid Services (CMS) Changes for the 2018 Marketplace, CMS Launches Technical Assistance to Help Small and Rural Practices Succeed in the Quality Payment Program, Office of the Inspector General (OIG) Revisions to the Safe Harbors Under the Anti-Kickback Statute – Final Rule

Updates include: Medicare Advancing Care Coordination through Episode Payment Models (EPMs), New Medicare Quality Report from the Office of the Assistant Secretary for Planning and Evaluation (ASPE), Rural Economic Development Loan and Grant Programs, Rural Transportation Systems Development

Updates include: Final Rule: Advanced Practice Registered Nurses, CMS Posts Final Hospital Notice, Final Rule on Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and CHIP, Proposed Rule on the Use of New or Increased Pass-Through Payments in Medicaid Managed Care Delivery Systems, New Medicare-Medicaid Accountable Care Organization (ACO) Model

Updates include: Request for Information (RFI): Home and Community-Based Services, Calendar 2017 Home Health Prospective Payment System Update, Final Rule for Health IT Certification Program, Calendar Year 2017 Physician Fee Schedule, Calendar Year 2017 Medicare Hospital Outpatient Payment Rule, Final Rule for Family Violence Prevention and Services Programs, Final Rule on Independent Living Services

Updates include: Final Rule for Long-Term Care Facilities, Final Rule for Child Care and Development Fund (CCDF) Program, Proposed Rule for Supplemental Nutrition Assistance Program (SNAP), CMS Finalizes the New Medicare Quality Payment Program, CMS Rural Health Solutions Summit

Updates include: Proposed 2018 Benefits and Payment Parameters for the ACA Marketplace,
CMS Announces Reporting Flexibility for the Quality Payment Program, Final Rule - Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, FY 2017 Inpatient Prospective Payment System (IPPS) Update Payment Changes
Medicare DSH Changes, Hospital Program Changes, FY 2017 Long-Term Care Hospital Prospective Payment System (LTCH PPS) Update

Updates include: Comments on Medicare Outpatient Observation Notice and Instructions, Proposed Rule on Bundled Payments for Cardiac Care and Hip Fractures, FY 2017 Hospice Payment Rate Update, FY 2017 Inpatient Rehabilitation Facility (IRF) PPS Update, FY 2017 Skilled Nursing Facility (SNF) PPS Update

Updates include: Calendar Year (CY) 2017 Home Health Prospective Payment System Rate Update, CY 2017 Hospital Outpatient Prospective Payment System Update, CY 2017 Physician Fee Schedule Update

Updates include: Proposed Rule: Advanced Practice Registered Nurses, Medicare Shared Savings Program; Accountable Care Organizations-Revised Benchmark Re-basing Methodology, Facilitating Transition to Performance-based Risk, and Administrative Finality of Financial Calculations, Proposed Rule: Hospital and Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care

Updates include: Final Rule: Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Manged Care, CHIP Delivered in Managed Care, and Revisions related to Third Party Liability, Interim Final Rule with comment period: Patient Protection and Affordable Care Act; Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program, Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and criteria for Physician-Focused Payment Models; FY 2017 Medicare Hospital Inpatient Prospective Payment Systems (IPPS); FY 2017 Medicare Long-Term Care Hospital Prospective Payment System (LTCH PPS), Temorary Exception for Certain Severe Wound Discharges from certain LTCHs and Modification of Limitations on Redesignation by the MGCRB, FY 2017 Skilled Nursing Facility Prospective Payment System (SNF PPS), FY 2017 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS), FY 2017 Hospice Payment Rate Update

Updates include: Final Rule: Medicaid and Mental Health Parity, Publication of State Operations Manual changes to CAH checklist, Announcement of Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter, Request for Information (RFI) on Concepts for Regional Multi-Payer Prospective Budgets

Updates include: proposed rule on program integrity to the provider enrollment process, final rules on the Medicaid covered outpatient drug and 2017 Health Insurance Marketplaces benefit and payment parameters, annual letter to issuers in federally-facilitated Marketplaces, publications on rural health clinics and guidance on the Physician Quality Reporting System (PQRS)

Updates include: Revised Survey & Certification Guidance for critical access hospital (CAH) recertification, quality measure development plan, proposed rules on patient confidentiality and Medicare Shared Savings Program and Accountable Care Organizations benchmark methodology and final rule on Medicaid home health services

Updates include: Extension of enforcement moratorium of supervision levels for outpatient therapeutic services, information about applications for funding in the Accountable Health Communities (AHC) Model, draft of Quality Measure Development Plan and information about changes to the Veterans Choice Program expanding access to non-VA care.

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,100,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.