June 2017

June 2017

The Federal Office of Rural Health Policy's (FORHP) Policy Team is ready to answer any questions you may have about these updates at RuralPolicy@hrsa.gov.

The Centers for Medicare and Medicaid Services (CMS) Delays Bundled Payment Programs to 2018 

CMS previously delayed the start date for new and expanded bundled payment programs from July 1, 2017, to October 1, 2017. On May 19, 2017, in response to 47 public comments, CMS again delayed the bundles. The rules for the new Episode Payment Models (EPMs) for cardiac care and expanded Comprehensive Care for Joint Replacement (CJR) model are effective May 20, 2017. Furthermore, CMS has delayed the start date to January 1, 2018, when hospitals in selected metropolitan areas will begin the new EPM bundles for heart attack and coronary bypass, including incentive payments for cardiac rehabilitation, and CJR will be expanded to include hip fracture surgeries. Although most rural hospitals will not participate in the bundles as the site of cardiac care or orthopedic surgery, rural hospitals may collaborate with EPM or CJR participants as providers of post-acute care.

Review Skilled Nursing Quality Measures

CMS has posted a user’s manual for the Skilled Nursing Facility Quality Reporting Program (SNF QRP). The manual provides detailed information for each quality measure in the program, including measure definitions, inclusion and exclusion criteria and specifications to calculate each measure. As CMS clarified in the 2017 update to SNF payment rules (81 FR 52010), rural hospitals should be aware that the SNF QRP applies to “all non-CAH swing-bed rural hospitals.” Remember, the SNF QRP is distinct from the Nursing Home Quality Initiative (NHQI), which includes its own set of quality measures displayed on Nursing Home Compare.

CMS Expands Comprehensive Primary Care Plus (CPC+)

CMS announced the regions selected for Round 2 of the CPC+ model: Louisiana, Nebraska, North Dakota and the Greater Buffalo Region of New York. The CPC+ model is an advanced primary care medical home model that offers an innovative payment structure, including a monthly care management fee, to support primary care practices to improve quality, access and efficiency. Physician practices in these regions can apply for 2018 participation via an online portal by July 13, 2017.

CMS Publishes Request for Information (RFI) for Affordable Care Act Market Improvements

On June 8, 2017, CMS published an RFI seeking recommendations from the public on how to create a more flexible, streamlined approach to the regulatory structure of the individual and small group health insurance markets. As rural consumers face fewer plan choices and issuers are leaving the Marketplace, CMS would like feedback on how it could change existing regulations or guidance to put patients first, promote greater consumer choice, enhance affordability and return more control over health care to the states. Rural stakeholders may be able to provide feedback explaining challenges particular to rural areas. See the press release for more information. Comments are due by July 12, 2017. 

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.