February 2018

February 2018

FORHP’s 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) Request Nominations for Advisory Panel on Hospital Outpatient Payment (HOP)

CMS is accepting nominations on a continuous basis for two vacancies on the Advisory Panel on Medicare HOP. The Panel may include urban and rural representatives of hospitals, hospital systems, or other Medicare outpatient providers and advises the Secretary of Health & Human Services and the Administrator of CMS on Medicare outpatient payment systems. The Panel also includes representatives of critical access hospitals (CAHs) who advise on the level of supervision of hospital outpatient services. Nominations can be submitted electronically to APCPanel@cms.hhs.gov.

CMS Updates Policy Manual for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

The 2018 update of Chapter 13 of the Medicare Benefit Policy Manual – Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHCs services – provides information on requirements and payment policies for RHCs and FQHCs, as authorized by Section 1861(aa) of the Social Security Act. This chapter now includes payment policy for Care Management Services in RHCs and FQHCs as finalized in the Calendar Year (CY) 2018 Physician Fee Schedule Final Rule. All other revisions serve to clarify existing policy.

CMS Releases Medicare Advantage/Prescription Drug Plan Updates

CMS seeks comments on proposed payment rate increases and other updates to Medicare Advantage (MA) and Part D prescription drug plans. Some proposals of interest to rural providers include an adjustment to the 2019 and 2020 quality Star Ratings to account for the effects of hurricanes and wildfires in 2017, adding new strategies to address the opioid epidemic, and allowing additional MA supplemental plan benefits if certain criteria are met.

CMS will accept comments through regulations.gov, on all proposals through Monday, March 5, 2018, before publishing final versions on April 2, 2018. Enter the docket number CMS-2017-0163 in the search field of regulations.gov and follow the instructions for submitting a comment. More information on the advance notices is available at this link.

CMS Launches New Medicare Episode Payment Model

The CMS Innovation Center is launching a new voluntary payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). This model includes financial risks as well as incentives, so it will qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program. Certain Medicare beneficiaries such as those covered under managed care plans will be excluded from the model, but many of the clinical episodes that will be tested are frequently encountered by rural providers, including Chronic Obstructive Pulmonary Disease (COPD), sepsis, stroke, and fractures of the femur, hip or pelvis. CAHs, hospitals in Maryland, hospitals participating in the Rural Community Hospital Demonstration and participant hospitals in the Pennsylvania Rural Health model are excluded from participating in this model.

Applications for participation will be accepted through March 12, 2018. More information is available in the fact sheet and frequently asked questions.

CMS Updates List of Alternative Payment Models (APMs)

CMS recently published a list of all APMs the agency operates. Rural providers can review this document to learn more about which APMs qualify as Advanced APMs for the purposes of the Quality Payment Program (QPP). The table shows which APMs are medical home models and whether the APMs require certified electronic health record (EHR) technology, quality measures comparable to those used in the Merit-based Incentive Payment System (MIPS) and financial risk.

CMS Releases Fact Sheet on Medicare EHR Incentive Program Payment Adjustment for CAHs

This fact sheet provides the payment reductions for CAHs that do not meet the meaningful use of Certified Electronic Health Record Technology (CEHRT) requirements. Beginning in Fiscal Year 2016, CAHs that don’t meet the requirements, or qualify for a hardship exemption, will be reimbursed 100.33% of reasonable costs. For each subsequent year, reimbursements will be reduced to 100% of reasonable costs.

CMS Annual Call for Medicare EHR Incentive Program Measures

CMS recently put out their annual call Medicare Electronic Health Record (EHR) Incentive Program measures and accepting proposals for new measures that advance meaningful use of Certified EHR Technology (CEHRT). Participating eligible hospitals and Critical Access Hospitals are encouraged to submit ideas for new measures that emphasize patient outcomes and patient safety as well as improved program efficiency. New measures can be submitted through June 29, 2018, using the Measures Submission Form.

CMS Issues New Guidance for Medicaid Beneficiaries

CMS has issued guidance for states interested in Medicaid demonstrations that create incentives for able-bodied, working-age Medicaid beneficiaries to participate in work and community engagement activities, such as skills training, education, job search, volunteering or caregiving. The CMS letter to state Medicaid directors describes considerations for states interested in these demonstrations, such as reasonable modifications for individuals with substance use disorders, and supports for beneficiaries in localities lacking transportation and/or facing economic stress. Rural providers and stakeholders can find updated information on Medicaid.gov with guidance for states on how reform strategies should align with the core objective of serving the health and wellness of vulnerable and low-income individuals and families.

CMS Releases Essential Community Providers List for 2019

CMS has posted the list of Essential Community Providers (ECPs) approved for the 2019 plan year for the Health Insurance Marketplace. ECPs are providers serving low-income, medically-underserved individuals and include Rural Health Clinics, Critical Access Hospitals, and Federally Qualified Health Centers. Insurers offering Qualified Health Plans are required to contract with at least 20 percent of ECPs in medically underserved areas. Insurers may “write in” providers not included on this list after the provider submits a petition for inclusion.

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.