Current Report Articles
Federal Focus

Federal Focus (Aug. 7, 2020) – Trump Issues Executive Order on Rural Health Care
President Donald Trump issued an executive order authorizing new pilot projects creating innovative payment models for rural hospitals. It also states that the Trump administration will issue a proposed rule to make permanent some of the temporary COVID-19 regulatory waivers that eased restrictions on Medicare coverage of telemedicine services, as well as flexibilities for rural staffing, reporting and supervision requirements.

CMS Releases Medicare FY 2021 IRF Final Payment and Policy Updates
The Centers for Medicare & Medicaid Services released fiscal year 2021 final payment and policy updates for the Medicare inpatient rehabilitation facility prospective payment system. CMS is projecting IRF payments will increase by 2.8 percent or $260 million.

CMS Releases CY 2021 Proposed Physician Fee Schedule Payment and Policy Updates
The Centers for Medicare & Medicaid Services released proposed calendar year 2021 physician fee schedule payment and policy updates. The proposed rule includes many proposals "that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment and innovation." Major changes include the following:

  • Expanding telehealth Category 1 and Category 3 telehealth services
    • Category 1 – visit complexity associated with certain office/outpatient evaluation and management, prolonged services, group psychotherapy, neurobehavioral status exam, home visits and more.
    • Category 3 – established patients domiciliary, rest home, or custodial care services, established patient home visits, emergency department visits, nursing facility discharge day management, and psychological and neuropsychological testing
  • Revisions to physiologic monitoring services
  • Updates to the quality payment program
  • Direct supervision by interactive telecommunications technology
  • Medical record documentation
  • Coverage for opioid use disorder treatment services furnished by Opioid
    Treatment Programs
  • Proposed policies for the diabetes prevention program

Comments are due 60 days after publication in the Federal Register.

Medicare FY 2021 Final Rule for Hospice, SNF and IPF
The Centers for Medicare & Medicaid Services previously released fiscal year 2021 final payment and policy updates for the Medicare hospice, skilled nursing facility and inpatient psychiatric facility prospective payment systems. Here are some highlights.

Hospice

  • Projected payment increase of $540 million or 2.4 percent as compared to FY 2020 payments
  • Adoption of the OMB delineations announced in the OMB Bulletin No. 18-04
  • Implementation of a 5 percent wage index reduction cap
  • Implementation of the hospice election statement addendum

Skilled Nursing Facility

  • Projected payment increase of $750 million or 2.2 percent as compared to FY 2020 payments
  • CMS projects that urban SNFs will receive a 2.2 percent increase while rural SNFs will receive a 2.4 percent increase
  • Federal per diem and case-mix adjustment updates
  • Adoption of the OMB delineations announced in the OMB Bulletin No. 18-04
  • Updates to the SNF value-based purchasing program achievement threshold and benchmark

Inpatient Psychiatric Facility

  • Projected payment increase of $90 million or 2.2 percent as compared to FY 2020 payments
  • Updates to the labor-related share, per diem base rate and ECT treatment rates
  • Adoption of the OMB delineations announced in the OMB Bulletin No. 18-04
  • Implementation of a 5 percent wage index reduction cap

MLN Connects Provider eNews Available
The Centers for Medicare & Medicaid Services issued updates to MLN Connects Provider eNews. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following:

NOSORH Publishes Article Defining Rural Population Health and Health Equity
The National Organization of State Offices of Rural Health published an article that establishes a unified definition of population health and health equity in rural and frontier communities. It's intended to educate rural health and clinical partners, and to help engage rural health stakeholders in discussions to improve the health and well-being of people living in rural areas. It provides examples of community-based programs addressing health inequities.

Carrot Health Offers Webinar about Identifying, Removing Health Barriers
Carrot Health is offering a webinar about social determinants of health in the context of public health and safety, explaining how those impacts are unevenly distributed by race and ethnicity, income, and geography. The panel will discuss and share insight from their latest research, including how incremental changes in food security and housing stability affect hospital admissions/readmission and emergency visits. The webinar is scheduled at noon CST, Thursday, Aug. 27.

CMS Announces Average Basic Medicare Part D Premiums
The Centers for Medicare & Medicaid Services released the 2021 Medicare Part D premiums for beneficiaries to gain access to prescription drugs. The 2021 Part D base beneficiary premium is $33.06, and the de minimis amount is $2. CMS stated that the 2021 average basic premiums are the second lowest since 2013. CMS Administrator Seema Verma stated, "At every turn, the Trump administration has prioritized policies that introduce choice and competition in Part D. The result is lower prices for life-saving drugs like insulin, which will be available to Medicare beneficiaries at this fall’s Open Enrollment for no more than $35 a month. In short, Part D premiums continue to stay at their lowest levels in years even as beneficiaries enjoy a more robust set of options from which to choose a plan that meets their needs."

CMS Publishes RFI for Electronic Prescribing of Controlled Substances in Medicare Part D
The Centers for Medicare & Medicaid Services released a Request for Information for the Electronic Prescribing of Controlled Substances in Medicare Part D. The RFI seeks input from stakeholders around implementation of Section 2003 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), which generally requires that prescriptions for controlled substances covered under a Medicare Part D prescription drug plan or Medicare Advantage Prescription Drug Plan be transmitted by a health care practitioner electronically. The RFI seeks input from stakeholders about whether CMS should include exceptions to the EPCS and under what circumstances, and whether CMS should impose penalties for noncompliance with this mandate in its rulemaking, and what those penalties should be. Comments will be due 60 days after the publication of the rule in the Federal Register.

CMS Seeks Feedback on QualityNet Submission Process
The Centers for Medicare & Medicaid Services is seeking feedback from hospitals that use QualityNet to submit data for the following quality reporting programs:

  • Inpatient Quality Reporting
  • Outpatient Quality Reporting
  • Inpatient Psychiatric Facility Quality Reporting
  • Ambulatory Surgical Center Quality Reporting
  • PPS-Exempt Cancer Hospital Quality Reporting

Interested hospitals will be asked to participate in a 30-60 minute call to discuss the submission process and potentially test updates. Registration is required.