- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- Public Inspection: CMS: Medicare Program: Fiscal Year 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- Public Inspection: CMS: Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
- CMS: Request for Information; Health Technology Ecosystem
- CMS: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
- VA: Staff Sergeant Fox Suicide Prevention Grant Program Funding Opportunity
- State: 60-Day Notice of Proposed Information Collection: J-1 Visa Waiver Recommendation Application
- HHS: Request for Information (RFI): Ensuring Lawful Regulation and Unleashing Innovation To Make American Healthy Again
- Public Inspection: CMS: Request for Information: Health Technology Ecosystem
CMS Innovation Center Reimagines Rural Health Care Approaches
CMS published Re-imagining Rural Health: Themes, Concepts, and Next Steps from the CMS Innovation Center “Hackathon” Series. The report describes lessons learned from previous Innovation Center models focused on rural health and their application to recent model development, as well as potential future areas the Innovation Center might explore to support rural communities. It also highlights themes and insights from the CMS Innovation Center-hosted 2024 Rural Health Hackathon. The Hackathon series convened rural health providers, community organizations, industry and tech entrepreneurs, philanthropies, policy experts, and patients to generate creative and actionable solutions to address the varied challenges to delivering quality health care in rural communities. The top thematic areas highlighted a need for training, regulatory changes, and collaboration to help improve access to care and support transformation.
As a next step, CMS intends to issue a Request for Application to fill the ten open spaces for the Rural Community Hospital Demonstration. The demonstration was directed by Congress and requires a test of cost-based payment for Medicare inpatient services for rural hospitals with fewer than 51 beds that are ineligible for Critical Access Hospital status. The demonstration has been operated by CMS since 2004 and is scheduled to end on June 30, 2028. The paper also outlines some possible considerations for future Accountable Care Organization-focused and other models.
The Innovation Center is committed to advancing rural health. The Center looks forward to further utilizing input from the Hackathon and robust engagement with rural health groups to design new models and innovations to address challenges facing rural, Tribal, frontier, and geographically isolated areas. Additionally, where possible, the Center may change existing models to enable greater participation by rural providers.
- Read more: Re-imagining Rural Health: Themes, Concepts, and Next Steps from the CMS Innovation Center “Hackathon” Series.
- Learn more about the CMS Innovation Center Strategy Direction
Deferred Action for Childhood Arrivals (DACA) Recipients Can Enroll in Pennsylvania’s Insurance Exchange
Pennie, Pennsylvania’s Health Insurance Exchange has announced that Deferred Action for Childhood Arrivals (DACA) recipients can enroll in health coverage through Pennie. See below for details.
What is happening?
- Effective, November 1, 2024, DACA recipients will no longer be excluded from the definition of lawfully present and, assuming they meet all other eligibility requirements, will be eligible to enroll in health coverage through Pennie and receive financial savings.
- A Special Enrollment Period (SEP) will begin November 1, 2024, allowing DACA recipients 60 days to enroll in coverage through Pennie. When enrolling, the SEP “Gain of Eligible Immigration Status” should be used.
- DACA recipients who enroll in Pennie in November will have a coverage effective date of December 1, 2024. DACA recipients who enroll in Pennie in December will have a coverage effective date of January 1, 2025.
How You Can Help:
- When DACA recipients come to enroll in Medicaid coverage and denied due to their status, encourage them to go to Pennie where they can find quality and affordable health coverage at visit pennie.com.
- DACA recipients will be denied Medicaid, the updated eligibility requirements only apply to State Based Health Insurance Marketplaces like Pennie
- IMPORTANT NOTE: These recipients will not be automatically transferred to Pennie if/when found ineligible for Medicaid.
- For questions, call Pennie Customer Service at +1-844-844-8040
New Telecommunications Public Searchable Map Database
The USDA Rural Utilities Service (RUS) Telecommunications Program is excited to announce the launch of the new Public Searchable Map Database!
This new resource provides the public a fully searchable database that contains information on all retail broadband projects provided assistance, or for which assistance was sought, in the United States, US Territories, and Compacts of Free Association (COFA) sovereign states under the RUS Telecommunications Program.
We encourage you to visit the Public Searchable Map Database and start exploring its functionality, including the advanced Search Filters and downloadable Results Table.
Please Note: The Public Searchable Map Database will be replacing the Telecommunications Program Funded Service Areas Map and the ReConnect Proposed and Approved Projects Map. Any applications that are not approved for funding will be removed from the Public Searchable Map Database.
Please submit any questions using the Contact Us Form.
New Rural Health Value Website and Resources Available: Rural VBC–The Payer Perspective and TEAM Model Summary
The Rural Health Value team is pleased to share that we have launched a redesigned website and logo. While we have a new look – you will continue to find trusted resources that facilitate the transition of rural healthcare organizations, payers, and communities from volume-based to value-based health care and payment models. Please take a look! On the new website you will find two new resources.
- Rural Value-Based Care – The Payer Perspective, Rural Health Value Summit Report. The Rural Health Value team convened professionals and executives from national and regional health care payer organizations to share and explore insights, innovations, successes, and challenges in rural health value-based care (VBC) contracting. This report summarizes challenges and solutions followed by suggestions for rural health care organization leaders from the Summit participants.
- A one-page summary of CMS’s Transforming Episode Accountability Model (TEAM). TEAM is a mandatory, episode-based, alternative payment model, in which selected acute care hospitals will coordinate care for people with Traditional Medicare undergoing one of the surgical procedures included in the model and assume responsibility for the cost and quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital. Of the 741 hospitals identified for mandatory participation, 124 (16.7%) are in non-metro counties. More from CMS on TEAM.
This summary is part of Rural Health Value’s Catalog of Value-Based Initiatives for Rural Providers. The catalog summarizes rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI).
Rural Health Value facilitates the transition of rural healthcare organizations, payers, and communities from volume-based to value-based health care and payment models. Visit www.ruralhealthvalue.org or contact Clint MacKinney, MD, MS, Co-Principal Investigator, clint-mackinney@uiowa.edu.
Draft Preliminary Recommendations from the Advisory Commission on Additional Licensing Models
– Comments due December 6. The Advisory Commission on Additional Licensing Models has released draft preliminary recommendations for public comment. These recommendations are intended to aid interested state medical boards and policymakers in developing new licensing pathways for internationally trained physicians. The recommendations, which focus on eligibility requirements, are available for feedback until December 6, 2024, with final guidance expected in early 2025.
Medicare Promoting Interoperability Program Hardship Exception Application Deadline for CAHs is November 30, 2024
For the calendar year 2023 reporting period, eligible hospitals and Critical Access Hospitals (CAHs) were required to use 2015 Edition Cures Update certified electronic health record technology (CEHRT) to meet the Medicare Promoting Interoperability Program requirements. CAHs may apply for a Hardship Exception if complying with this requirement results in significant hardship. CAHs may submit their application electronically or contact the Center for Clinical Standards and Quality Service Center (CCSQ) Service Center at (866) 288-8912 to complete a verbal application.
Medicare Finalizes New Standards for Hospital Obstetric Care
Last week, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Outpatient Hospital Prospective Payment System (OPPS) Final Rule for Calendar Year 2025. In addition to annual updates in outpatient hospital Medicare payment rates, this rule finalizes new standards for hospitals and Critical Access Hospitals (CAHs) with obstetric (OB) units regarding maternal quality assessment and performance improvement, the organization, staffing, and delivery of OB care, and staff training on evidence-based maternal health practices. For hospitals and CAHs with emergency services, it adds standards on facility readiness in caring for emergency services’ patients, including pregnant, birthing, and postpartum women. The rule also finalizes new transfer policies for hospitals that mirror the current CAH and Rural Emergency Hospital standards. These Conditions of Participation (CoPs) will be phased in over two years.
Medicare Finalizes Changes to Medicare Home Health Program
Effective January 1, 2025. On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which updates the Medicare payment policies and rates for home health agencies (HHAs). CMS projects an increase in aggregate payments by 0.5 percent, and also finalizes a permanent prospective adjustment of -1.975% to the CY 2025 home health payment rate. CMS finalized a new standard for acceptance to service policy in the Home Health Conditions of Participation (HH CoPs) and their proposal with modification to require ongoing respiratory illness reporting for Long-Term Care (LTC) facilities. The rule is effective January 1, 2025.
Medical Debt in Collections Among Counties by Rural-Urban Location and Racial-Ethnic Composition
Among key findings from the University of Minnesota Rural Health Research Center:
- Rural counties have a higher proportion of people with medical debt in collections than urban counties, and this difference is associated with lower average household incomes.
- The county-level median amount of medical debt in collections held by rural residents is higher compared to their urban counterparts, even after accounting for income differences.
- The proportion of people with and amount of medical debt in collections are both higher in rural and urban communities of color than in rural and urban communities overall.
HHS: Current Trends and Key Challenges to Health Care in Rural America
A new report evaluates programs at the U.S. Department of Health & Human Services (HHS) and finds that uninsured rates among adults under age 65 in rural areas have fallen substantially since the passage of the Affordable Care Act (ACA), from 23.8 percent in 2010 to 12.6 percent in 2023. Uninsured rates among rural residents are much higher in states that have not yet expanded Medicaid, and analysts acknowledge ongoing disparities in health outcomes between rural and urban areas. Research has shown, for instance, disparities in maternal outcomes, behavioral and mental health outcomes, risk factors for chronic disease such as obesity, hypertension, and cardiovascular disease as well as in potentially harmful health behaviors such as smoking and physical inactivity, to name a few.