';
CLOSE
Tags Posts tagged with "CMS"

CMS

0 370
physiotherapist helping patient to walk

The Centers for Medicare and Medicaid Services (CMS) recently released the fiscal year (FY) 2027 hospital inpatient prospective payment system (IPPS) proposed rule. Included in this rule is a proposal for the expansion of CMS’s Comprehensive Care for Joint Replacement (CCJR) model nationwide to improve care coordination and reduce costs for Medicare patients undergoing hip, knee, and ankle replacements. The model would hold hospitals accountable for the full episode of care, including surgery and 90 days of recovery, encouraging better outcomes and a more efficient use of resources.

For background purposes, from April 2016 through December 2024, the CMS Innovation Center tested the CJR Model to improve care for Medicare patients undergoing joint replacement procedures. During that time, the model generated significant Medicare savings while maintaining quality of care for beneficiaries. Under the CJR Model, hospitals were held responsible for Medicare spending for the joint replacement surgery, the hospital stay, and the first 90 days of recovery, including follow-up care such as physical therapy.

Based on the evaluation of the CJR Model, the CJR Expanded (CJR-X) Model would create strong incentives for hospitals to coordinate care more effectively, avoid unnecessary services like avoidable re-hospitalization and emergency care, and focus on delivering the best outcomes for patients. It would specifically encourage better communication with post-acute care providers to support recovery. Beginning October 1, 2027, CJR-X would be required for most hospitals, making it the first mandatory, nationwide test of an episode-based payment model.

Comments on the proposed rule are due by June 9, 2026.

0 788

The Centers for Medicare and Medicaid Services (CMS) has released the fiscal year (FY) 2027 inpatient rehabilitation facility prospective payment system (IRF PPS) proposed rule.

The proposed rule includes some technical proposals that would modify the IRF coverage and documentation requirements as well as IRF QRP submission deadlines. The proposed rule does not include any proposals to modify the existing IRF transfer policy. The proposed rule does, however, include several Requests for Information (RFI) that could indicate potential future impactful changes.

On the FY 2027 payment side, the rule would provide an overall 2.8% increase to estimated payments per discharge, compared to the 2.6% payment update that CMS finalized for FY 2026.

FY 2027 Payment Updates

  • Aggregate Estimated Payment Increase: 2.8% / $355 million (field-wide)
  • Market Basket Update (with Productivity Adjustment): 2.4%
  • Labor-Related Share: 74.5%
  • Standard Payment Conversion Factor: $19,881
  • Outlier Threshold: $8,689 (from $10,141 in FY 2026)

FY 2027 Coverage, Payment, and Documentation Policy Changes

Initiation of Therapy Requirement
CMS proposes to clarify the requirement that therapy be initiated within 36 hours of midnight of the day of admission to the IRF.

Documenting Function in Preadmission Screen
CMS proposes to expand the elements required in the preadmission screening (PAS) to include “current functional status” as well as prior level of function.

Timing of Interdisciplinary Team Meeting
CMS proposes to tighten the requirement for the timing of the weekly interdisciplinary team meeting by requiring an initial interdisciplinary team meeting to occur “on or before the fourth day from midnight on the date the patient is admitted” and subsequent team meetings to occur “at least once per week after the date of the prior team meeting.”

Request for Information on Future IRF Payment Reform
The rule includes an extensive Request for Information (RFI) on future IRF payment reform, specifically two major areas of reform:

  1. Refining the current IRF patient classification system by creating a draft list of IRF-specific clinical categories; and
  2. Creating a new system of comorbidity scoring to better account for the severity and number of comorbidities for IRF patients.

The RFI does not propose any of these changes be implemented in FY 2027 but requests stakeholder feedback on both areas. CMS also references two new technical reports addressing their PPS changes under consideration; these are available for download as part of the rule’s associated data files here.

FY 2027 Quality Reporting Program Updates

Proposal to Revise Data Submission Deadlines for the IRF QRP
For the FY 2029 IRF QRP, which will be based upon Calendar Year 2027 data, CMS is proposing to reduce this timeline to the “15th day of the second month following the end of calendar quarter.”

The proposed rule will be published in the Federal Register on April 6, 2026. Comments on the proposed rule are due by June 1, 2026.

0 1031

Yesterday, March 31, 2026, the Department of Human Services (DHS) held a “kickoff” webinar to discuss the Rural Health Transformation Plan (RHTP). The slides have not been released; however, RCPA will share the PowerPoint with members once they are available.

The webinar did not provide definitive next steps in terms of which category of Request for Proposal (RFP) would be released and when. RFPs will be periodically rolled out, and DHS indicated that the first RFP release would be in the next two weeks. The Department also shared the broad categories of project areas for consideration, stating that all RFP responses should closely tie back to their approved CMS plan.

DHS touched on the fact that RHTP funding and compliance will be achieved through continual cooperative agreements with CMS. Below is a broader timeline highlighting certain reporting and funding dates, as well as broader categorical areas the state is pursuing.

  • End of First Reporting Period – July 31, 2026
  • First Annual Report Due to CMS – August 31, 2026
  • Obligation of Year 1 Funding – October 30, 2026
  • Year 2 Funding – October 31, 2026
  • Quarterly Reports Due to CMS – November 29, 2026; March 1, 2027, May 30, 2027
  • Spending Deadline for Year 1 – September 30, 2027
    • By March 31, 2028, CMS will begin determining the amount of unused funds from the prior period to redistribute them to other states.

Year 1 Funding Mechanisms will include:

  • Expansion of existing programs;
  • Program payments;
  • Intergovernmental agreements; and
  • Grant agreements.

If your organization has an interest in these RFPs, RCPA will provide updates as appropriate, but we also encourage you to sign up directly for the DHS listserv info. Direct RHTP inquiries can be sent here.

If you have further questions, please contact your RCPA Policy Director.

0 1748

The Centers for Medicare and Medicaid Services (CMS) has released the final rule that implements requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Patient Protection and Affordable Care Act (ACA), as amended by the Health Care and Education Reconciliation Act of 2010, enacted on March 30, 2010.

Specifically, this final rule adopts standards for health care claims attachments transactions, which will support health care claims transactions and a standard for electronic signatures to be used in conjunction with health care claims attachments transactions.

The final rule will slash wasteful spending and antiquated paperwork by swapping out faxing and mailing for streamlined electronic transactions. This action lets providers spend less time on administrative hassle and more time caring for patients and is projected to save the healthcare industry approximately $781 million on an annual basis.

The final rule will be published in tomorrow’s (March 24, 2026) Federal Register and will become effective on May 19, 2026. Covered entities must comply by May 19, 2028.

0 495

The Office of Developmental Programs (ODP) waivers are required to be renewed with the Centers for Medicare and Medicaid Services (CMS) every five years. The Consolidated, Community Living, and Person/Family-Directed Support (P/FDS) Waivers, collectively known as the ID/A waivers, are scheduled for renewal effective July 1, 2027.

ODP invites you to participate in an upcoming listening session as part of the renewal process. Please join Deputy Secretary Kristin Ahrens and Director of Policy Julie Mochon for a general overview of the ID/A waivers and the renewal process during one of the two sessions listed below.

Attendees will have the opportunity to share valuable feedback and insights to help strengthen the Waivers and enhance the services provided through them. Stakeholder input gathered during these sessions will play an important role in informing the ID/A waiver renewal process.

Registration is required for each session. Due to limited space, ODP asks that you only register for one session. Register below:

Interested in providing feedback?

When registering for a session, you will be asked if you would like to provide verbal comments. Registrants can participate without providing comments.

If you register to provide comments, on the day of the session a moderator will share additional instructions about using the virtual meeting features.

When your name is called, you will have 3 minutes to provide your input.

123...24Next Page 1 of 24
© 2021 - Rehabilitation & Community Providers Association