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CMS

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The Centers for Medicare and Medicaid Services (CMS) released two notices of proposed rulemaking (NPRM): Ensuring Access to Medicaid Services and Managed Care Access, Finance, and Quality.

If adopted as proposed, the rules would establish national standards for access to care regardless of whether that care is provided through managed care plans or directly by states through fee-for-service (FFS). Specifically, they would establish access standards through Medicaid or CHIP managed care plans, as well as transparency for Medicaid payment rates to providers, including hourly rates and compensation for certain home care and other direct care workers. The rules would also establish other access standards for transparency and accountability and empower beneficiary choice.

The proposed rules together include new and updated proposed requirements for states and managed care plans that would establish tangible, consistent access standards and a consistent way to transparently review and assess Medicaid payment rates across states. The rule also proposes standards to allow enrollees to easily compare plans based on quality and access to providers through the state’s website.

Other highlights from the proposed rules include:

  • Establishing national maximum standards for certain appointment wait times for Medicaid or CHIP managed care enrollees, and stronger state monitoring and reporting requirements related to access and network adequacy for Medicaid or CHIP managed care plans, which now cover the majority of Medicaid or CHIP beneficiaries;
  • Requiring states to conduct independent secret shopper surveys of Medicaid or CHIP managed care plans to verify compliance with appointment wait time standards and to identify where provider directories are inaccurate;
  • Creating new payment transparency requirements for states by requiring disclosure of provider payment rates in both fee-for-service and managed care, with the goal of greater insight into how Medicaid payment levels affect access to care;
  • Establishing additional transparency and interested party engagement requirements for setting Medicaid payment rates for home and community-based services (HCBS), as well as a requirement that at least 80 percent of Medicaid payments for personal care, homemaker, and home health aide services be spent on compensation for direct care workers (as opposed to administrative overhead or profit);
  • Creating timeliness-of-access measures for HCBS and strengthening necessary safeguards to ensure beneficiary health and welfare as well as promote health equity;
  • Strengthening how states use state Medical Care Advisory Committees, through which stakeholders provide guidance to state Medicaid agencies about health and medical care services, to ensure all states are using these committees optimally to realize a more effective and efficient Medicaid program that is informed by the experiences of Medicaid beneficiaries, their caretakers, and other interested parties;
  • Requiring states to conduct enrollee experience surveys in Medicaid managed care annually for each managed care plan to gather input directly from enrollees; and
  • Establishing a framework for states to implement a Medicaid or CHIP quality rating system, a “one-stop-shop” for enrollees to compare Medicaid or CHIP managed care plans based on quality of care, access to providers, covered benefits and drugs, cost, and other plan performance indicators.

The proposed rules will be published in the May 5, 2023, Federal Register, and comments will be accepted through July 3, 2023.

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Photo by Christina @ wocintechchat.com on Unsplash

The Centers for Medicare and Medicaid Services (CMS) will be hosting an informational National Office Hours call on April 25, 2023, at 3:30 pm. The call will focus on the ending of the COVID-19 Public Health Emergency (PHE) that will take place on May 11, 2023, and will help providers, facilities, and people with Medicare prepare. CMS leaders and expert staff will present an overview of the effects of the PHE’s ending on the current waivers and flexibilities and then answer questions.

In preparation for this webinar, CMS encourages participants to review the following resources to determine what questions remain that will support your efforts after the end of the PHE:

Speakers:

  • CMS Leaders from the Office of the Administrator, Center for Medicare, and Center for Clinical Standards and Quality
  • CMS Subject Matter Experts on Medicare policy and PHE-related waivers and flexibilities

RSVP — Register Here

After registering, a confirmation email will be sent containing information about joining the call. When you select the link to join the call on April 25, you will see a message stating that the host will allow you to join the event momentarily. Please continue to wait at that screen until the CMS team opens the call and admits everyone.

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The Centers for Medicare and Medicaid Services (CMS) will conduct the next hospital/quality initiative open door forum on April 18, 2023, at 2:00 pm. Agenda topics include:

  • Announcements & Updates;
  • Upcoming Wage Index April PUF;
  • FY 2024 IPPS/LTCH PPS Proposed Rule; and
  • FY 2024 IPF PPS Proposed Rule.

To participate by phone, dial 888-455-1397.
Reference Conference Passcode: 4325849
Instant Replay: 866-415-8391, Conference ID: No Passcode Needed

Instant Replay is an audio recording of this call that can be accessed by dialing 866-415-8391 beginning one hour after the call has ended. The recording expires after April 21, 2023, 11:59 pm ET.

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Late yesterday, the Centers for Medicare and Medicaid Services (CMS) issued the fiscal year (FY) 2024 inpatient rehabilitation facility prospective payment system (IRF PPS) proposed rule.

The proposed rule includes a 3.7 percent payment increase, compared to the 3.9 percent payment update that CMS finalized for FY 2023. This payment update reflects the effects of the proposed IRF market basket update for FY 2024 of 3.0 percent, which is based on the proposed IRF market basket increase factor (3.2 percent), productivity adjustment (0.2 percent), and outlier payment increase (0.7 percent).
** Please note that these figures are subject to change in the final rule if updated forecasts become available, which typically occurs.

CMS is making a number of changes to the Quality Reporting Program (QRP), including the future addition of a discharge function score measure and patient-level COVID vaccination measure as well as a modification of the current healthcare personnel COVID-19 vaccination measure to reflect the latest vaccination recommendations.

In addition, CMS is proposing to allow hospitals to open a new IRF unit and begin being paid under the IRF PPS at any time during the cost reporting period (rather than the current restrictive enrollment rules). The proposed rule does not address any of the COVID-19 PHE waivers, including the three-hour rule and virtual team conferences, nor does it include any further discussion of the expanded transfer policy (to include certain discharges under the care of home health) that was the subject of a Request for Information (RFI) in last year’s rule.

A more detailed and extensive summary of the proposed rule will be forthcoming.

The proposed rule will be published in the Federal Register for April 7, 2023. Comments on the proposed rule will be considered until 5:00 pm on June 2, 2023. For additional information, CMS also released a fact sheet.

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The Office of Long-Term Living (OLTL) has released the transition plans that outline how the Appendix K flexibilities will be phased out on May 11, 2023, with the end of the Public Health Emergency. The transition plans apply to the Community HealthChoices (CHC) Waiver, OBRA Waiver, and Act 150 program.

Since March 6, 2020, the Office of Long-Term Living (OLTL) has been operating under an Appendix K Emergency Preparedness and Response amendment that was approved by the Centers for Medicare & Medicaid Services (CMS). Appendix K allowed temporary changes to the CHC Waiver, OBRA waiver, and Act 150 waiver in response to the COVID-19 Public Health Emergency.

Effective May 11, 2023, OLTL is discontinuing the emergency flexibilities noted in the attached guidance and is returning to pre-emergency operations. Providers should make any changes that are necessary to resume normal operations and be in compliance by May 11, 2023. Service Coordinators have been instructed to work with participants and providers to ensure a seamless transition to normal operations.

The transition plans have been updated to reflect the new expiration date for the flexibilities. In addition, as a general note, resuming pre-emergency waiver operations means the following:

  • All assessments, including the comprehensive needs assessments and reassessments, must be conducted face-to-face;
  • Service Coordinators must monitor participants and Individual Services Plans (ISPs) through face-to-face contacts; and
  • ISP meetings and development must be conducted face-to-face.

Questions about this information should be directed to the OLTL Provider Helpline at 800-932-0939.

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The Centers for Medicare and Medicaid Services (CMS) has approved the Office of Long-Term Living’s (OLTL) OBRA Waiver Amendment. Changes in the approved OBRA Waiver Amendment include:

  • Revised the Benefits Counseling service definition;
  • Amended the responsibilities of the Fiscal/Employer Agent;
  • Updated Appendix H Quality Improvement Strategy to the current process; and
  • Removed performance measure AA-6, as the data in AA-6 is being collected by AA-5.

The current approved OBRA Waiver document can be viewed here. If you have any questions, please contact the OLTL Bureau of Policy Development and Communications Management at (717) 857-3280.

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The Centers for Medicare and Medicaid Services (CMS) has created short videos and developed patient cue cards to assist providers with learning how to code patient assessment instruments for the following Post-Acute Care (PAC) Quality Reporting Programs (QRP):

Help LTCH, IRF, and HH patients select responses by showing them the new cue cards for:

See LTCH, IRF, HH, and SNF Quality Reporting Program Training for more information.

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The Centers for Medicare and Medicaid Services (CMS) has released the updated inpatient rehabilitation facility (IRF) provider preview reports. These ‎reports contain provider performance scores for quality measures and contain IRF-Patient Assessment Instrument (PAI) data submitted ‎by IRFs from Quarter 4 2021 through Quarter 3 2022, as well as Centers for Disease Control and Prevention (CDC) Clostridium Difficile (CDI) and Catheter-‎Associated Urinary Tract Infections (CAUTI) measures from Quarter 4 2021 through Quarter 1 2022 and Quarter 4 2021 ‎through Quarter 1 2022 of the Healthcare Personnel (HCP) Influenza measure. The HCP COVID-19 Vaccination ‎Coverage measure data for Quarter 3 2022 is also included. ‎

Providers have until April 14, 2023, to review their performance data. Providers can request CMS ‎review their data during the preview period if they believe the scores are inaccurate. The final reports ‎will be published on Care Compare and Provider Data Catalog (PDC) during the June 2023 refresh of ‎the website. For additional information, visit the CMS IRF QRP Public Reporting website.

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