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Tags Posts tagged with "Final Rule"

Final Rule

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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.

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On September 24, 2025, WellSky will be conducting a webinar on the fiscal year (FY) 2026 inpatient rehabilitation facility prospective payment system (IRF PPS) final rule that was released by the Centers for Medicare and Medicaid Services (CMS) in early August. The webinar will begin at 12:00 pm. There is no cost to participate in this webinar.

Topics will include:

  • The key changes in the 2026 IRF Final Rule impacting reimbursement;
  • The technical changes and their indirect effects on your program;
  • The amendments to the QRP and the appeal process; and
  • The latest concerns about potential IRF reimbursement denials.

To participate in the webinar, register here.

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The Pennsylvania Department of Drug and Alcohol Programs (DDAP) will host a webinar at 10:00 am on Monday, March 3, to discuss the changes to 42 CFR Part 8 and their real-world implications in treatment settings. The interactive session will feature Dr. Sarah Kawasaki and Elizabeth Ward, both from the Pennsylvania Psychiatric Institute’s Advancement in Recovery Opioid Treatment Program.

Add the meeting to your calendar.

Email DDAP to receive calendar invitations to upcoming webinars, which are held the first Monday of every month.

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The Center for Medicare and Medicaid Services (CMS) has released the Physician Fee Schedule CY 2025 Final Rule. You can view CMS’ press release, fact sheet, and final rule page in the Federal Register for more information. There were critical areas addressed in this year’s Physician Fee Schedule (PFS), including:

  • The extension of some telehealth flexibilities permitted under CMS’ authority absent Congressional action;
  • Updated payment for social determinants of health risk assessments as a part of Opioid Use Disorder intake activities furnished at Opioid Treatment Programs (OTP);
  • The establishment of a new add-on code to account for coordinated care, referral services, and peer supports at OTPs;
  • Payment for safety planning intervention and post-discharge follow-up;
  • The establishment of six G codes that mirror current interprofessional consultation Common Procedural Terminology codes used by practitioners who are eligible to bill E/M visits; and
  • Recognition of responses to CMS’ request for information on Certified Community Behavioral Health Clinics.

For the OPPS Final Rule, please see links to CMS’ press release, fact sheet, and final rule page in the Federal Register. Some highlights from this final rule include:

  • The maintenance of the Partial Hospitalization Program and Intensive Outpatient Program rate structures;
  • Narrowing the definition of “custody” in Medicare’s payment exclusion rule to mitigate barriers to Medicare access by individuals who have recently been released from incarceration or are on parole, probation, or home detention; and
  • Changes to Medicaid regulation, allowing states implementing the Medicaid clinic services benefit to cover clinic services outside the “four walls” of behavioral health clinics.

If you have any further questions regarding these final rulings or the application of the “four walls” impacts on Pennsylvania, please contact RCPA COO and Mental Health Director Jim Sharp.

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The Pennsylvania Department of Drug and Alcohol Programs (DDAP) issued Licensing Alert 07-2024 today to grant statewide exceptions to narcotic treatment programs (NTP) to expand access to medication for the treatment of opioid use disorder in alignment with the federal government’s Final Rule on 42 CFR Part 8.

The statewide exceptions to DDAP regulations that are being granted will enable:

  • People with less than one year of physical dependence on opioids to be treated at an NTP;
  • Verbal consent to treatment;
  • A wider range of dosages based on physician discretion;
  • Eight drug screens per year instead of 12;
  • An increase in take-home medication; and
  • Clinicians to determine counseling requirements unique to each person’s needs instead of mandatory minimums.

DDAP granted the statewide exceptions using 28 Pa. Code § 701.11, which gives it the authority to do so. Through Licensing Alert 07-2024, DDAP is granting these exceptions if the NTPs comply with the rules in 42 CFR Part 8. There is no need for NTPs to submit exception requests or to inform DDAP they are using these exceptions.

DDAP plans to include the changes to the federal rules when it updates its own state rules.

You can email DDAP with questions about this licensing alert.

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WellSky will be offering a one-hour webinar entitled “60 Minutes With the IRF Final Rule” that will focus on the fiscal year (FY) 2025 Inpatient Rehabilitation Facility (IRF) Final Rule, which was finalized on July 31, 2024. It will go into effect October 1, 2024. As with past final rules, it will have a financial impact on reimbursement for IRFs as well as operational changes from both this final rule and past final rules going into effect. Join long-term care expert Jane Snecinski, FACHE, MRMC, MBA, for a live webinar and learn about:

  • The algorithm for IRF reimbursement (and key factors you should know);
  • The financial impact the rule will have on your IRF reimbursement;
  • Changes to the quality reporting factors; and
  • Changes included in previous years’ IRF final rules that may go into effect October 1, 2024.

The webinar is scheduled for September 18, 2024, from 12:00 pm – 1:00 pm ET. To participate in the webinar, register here.

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Image by Markus Winkler from Pixabay

The Centers for Medicare and Medicaid Services (CMS) will host the next hospital/quality initiative (QI) open door forum call tomorrow, September 10, at 2:00 pm. Agenda topics for this call will include:

  • FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule CMS-1808-F
  • FY 2025 Inpatient Psychiatric Facilities PPS Final Rule
  • Open Question and Answer

The call will be held via Zoom webinar. Attendees must register in advance for this webinar. Register here. After registering, you will receive a confirmation email containing information about joining the webinar.

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