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Tags Posts tagged with "CMS"

CMS

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The Centers for Medicare and Medicaid Services (CMS) recently released their CMS Fast Facts resource document for 2022 – 2025. The document includes summary information on Medicare and Medicaid total program enrollment, utilization, and expenditures, as well as the total number of Medicare providers, including physicians by specialty area.

There are a number of new items provided in 2025:

  • Medicare Populations, Calendar Year (CY) 2024
  • Medicaid & Children’s Health Insurance Program (CHIP) Populations, CY 2024
  • Medicare Deductibles, Coinsurance, Premiums, CY 2025
  • Original Medicare Persons Served and Payments by Type of Service, CY 2023
  • Medicare Part D Utilization and Expenditures, CY 2023
  • Medicaid & CHIP Payments by Type of Service, FY 2023
  • Medicare Institutional Providers, CY 2023
  • Medicare Non-Institutional Providers by Specialty, CY 2023
  • Medicare Durable Medical Equipment Prosthetics, Orthotics & Supplies (DMEPOS) Providers by Specialty, CY 2023
  • Medicare Prepaid Contracts, February 2025
  • National Health Expenditures, CY 2023
  • CMS Financial Data, FY 2024

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Help shape the future of healthcare technology for Medicare beneficiaries. Register now for an upcoming Question and Answer session with The Centers for Medicare & Medicaid Services (CMS).

Date: Tuesday, May 20, 2025
Time: 1:00 pm EST
Location: Virtual via Zoom (link will be provided following registration)
Who Should Attend:
Technology developers, patients, caregivers, providers, payers, and other healthcare stakeholders.

Event Description:
Help create modern digital technologies to empower seniors to manage their health journey. We want YOUR ideas. Please join us for a Q&A session on the recent CMS Request for Information (RFI) on Improving Technology to Empower Medicare Beneficiaries. The session will also review how to submit responses to the RFI.

The CMS Office of the Administrator team will be present to hear your valuable input as we shape the future for Medicare beneficiaries. Our panel includes:

  • Stephanie Carlton, Chief of Staff and Deputy Administrator;
  • Amy Gleason, Strategic Advisor to HHS/CMS & Acting Administrator, U.S. DOGE Service;
  • Arda Kara, Senior Advisor for Technology; and
  • Alberto Colon Viera, Senior Advisor for Technology.

Why Attend:
Your insights will directly contribute to improving technology solutions for Medicare beneficiaries. This is your opportunity to help shape the future of Medicare.

Register Here

Note: Space is limited. Please register early to secure your spot. Official comment should be made in the Federal Register by June 16.

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Last week, the Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2026 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) proposed rule, as well as an accompanying fact sheet. The rule does not include proposed changes to the IRF coverage requirements. On the payment side, the rule would provide an overall 2.8% increase to estimated payments per discharge, compared to the 2.5% payment update that CMS finalized for FY 2025. The rule is more substantive with respect to the future Quality Reporting Program (QRP) changes. Specifically, the rule proposes to remove certain quality measures and standardized patient assessment data elements (SPADE) implemented in recent years relating to COVID-19 vaccination and social determinants of health (SDOH), and to modify the process for reconsideration of IRF QRP non-compliance penalties. Finally, the rule includes various requests for information (RFI), soliciting feedback on the IRF QRP and IRF-Patient Assessment Instrument (PAI).

The proposed rule will be published in the Federal Register on April 30, 2025. RCPA will provide a more detailed overview of the proposed rule following this date. Comments on the rule are due to CMS by June 10, 2025.

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Photo by Chris Montgomery on Unsplash

The Pennsylvania Department of Human Services (DHS) is holding a post-award forum to afford the public with an opportunity to provide comments on the progress of the federal Section 1115 Demonstration titled “Medicaid Coverage for FFCY from a Different State and SUD Demonstration.” The FFCY component of the demonstration was approved by the Centers for Medicare & Medicaid Services (CMS) effective October 1, 2017, and enables the Commonwealth to provide Medicaid coverage to out‑of‑state former foster care youth under the age of 26 years who were in foster care under the responsibility of another state or tribe when they turned 18. The SUD component of the demonstration was approved by CMS effective July 1, 2018, and provides necessary funding that is critical to continue supporting the provision of a full continuum of medically necessary SUD services, including residential services. In September 2022, CMS approved the Commonwealth’s application to renew the Demonstration through September 30, 2027.

The forum will be held on Friday, March 28, 2025, from 2:00 pm – 3:30 pm via WebEx. Please register for the Post Award Forum prior to the meeting date here.

Please contact RCPA Policy Associate Emma Sharp with any questions.

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The Centers for Medicare and Medicaid Services (CMS) require a statewide process to ensure providers are qualified to render services to waiver-funded individuals. The Provider Qualification Process described in announcement ODPANN 25-014 outlines the steps the Assigned Administrative Entity (AE) and provider must follow to meet these requirements and the steps Supports Coordinators (SC) take to transition individuals if needed. This communication does not describe the qualification process for SC organizations.

Please view the announcement for additional information and details.

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Young caregiver helping older lady to stand up

The Office of Long-Term Living (OLTL) recently shared additional guidance for providers related to the Centers for Medicare & Medicaid Services (CMS) Home and Community-Based Services (HCBS) Settings Final Rule.

This clarification applies to Residential Habilitation and Personal Care Home Providers.

Regulations at 42 CFR 441.301(c)(4)(vi)(B) require that participants in residential settings have the ability to close and lock doors within their living units. As a part of the Office of Long-Term Living (OLTL) residential provider reviews, it was found that several sites did not meet this requirement. As remediation, some providers opted to have participants sign a form stating that they do not wish to have a lock on their doors, which OLTL’s settings review panel accepted as compliant.

The Centers for Medicare & Medicaid Services (CMS) has reviewed OLTL’s oversight activities and has deemed that participant sign-off waiving installation of locks does not sufficiently satisfy the requirement. CMS has determined that all doors with access to participant units or private spaces (such as a bedroom) must have locks installed. The participant’s choice is whether to utilize the lock or not. Based on this feedback, as OLTL moves forward with ongoing oversight of HCBS settings requirements, all doors to participant units/private spaces in residential settings will be required to have working locks in order to be deemed compliant for future settings reviews.

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The Centers for Medicare & Medicaid Services (CMS) has made updates to the training schedule for Home and Community-Based Services (HCBS) provisions of the Medicaid Access Rule. The new training session dates and tentative topics for each session can be found below. These dates and topics are subject to change.

  • May 14, 2025, 3:00 pm ET: Timely Access, Waiting Lists, Person-Centered Planning Reporting Requirements & Minimum Performance Levels, and Website Requirements
  • June 11, 2025, 3:00 pm ET: Institutional Rule Provisions*

*Nursing Facility and Intermediate Care Facilities for Individuals with Intellectual Disabilities Rate Transparency provisions finalized in CMS-3442-F: Medicare and Medicaid

You can learn more about the training series and register for upcoming sessions on the HCBS Provisions of the Medicaid Access Rule Training Series registration web page.

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The Centers for Medicare and Medicaid Services (CMS) published and released a summary report from a recent inpatient rehabilitation facility (IRF) listening session that focused on revising the transmission schedule for the inpatient rehabilitation facility Patient Assessment Instrument (IRF-PAI).

The summary highlights the discussion about potential changes to the IRF-PAI transmission schedule for unplanned discharges as well as changes in payer source, providing the rationale for this discussion, and questions posed during the listening session. The listening session also discussed opportunities to improve the assessment and data collection for pediatric patients.

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The Centers for Medicare and Medicaid Services (CMS) has approved the Office of Long-Term Living’s (OLTL) Community HealthChoices (CHC) Waiver renewal. The renewal will be effective on January 1, 2025.

The current approved CHC Waiver document is available here. Additional information about the CHC Waiver is located here.

Changes in the approved renewal include:

  1. Amend the following service definitions:
    1. Benefits Counseling
    2. Employment Skills Development Home Adaptations
    3. Telecare
  2. Add teleservices to the following services (details regarding teleservices can be found within each service definition as well as in the Main Module):
    1. Cognitive Rehabilitation
    2. Counseling Services
    3. Nutritional Consultation
  3. Add Chore Services as a new waiver service.
  4. Add language to reinforce that if a participant’s rights in a setting need to be modified due to an assessed need, it must be documented in the Person-Centered Service Plan (PCSP), and if a provider creates a treatment or service plan, that plan must be incorporated into the PCSP.
  5. Remove references to the Organized Health Care Delivery System (OHCDS) and the Participant Review Tool.
  6. Reduce timeframes for developing and implementing Person-Centered Service Plans from 30 days to 15 business days.
  7. Reduce the years of experience needed for Structured Day Habilitation Support Staff from five years to two years.
  8. Update Appendix C-5 to include information about the Home and Community-Based Settings Rule.
  9. Update Appendix E: Participant Direction of Services that Service Coordinators are responsible to inform the participant of the availability of the direct care worker referral and matching system.
  10. Update Appendix G: Participant Safeguards to the current process.
  11. Update the Quality Strategy to current process.
  12. Modify language throughout for better readability.

Questions about the 2025 CHC renewal can be submitted electronically.

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In early December, the Centers for Medicare and Medicaid Services (CMS) released the Comprehensive Care for Joint Replacement (CJR) Model Evaluation Report. This report provides the results for the first year of the CJR model extension (performance year six) after significant changes to the CJR model were implemented. According to CMS, the revisions to the CJR model generated net savings of $54.2 million for Medicare in performance year six while maintaining the quality of care for patients.

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