The Centers for Medicare & Medicaid Services (CMS) issued an alert about a fraud scheme that uses phishing fax requests, which falsely claim to be from CMS staff, to obtain medical records and documentation for auditing purposes.
CMS does not initiate audits by requesting medical records via fax, and if you receive a suspicious request, do not respond. If you have additional questions about this alert, please reach out to Karissa Bjorkgren of CMS via email.
Message from Rep. Dan Williams’s Office:
HARRISBURG, June 24 – Bipartisan legislation introduced by state Rep. Dan Williams, D-Chester, that would help Pennsylvanians take advantage of new federal Medicaid rules that give patients and clinicians more telehealth options for behavioral health services passed the PA House today with overwhelming support.
“The longstanding and outdated ‘four walls’ requirement has limited Medicaid reimbursement to services within the physical walls of a clinic,” said Williams. “This only creates barriers to care, particularly in rural areas and regions experiencing mental health workforce shortages.”
The Centers for Medicare and Medicaid Services gave states the option to waive the requirement on Jan. 1. In response, the Pennsylvania Department of Human Services has submitted a State Plan Amendment to adopt this flexibility, which is currently awaiting federal approval.
House Bill 1590 would repeal state regulations that conflict with the new federal flexibility. Importantly, the bill would not change existing rules requiring in-person treatment hours for outpatient behavioral health clinics.
“Under this bill, Pennsylvania can fully implement the change, expanding access to behavioral health services and reducing care gaps for our vulnerable populations across the Commonwealth,” Williams said.
The bill now moves to the state Senate for consideration.
It is important to note that, at this time, OMHSAS is awaiting approval from CMS. To address the Federal Medicaid payment conditions in the Pennsylvania statute, there was a need for this legislation to permit services be covered under Medicaid, and HB 1590 would achieve this. It is also important to reiterate that this bill will not change outpatient behavioral health clinic rules requiring in-person treatment hours. The passage of this bill will address these conditions for outpatient clinics as well as the delivery of SUD services.
Both the CMS SPA approval and the legislation would be retroactive to January 1, 2025.
Until then, the completion of both the SPA and the legislation on 4 walls flexibilities will remain in place. RCPA is grateful to have partnered with OMHSAS, House legislators, and other stakeholder associations on the development of this bill. We will continue our efforts in getting the legislation to the Governor’s desk.
If you have any questions, please contact RCPA COO and Director of Mental Health Services Jim Sharp.
The Trump Administration’s “Big Beautiful Bill” was passed by House Republicans on May 22 and contains significant Medicaid cuts that could leave millions of Americans without coverage as well as severely reduce access to care. The proposed bill also includes cuts to Medicare funding, new restrictions on federal loans for medical students, and provisions to create a permanent, inflation-based mechanism for annual updates to Medicare physician payments. The legislation now heads to the Senate, where it will face further debate by lawmakers.
The proposed legislation seeks to accomplish the following:
Medicaid:
Medicare:
CMS:
Outside of Congress, the Center for Medicaid Services (CMS) has also made announcements that could threaten access to healthcare:
Please contact Emma Sharp with any questions.
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:
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:
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.
Note: Space is limited. Please register early to secure your spot. Official comment should be made in the Federal Register by June 16.
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.
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.
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.
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.
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.
*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.
