- Social Factors Help Explain Worse Cardiovascular Health among Adults in Rural Vs. Urban Communities
- Reducing Barriers to Participation in Population-Based Total Cost of Care (PB-TCOC) Models and Supporting Primary and Specialty Care Transformation: Request for Input
- Secretary Kennedy Renews Public Health Emergency Declaration to Address National Opioid Crisis
- 2025 Marketplace Integrity and Affordability Proposed Rule
- Rural America Faces Growing Shortage of Eye Surgeons
- NRHA Continues Partnership to Advance Rural Oral Health
- Comments Requested on Mobile Crisis Team Services: An Implementation Toolkit Draft
- Q&A: What Are the Challenges and Opportunities of Small-Town Philanthropy?
- HRSA Administrator Carole Johnson, Joined by Co-Chair of the Congressional Black Maternal Health Caucus Congresswoman Lauren Underwood, Announces New Funding, Policy Action, and Report to Mark Landmark Year of HRSA's Enhancing Maternal Health Initiative
- Biden-Harris Administration Announces $60 Million Investment for Adding Early Morning, Night, and Weekend Hours at Community Health Centers
- Volunteer Opportunity for HUD's Office of Housing Counseling Tribe and TDHE Certification Exam
- Who Needs Dry January More: Rural or Urban Drinkers?
- Rural Families Have 'Critical' Need for More Hospice, Respite Care
- Rural Telehealth Sees More Policy Wins, but Only Short-Term
- States Help Child Care Centers Expand in Bid To Create More Slots, Lower Prices
CMS Announces 2025 final rules for Physician Fee Schedule, OPPS, and ASC
CMS announced the final rules for the 2025 physician fee schedule, the hospital outpatient prospective payment system (OPPS) and the Ambulatory Surgical Centers. Within these rules, CMS is finalizing new coding and payment policies for advanced primary care management services, advancing maternal safety standards, removing barriers to expand access to care for those formerly incarcerated and others in underserved communities, and setting policies to reduce the use of opioids and to increase access to high-cost drugs in tribal communities.
Physicians will see finalized average payment rates reduced by 2.93% in CY 2025 compared to the average payment rates for most of CY 2024, while payment rates for hospital outpatient and ASC services will increase by 2.9% in CY2025.
You can find more at the links below. Please contact me at (insert) with questions or if you’d like to learn more.
FINAL FULL PACKAGE: Calendar Year (CY) 2025 Physician Fee Schedule (PFS) Final Rule CMS-1807-F
Web links:
- Press Release: https://www.cms.gov/newsroom/press-releases/hhs-finalizes-physician-payment-rule-strengthening-person-centered-care-and-health-quality-measures
- PFS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-medicare-physician-fee-schedule-final-rule
- MSSP Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-medicare-physician-fee-schedule-final-rule-cms-1807-f-medicare-shared-savings
- QPP Fact Sheet and FAQs: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3057/2025-QPP-Policies-Final-Rule-Fact-Sheet.pdf
- IRA Fact Sheet: https://www.cms.gov/inflation-reduction-act-and-medicare/inflation-rebates-medicare
- Federal Register: https://www.federalregister.gov/public-inspection/2024-25382/medicare-and-medicaid-programs-calendar-year-2025-payment-policies-under-the-physician-fee-schedule
New Report: 2024 State of Children’s Health Finds Uninsured Rates for Pennsylvania Children Stable, Yet Remains Too High
The number of uninsured children in Pennsylvania remains stable following last year’s unwinding of the Medicaid continuous coverage provision, but no progress has been made, according to our 2024 State of Children’s Health report. The report provides the first look at the impact of resuming Medicaid renewals following a three-year federal hiatus during the COVID-19 public health emergency.
Between 2022 and 2023, the rate of Pennsylvania children without health insurance remained steady at 5.2%. However, steady rates do not mean progress. Too many children live in Pennsylvania without access to health insurance. The number of Pennsylvania children under age 19 without health insurance increased slightly from 145,000 to 147,000 from one year ago.
According to the report, factors such as age, race and ethnicity, and poverty level impact children’s access to health insurance. Demographic highlights include:
- Children under 6 are more likely to be uninsured (5.6%) than school age children (5.1%).
- Uninsured rates improved for American Indian and Alaska Native children and White children. Uninsured rates worsened for Asian children, Black children, Hispanic children, and children of multiple races.
- Children in lower-income families are more likely to be uninsured, and approximately 6.8% of PA children are financially eligible for Medicaid but not enrolled.
Accompanying fact sheets for each of the 67 counties show the local uninsured rate, race and ethnicity profiles, and public health insurance enrollment data.
The report finds that Medicaid, CHIP and Pennie™ remain significant sources of coverage with approximately 47% of Pennsylvania children relying on those programs’ health plans to meet their health care needs. A growing concern is that the Pennie™ “no wrong door” policy may not be working as intended since more than half of children enrolled through Pennie™ appear financially eligible for Medicaid or subsidized CHIP programs.
While the Medicaid unwinding process did not cause significant disruptions to children’s coverage in 2023, we will know next year if there were disruptions in 2024 as the process wrapped up in June.
Approximately 8 out of 10 children with renewals completed within Medicaid unwinding maintained public coverage. However, procedural disenrollments occurred too often with 42% of children disenrolled due to administrative reasons, not eligibility. To counter this trend, the report recommends that the state improve its poor track record of using automated “ex parte” renewals instead of enrollees submitting renewal applications.
The report also recommends strengthening the state’s continuous eligibility (CE) policy and supports DHS’ plan to provide continuous eligibility to children from birth until age 6. In a big win for kids, DHS has received federal approval last week of its plan to provide Medicaid continuous coverage for Pennsylvania’s youngest children, which is expected to start in January.
To help ensure no child is disconnected from care and to keep down costs for families and the state, the report recommends that Pennsylvania:
- Strengthen automated renewals
- Provide continuous coverage to young children
- Improve PA’s ‘no wrong door’ policy
CMS Releases New Provider Toolkit for Sickle Cell Disease
The U.S. Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) has released a new resource: CMS Sickle Cell Disease (SCD) Health Care Provider Toolkit: Resources for Health Care Professionals to Support Individuals with SCD .
This new toolkit builds on the CMS Sickle Cell Disease Action Plan (released in September 2023) to strengthen the infrastructure for primary care and other care settings to care for people with SCD, improve care management, and assist providers with supporting the needs of people with SCD and other chronic conditions. The SCD Toolkit consists of 6 sections that equip healthcare providers in delivering quality care to individuals with sickle cell disease. This toolkit is designed to assist the care team in supporting people by introducing SCD, including the common barriers to care, and summarizing CMS program coverage for services around social determinants and drivers of health as well as and new sickle cell disease treatments.
Culturally Responsive Approaches to Anti-Human Trafficking Programming in Native Communities
This policy brief from the Administration for Children and Families (ACF) examines the results of a demonstration project created by ACF’s Office on Trafficking in Persons for Native Communities. Analysts describe how six communities chosen for the project used culture as a resource to integrate values, beliefs, traditions, and activities into various project strategies and services offered.
Growing the Rural Physician Workforce: Decades of Federal Funding Impacts Rural Graduate Medical Education
A new feature article in The Rural Monitor provides a historical review of graduate medical education funding and its relationship to the supply of rural physicians.
New Resources for Providers from Experts at Rural Health Value
Rural Health Value is an initiative funded by the Federal Office of Rural Health Policy to provide analysis, technical assistance, and strategy for rural health care delivery. Along with a new website and logo, they’ve launched two new resources to help rural healthcare organizations, payers, and communities make the transition from volume-based to value-based health care and payment models:
Frontier Community Health Integration Project (FCHIP) Demonstration Updates
The Centers for Medicare & Medicaid Services (CMS) has an updated factsheet for its Frontier Community Health Integration Project (FCHIP) Demonstration. The model tests new models of health care delivery in the most sparsely populated rural counties by waiving certain Medicare requirements regarding skilled nursing facility beds, telehealth, and ambulance services. In the initial demonstration period (August 2016 through July 2019), CMS received applications from Critical Access Hospitals (CAHs) in Montana, Nevada, and North Dakota (though eligible to apply, CAHs in Alaska and Wyoming did not apply). The Consolidated Appropriations Act of 2021 extended FCHIP. Five CAHs in Montana and Nevada are continuing their participation with the goal of improving health and reducing Medicare expenditures.
Medicare Finalizes Updates to End Stage Renal Disease Prospective Payment System
– Effective January 1, 2025. On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services for Medicare beneficiaries. This rule includes updates to base payment rates, a modified low volume payment adjustment, new inclusion of oral-only dialysis drugs in bundled payments, and coverage for home dialysis services for beneficiaries with acute kidney injury.
Medicare Finalizes Updates to Physician Fee Schedule
– Effective January 1, 2025. On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year 2025 Medicare Physician Fee Schedule (PFS) final rule to update payments for physicians and other providers under the PFS and other Medicare Part B policies. The rule contains updates for Rural Health Clinics (RHCs), like the ability to bill for administration of Part B vaccines at the time of service beginning July 1, 2025, removal of RHC productivity standards, changes to the Conditions of Certification, changes to required lab services, and new care coordination billing processes. CMS continues several telehealth flexibilities through the end of 2025, and changes for behavioral health, opioid treatment programs, and more are also in the rule. Learn how these changes affect Rural Health Clinics at the NARHC webinar listed under Learning Events below.
Understanding the Impact of Medical Debt in Rural Communities: Perspectives From Rural Hospital Administrators
This policy brief presents findings from key informant interviews with nine administrators representing rural hospitals in seven states (Arkansas, California, Illinois, Texas, Vermont, Washington, and West Virginia). Using content analysis of interview data, researchers share findings around hospital and community-level implications of medical debt, and policies that may help or hinder this issue.