The Centers for Medicare & Medicaid Services (CMS) released guidance for the implementation of the Office & Outpatient (O/O) Evaluation and Management (E/M) visit complexity add-on code G2211 beginning January 1, 2024. Included in the guidance are the documentation requirements for G2211, the correct use of the code and modifier 25, and patient coinsurance and deductible.

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Starting January 1, 2024, Medicare began coverage and payment for Intensive Outpatient Program (IOP) services that Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) provide for people with mental health needs. An IOP is a distinct and organized outpatient program of psychiatric services provided for patients with acute mental illness including, but not limited to, conditions such as depression, schizophrenia, and substance use disorder. The Centers for Medicare & Medicaid Services (CMS) will pay for IOP services provided at the same payment rate as those paid to hospitals. Additional information on IOP services including scope of benefits, certification and plan of care requirements, payment policies, and coding and billing requirements is included in the recent CMS guidance.

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The Centers for Medicare & Medicaid Services (CMS) seeks feedback on how best to enhance Medicare Advantage (MA) data capabilities and increase public transparency.  With over half of Medicare beneficiaries, and 45 percent of rural beneficiaries, enrolled in MA, transparency about the program has become increasingly important.  In this request for information, CMS is seeking detailed information on common challenges and experiences in the MA program for which limited data are currently available.  Feedback may include data-related recommendations related to beneficiary access to care; prior authorization and utilization management strategies; cost and utilization of supplemental benefits; all aspects of MA marketing and consumer decision-making; care quality and outcomes; health equity; market competition; and special populations, such as individuals dually eligible for Medicare and Medicaid and other enrollees with complex conditions. They encourage input from beneficiaries and beneficiary advocates, plans, providers, community-based organizations, researchers, employers and unions, and the public at large.

Comment by May 29.

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The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on the information collection requirements in two key areas for rural stakeholders:

1. CMS Plan Benefit Package and Formulary 2025: Medicare Advantage and Prescription Drug Plan organizations are required to submit plan benefit packages for all Medicare beneficiaries residing in their service area. These include information on premiums, formularies, cost sharing, prior authorizations, and supplemental benefits. This information is commonly reviewed by beneficiaries on Medicare Plan Finder, which allows beneficiaries to access and compare Medicare Advantage and Prescription Drug plans.
2. Satisfaction of Nursing Homes, Hospitals, and Outpatient Clinicians Working with the CMS Network of Quality Improvement and Innovation Contractors Program:  CMS is also seeking input on revisions to its data collection requirements for several health care provider-focused quality improvement surveys that are part of the Network of Quality Improvement and Innovation Contractors Program. CMS made these changes to inform its evaluation of technical assistance provided to nursing homes and outpatient clinicians in community settings, as well as to hospitals.

Comment by February 26.

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According to the Centers for Medicare & Medicaid Services (CMS), a record number of people renewed their health coverage or became newly enrolled using either a federally facilitated marketplace or a state-based marketplace. Historically, about 18 percent of plan selections were from consumers living in rural areas.   While the annual Open Enrollment Period has ended, those no longer eligible for Medicaid or CHIP will have a special enrollment period to enroll in Marketplace coverage. Additionally, eligible individuals with household incomes less than 150% of the federal poverty level (approximately $22,000/year for an individual and $45,000/year for families of four) can enroll in Marketplace coverage anytime through a special enrollment period. Consumers who experience a change of life circumstance — such as marriage, birth, adoption, or loss of qualifying health coverage — may also be eligible for a special enrollment period. Consumers may go to Find Local Help on HealthCare.gov to find a Navigator, Certified Application Counselor, or agent or broker.

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Last week, the U.S. Department of Health and Human Services (HHS), through the Administration for Strategic Preparedness and Response, announced new efforts in ongoing work to protect the healthcare sector from cyberattacks.  What’s new is a set of cybersecurity performance goals that are designed to improve the response to attacks and minimize residual risk. A recent analysis by HHS reports that federal law enforcement agencies are now treating cyberattacks on hospitals as “threat to life” crimes, and that rural hospitals face additional challenges, including antiquated hardware and software systems, rising cybersecurity insurance premiums, and securing talent with the right technical skills.

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When prompted about the new health equity and social drivers of health quality measures collected by the Centers for Medicare & Medicaid Services (CMS), participating CAHs discussed their current practices and preparations for these measures, including collection of data on demographic and social needs in their electronic health records (EHR) and generating reports to identify health disparities.  The interviews and report were conducted by the Flex Monitoring Team, a FORHP-supported consortium of researchers who evaluate the impact of HRSA’s Medicare Rural Hospital Flexibility Program.  HRSA is currently accepting applications from states for this program until April 16.

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The U.S. Preventive Services Task Force released a final recommendation statement on screening for speech and language delay and disorders in children. The Task Force determined that more research is needed to recommend for or against screening all children aged 5 years and younger. To view the recommendation, the evidence on which it is based, and a summary for clinicians, please go here.

The Centers for Medicare and Medicaid Services (CMS) finalized on Jan. 17, 2024, the CMS Interoperability and Prior Authorization Final Rule, to improve the electronic exchange of health information and prior authorization processes for medical items and services for Medicare Advantage organizations, fee-for-service, and managed Medicaid, Children’s Health Insurance Program plans, and issuers of Qualified Health Plans offered on the federally facilitated exchanges. Beginning in 2026, the rule requires payers to streamline prior authorization by setting deadlines for decisions, providing justification for denied requests, publicly reporting metrics, and implementing an application programming interface (API). Payers must also expand their current Patient Access API to include prior authorization information and implement a Provider Access API to broaden provider access to patient information beginning in 2027. These policies are expected to result in approximately $15 billion of estimated savings over ten years. Read More.