On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) released proposed changes to the outpatient prospective payment system and the ambulatory payment system for the 2020 calendar year. The proposals on price transparency are highlighted with CMS proposing that all hospitals, including rural PPS hospitals and critical access hospitals (CAHs) make pricing information publicly available. Proposals also include reducing payment differences between certain sites of services, using the inpatient wage index values to address wage index disparities, and changing the generally applicable minimum required level of supervision from direct supervision to general supervision for hospital outpatient therapeutic services furnished by all hospitals and CAHs.  Comments are due on September 27, 2019.  The full announcement can be accessed here.

For more than 50 years, community health centers have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay. Today, there are nearly 1,400 HRSA-funded health centers, operating approximately 12,000 delivery sites, across our country.  Health centers deliver care to the nation’s most vulnerable individuals and families, including people experiencing homelessness, agricultural workers, residents of public housing, and the nation’s veterans.

Learn more about the Health Center Program. Visit data.HRSA.gov for current and comprehensive data on health centers.  Join HRSA on Twitter and Facebook during Health Center Week as we celebrate the work that health centers do.

On Tuesday, July 23, 2019, HRSA HIV/AIDS Bureau Associate Administrator Laura Cheever, MD, ScM, and HRSA Bureau of Primary Health Care Associate Administrator Jim Macrae, MA, MPP, met with public health leaders in South Carolina to discuss the Ending the HIV Epidemic: A Plan for America initiative and the progress being made in ending the HIV epidemic in the state.  South Carolina is one of seven states with substantial rural HIV burden, with an HIV/AIDS incidence case rate of a little over eight for every 100k residents.

Through HRSA’s Ryan White HIV/AIDS Program and the HRSA-funded Health Center Program, the agency will play a leading role in helping to diagnose, treat, prevent, and respond to end the HIV epidemic.

July 25, 2019 – The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA) awarded almost $42 million in funding to 49 Health Center Controlled Networks (HCCNs). These awards will enable the HCCNs to support 1,183 federally-funded health centers across all 50 states, the District of Columbia and Puerto Rico to expand the use of health information technology (health IT). Empowering patients and promoting data sharing through health IT is an element of President Trump’s vision for a healthcare system that delivers better value and better health for American patients.

“Health centers play a crucial role in providing their communities with access to high quality, affordable healthcare,” said HHS Secretary Alex Azar. “Investing in more advanced health IT will help put patients at the center and unleash the power of data, helping us get better value from the care delivered by health centers and delivering on President Trump’s vision for healthcare.”

Read the news release.

On July 1, 2019, the Federal Office of Rural Health Policy (FORHP) announced that it will award approximately $2.2 million to 25 awardees for the 2019 Rural Health Network Development Planning Program (Network Planning). This is a one-year, community-driven program designed to assist in the planning and development of an integrated health care network at the local level. By emphasizing the role of networks, the program creates a platform for medical care providers, social service providers, and community organizations to coalesce key elements of a rural health care delivery system for the purpose of improving local capacity and coordination of care.

The Network Planning program will aid providers as they move from focusing on the volume of services to focusing on the value of services. For grantees, the award (of up to $100,000) provides an opportunity to implement new and innovative approaches towards a dynamic health care environment that may in turn serve as a model for other rural communities. The incoming cohort of Network Planning grantees have projects that focus on building, strengthening, and formalizing integrated health care networks and systems, developing training cooperatives, conducting community health needs assessments, increasing service capacity, addressing behavioral and mental health conditions, and addressing the rural opioid epidemic.

Historically, previously awarded grantees have been successful in leveraging finances by using FORHP grants to sustain their efforts; they have been able to combine federal funds with local and foundation dollars to support the continuation and development of health care services in rural areas. Organizations have also demonstrated the ability to achieve innovative expansion and replication of their funded projects to successfully serve additional populations and regions, providing support to other rural communities with similar healthcare needs.

As FORHP continues to focus on showcasing program outcomes, the identification and dissemination of rural evidence-based models maintains as a priority. The Rural Community Health Gateway, located on The Rural Health Information Hub (RHIhub) consists of a number of resources, including successful program models and evidence-based toolkits.

If you have any questions about the program, please contact Jillian Causey:  JCausey@hrsa.gov or 301-443-1493.

The Federal Office of Rural Health Policy is pleased to announce approximately $6.3 million in grant awards to 32 rural communities across 19 states for the Small Health Care Provider Quality Improvement (Rural Quality) Program.  Each award recipient will receive up to $200,000 per year for a three-year project period to improve to patient health outcomes through implementation of activities designed to address improvements to the quality and delivery of rural health care services in primary care settings.  Organizations participating in the Rural Quality Program are required to utilize an evidence-based or promising practice quality improvement model, perform tests of change focused on improvement, and use health information technology (HIT) to collect and report data.  The Incoming cohort of Rural Quality grantees include projects that focus on substance use disorders and chronic disease conditions, such as diabetes and cardiovascular disease, and propose goals to integrate metal/behavioral health and primary care, enhance chronic disease management, improve transitions of care, reduce preventable hospital and emergency department utilization and better engage patients and their caregivers.  Several projects also align with national quality improvement initiatives such as value-based care and the accreditation and application of the patient centered medical home model. Historically, grantees have demonstrated success in leveraging finances by using FORHP grants to sustain their efforts; they have been able to combine federal funds with local and foundation dollars to support the continuation and development of health care services in rural areas.  Organizations have innovatively expanded their programs to serve different populations and regions while ensuring alignment with the current health care landscape.

As FORHP continues to focus on showcasing program outcomes, the identification and dissemination of rural evidence-based models maintains as a priority.  The Rural Community Health Gateway, located on The Rural Health Information Hub (RHIhub) consists of a number of resources, including successful program models and evidence-based toolkits.  If you have any questions about the program, please contact Katherine Lloyd:  Klloyd@hrsa.gov or 301-443-2933.  Thank you for your continued support and dedication to rural health!

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2020. This rule also:

• Proposes updates to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI
• Proposes changes to the ESRD Quality Incentive Program
• Includes requests for information on data collection resulting from the ESRD PPS technical expert panel, on possible updates and improvements to the ESRD PPS wage index, and on new rules for the competitive bidding of diabetic testing strips.

In addition, this rule proposes a methodology for calculating fee schedule payment amounts for new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services and making adjustments to the fee schedule amounts established using supplier or commercial prices if such prices decrease within five years of establishing the initial fee schedule amounts. This rule would also:

• Make amendments to revise existing policies related to the competitive bidding program for DMEPOS
• Streamline the requirements for ordering DMEPOS items, and create one Master List of DMEPOS items that could potentially be subject to face-to-face encounter and written order prior to delivery and/or prior authorization requirements

The proposed CY 2020 ESRD PPS base rate is $240.27, an increase of $5.00 to the current base rate of $235.27.  This proposed amount reflects a reduced market basket increase as required by section 1881(b)(14)(F)(i)(I) of the Act (1.7 percent) and application of the wage index budget-neutrality adjustment factor (1.004180).

The proposed rule also includes:

• Annual update to the wage index
• Update to the outlier policy
• Eligibility criteria for the Transitional Drug Add-on Payment Adjustment (TDAPA)
• Basis of Payment for the TDAPA for calcimimetics
• Average sales price conditional policy for the application of the TDAPA:
• New and innovative renal dialysis equipment and supplies
• Discontinuing the application of the erythropoiesis-stimulating agent monitoring policy
• Impact analysis:

For more information see:

• Proposed Rule: Public comments due by September 27, 2019
• Press Release

See the full text of this excerpted CMS Fact Sheet (issued July 29, 2019).

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) proposed policies that follow directives in President Trump’s Executive Order, entitled “Improving Price and Quality Transparency in American Health Care to Put Patients First,” that lay the foundation for a patient-driven health care system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services.

The proposed changes also encourage site-neutral payment between certain Medicare sites of services.  Finally, the proposed rule proposes updates and policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed polices in the CY 2020 OPPS/ASC Payment System proposed rule would further advance the agency’s commitment to increasing price transparency, (including proposals for requirements that would apply to each hospital operating in the United States), strengthening Medicare, rethinking rural health, unleashing innovation, reducing provider burden, and strengthening program integrity so that hospitals and ambulatory surgical centers can operate with better flexibility and patients have what they need to become active health care consumers.

In accordance with Medicare law, CMS is proposing to update OPPS payment rates by 2.7 percent. This update is based on the projected hospital market basket increase of 3.2 percent minus a 0.5 percentage point adjustment for Multi-Factor Productivity (MFP).

In the CY 2019 OPPS/ASC final rule with comment period, we finalized our proposal to apply the hospital market basket update to ASC payment system rates for an interim period of 5 years (CY 2019 through CY 2023). CMS is not proposing any changes to its policy to use the hospital market basket update for ASC payment rates for CY 2020-2023. Using the hospital market basket, CMS proposes to update ASC rates for CY 2020 by 2.7 percent for ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 3.2 percent minus a 0.5 percentage point adjustment for MFP. This change will also help to promote site neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower cost ASC setting.

The proposed rule also includes:

• Proposed definition of ‘hospital,’ ‘standard charges,’ and ‘items and services’
• Proposed requirements for making public all standard charges for all items and services
• Proposed requirements for making public consumer-friendly standard charges for a limited set of ‘shoppable services’
• Proposals for monitoring and enforcement
• Method to control for unnecessary increases in utilization of outpatient services
• Changes to the Inpatient Only list
• ASC covered procedures list
• High-cost/low-cost threshold for packaged skin substitutes
• Device pass-through applications
• Addressing wage index disparities
• Changes in the level of supervision of outpatient therapeutic services in hospitals and critical access hospitals
• Hospital Outpatient Quality Reporting Program
• Ambulatory Surgical Center Quality Reporting Program
• CY 2020 OPPS payment methodology for 340B purchased drugs
• Partial Hospitalization Program rate setting and update to per diem rates
• Revision to the organ procurement organization conditions for certification
• Potential changes to the organ procurement organization and transplant center regulations: Request for Information

For more information see:

• Proposed Rule: Public comments due by September 27, 2019
• Press Release

See the full text of this excerpted CMS Fact Sheet (issued July 29, 2019).

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020. This proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation. It also includes proposals to streamline the Quality Payment Program with the goal of reducing clinician burden. This includes a new, simple way for clinicians to participate in our pay-for-performance program, the Merit-based Incentive Payment System (MIPS), called the MIPS Value Pathways.

The proposed rule also includes:

• CY 2020 PFS rate setting and conversion factor
• Medicare telehealth services
• Payment for evaluation and management services
• Physician supervision requirements for physician assistants
• Review and verification of medical record documentation
• Care management services
• Comment solicitation on opportunities for bundled payments
• Medicare coverage for opioid use disorder treatment services furnished by opioid treatment programs
• Bundled payments for substance use disorders
• Therapy services
• Ambulance services
• Ground ambulance data collection system
• Open Payments Program
• Medicare Shared Savings Program
• Stark advisory opinion process

For More information see:

• Proposed Rule: Public comments due by September 27, 2019
• Press Release
• PFS Proposed Rule Fact Sheet
• Quality Payment Program Proposed Rule Fact Sheet

See the full text of this excerpted Fact Sheet (Issued July 29, 2019).