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The regulations impact CMS-regulated payers and provide incentives for providers and hospitals that participate in the Medicare Promoting Interoperability Program and the Merit-based Incentive PaymentSystem (MIPS). Most of the Proposed Rule’s provisions will be effective on January 1, 2026.
An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. Many states are taking advantage of Medicaid program flexibility and federal financing to implement APMs in a variety of ways. Types of Alternative Payment Models.
On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.
On August 1, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the Fiscal Year 2025 Hospital Inpatient Prospective PaymentSystem Final Rule (“Final Rule”), finalizing the proposed Transforming Episode Accountability Model (“TEAM”). TEAM will begin on January 1, 2026.
The Centers for Medicare & Medicaid Services (“CMS”) will publish the 2025 Inpatient Prospective PaymentSystem (“IPPS”) Final Rule (“Final Rule”) in the Federal Register on August 28 with an effective date of October 1, 2024.
On August 28, 2024, the Centers for Medicare & Medicaid Services (“CMS”) published the Fiscal Year 2025 Inpatient Prospective PaymentSystem (“IPPS”) Final Rule (“Final Rule”), which can be found here. Applications for this process are due March 31, 2025, and any FTE gained will be effective July 1, 2026.
The Final Rule also imposes additional reporting requirements under the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals and for eligible clinicians reporting under the Promoting Interoperability performance category of the Merit-Based Incentive PaymentSystem.
On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective PaymentSystem proposed rule.
On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective PaymentSystem Rate Update (“PPS Rule”). One of the largest changes to home health payment under PDGM was the move to variable LUPA thresholds.
On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective PaymentSystem Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register.
On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective PaymentSystem Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment.
Administrator, Centers for Medicare & Medicaid Services. economy, and by 2026 the CMS Office of the Actuary projects that one in every five dollars spent in America will be spent on healthcare. However, while medical technology is developing at a rapid pace, Medicare’s paymentsystems haven’t always been as quick to change.
On August 7, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule (“Final Rule”) that updated Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective PaymentSystem (“SNF PPS”) for fiscal year (“FY”) 2024.
On April 4, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) that would update Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective PaymentSystem (“SNF PPS”) for fiscal year 2024.
Administrator, Centers for Medicare & Medicaid Services. CMS is hard at work to move to a value-based system, not just because we want to, but because the American healthcare system is on an unsustainable trajectory, with one in five dollars spent in our economy projected to be spent on healthcare by 2026. Seema Verma.
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