2023-06-29-MLNC

On June 26, CMS issued a proposed rule that proposes to update payment rates and policies and includes requests for information under the ESRD Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2024. This rule also proposes an update to the Acute Kidney Injury dialysis payment rate for renal dialysis services furnished by ESRD facilities for CY 2024. In addition, the rule proposes to update requirements for the ESRD Quality Incentive Program.

For CY 2024, CMS is proposing to increase the ESRD PPS base rate to $269.99, increasing total payments to ESRD facilities by approximately 1.6%.

See the full fact sheet.

Transforming Medicare Coverage: A New Medicare Coverage Pathway for Emerging Technologies and Revamped Evidence Development Framework

CMS is committed to fostering innovation while ensuring that people with Medicare have faster and more consistent access to emerging technologies that will improve health outcomes. As part of this commitment, CMS announced a proposed Transitional Coverage for Emerging Technologies pathway. This announcement includes a proposed procedural notice and several proposed guidance documents that propose a substantial transformation to our approach to coverage reviews and evidence development.

Comment on the Federal Register notice by August 28.

More Information:

New Details of Plan to Cover New Alzheimer’s Drugs

CMS released new details about how people can get drugs that may slow the progression of Alzheimer’s disease covered by Medicare. Medicare will cover drugs with traditional FDA approval when a physician and clinical team participates in the collection of evidence about how these drugs work in the real world, also known as a registry. Clinicians will be able to submit this information through a nationwide, CMS-facilitated portal.

See the full fact sheet.

Model Participants for the Enhancing Oncology Model

The Center for Medicare and Medicaid Innovation is pleased to announce the organizations participating in the Enhancing Oncology Model (EOM). Launching on July 1, 2023, the five-year model test delivers towards the Biden-Harris Administration’s Cancer Moonshot goals, to decrease the cancer death rate by at least 50% over 25 years – saving and extending 4 million Americans lives – and to transform the experience of people who are touched by cancer and their families and caregivers.

As of June 27, 2023, 67 oncology physician group practices (PGPs) are participating in EOM. Across the 67 PGP participants, there are over 600 sites of care representing approximately 37 states nationally and over 3,000 unique practitioners. Approximately 15% of EOM participants’ sites of care are located in a rural/small town/micropolitan area, with a little over half of EOM participants having previously participated in the Oncology Care Model (OCM).

EOM builds on the successes of and lessons learned from the OCM and feedback from the oncology community, including, but not limited to OCM participants, patient advocacy groups, oncology professional associations, and others. The goal of EOM is to drive transformation in oncology care by preserving and enhancing the quality of care furnished to Medicare beneficiaries undergoing treatment for cancer while reducing Medicare program spending. EOM aims to improve quality and reduce costs through payment incentives and required participant redesign activities such as ensuring patients with Medicare have equitable access to navigation services and that providers discuss and develop an individualized care plan for their patients. Oncology practices that participate in EOM will take on financial and performance accountability for episodes of care surrounding systemic chemotherapy administration to patients with common cancer types.

EOM will include screening for health-related social needs, introduce data reports on expenditure and utilization patterns of their patient population to help health care professionals identify and address health disparities, and offer an additional payment for the provision of Enhanced Services to patients who are dually eligible for Medicare and Medicaid that is not included in the total cost of care responsibility. EOM participants will ask patients to routinely report their symptoms in order to encourage better communication and a more proactive care response, and EOM participants will be required to submit plans outlining how they will promote health equity.

More Information:

Fact sheet
Enhancing Oncology Model webpage
Contact EOM@cms.hhs.gov with questions or comments

Hospital Price Transparency: Volunteer for Machine-Readable File Validator Testing

CMS seeks volunteers to test a new validator tool for voluntary sample formats. If you’re interested, contact TalkToUs@cms.hhs.gov with “HPT Validator Tool Testing” in the subject line. You don’t need to currently use a sample format to volunteer.

Effective January 1, 2021, each hospital operating in the U.S. is required to provide publicly-accessible standard charge information online for the items and services they provide. You may opt to use a voluntary sample format to meet this requirement. Visit Hospital Price Transparency to learn more.

Claims, Pricers, & Codes

RARCs, CARCs, Medicare Remit Easy Print, & PC Print: July Update

Get updated remittance advice remark codes (RARCs) and claim adjustment reason codes (CARCs), and learn what to do if you use Medicare Remit Easy Print or PC Print.

More Information:

Sections 40.5, 60.2, and 60.3 Medicare Claims Processing Manual, Chapter 22
Instruction to your Medicare Administrative Contractor

Events

Hospital Price Transparency Machine-Readable File Sample Format Webinar — July 26

Wednesday, July 26 from 2:30–4 pm ET

Join CMS to review voluntary sample formats you may use to make your standard charges public in a machine-readable file. We’ll present sample formats that use a standardized set of data elements and a new validator tool you can use to test the accuracy of your file. See Hospital Price Transparency Resources for sample formats and data dictionaries.

MLN Matters® Articles

Ambulatory Surgical Center Payment System: July 2023 Update — Revised

CMS added information about a corrected payment for CPT 0697T.

From Our Federal Partners

Locally-Acquired Malaria Cases Identified in U.S.

The CDC issued a Health Alert Network Health Advisory to notify clinicians, public health authorities, and the public about locally-acquired malaria cases (P. vivax) in Florida and Texas within the last 2 months and to provide recommendations for clinicians.

Measles Guidance for the Summer Travel Season

The CDC issued a Health Alert Network Health Advisory to remind clinicians and public health officials to provide guidance for measles prevention to international travelers and be on alert for cases of measles.

Information for Patients

States Are Restarting Medicaid & CHIP Eligibility Reviews: Tell Your Patients to Prepare Now

Share the Renew Your Medicaid or CHIP Coverage flyer with your Medicaid and Children’s Health Insurance Program (CHIP) patients.

Starting February 1, 2023, some states resumed Medicaid and CHIP eligibility reviews that they temporarily stopped during the pandemic. This means millions of people could lose their current Medicaid or CHIP coverage in the coming months. To find out if they can continue their coverage, people with Medicaid and CHIP must get ready to renew now.

Here are 3 things your patients with Medicaid or CHIP can do to prepare:

Make sure their state has their current contact information
Check the mail for a letter about their Medicaid or CHIP coverage
Complete their renewal form right away (if they get one)

Related Resources:

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