Programs
Regulatory Updates
Total of 165 Records Returned
State: All
Effective August 12: New Orthoses Codes Added to Required Prior Authorization and WOPD
Date Posted : 08/5/2024
Date Effective : 08/12/2024
Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Pharmacy
Effective August 12, 2024, CMS selected six more orthoses codes for required prior authorization to begin nationwide on August 12, 2024: L0631, L0637, L0639, L1843, L1845, L1951. We began accepting prior authorization requests for the added codes on July 29, 2024. CMS also selected eight more orthoses codes for required face-to-face encounter and written order prior to delivery (WOPD): L0635, L0636, L0638, L0639, L0640, L0651, L1845, and L1852 Effective August 12, 2024, Medicare will not require prior authorization and face-to-face encounter and Written Order Prior to Delivery (WOPD) for HCPCS code L1833.
Read MoreState: All
Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System FY 2025 Final Rule
Date Posted : 08/8/2024
Date Effective : 01/1/2025
Program: Acute Care Hospital
On August 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule. The final rule updates Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for fiscal year (FY) 2025. CMS is publishing this final rule to meet the legal requirements for updating Medicare payment policies for IPPS hospitals and LTCHs on an annual basis. This fact sheet discusses major provisions of the final rule, which can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/current
Read MoreState: All
CMS FY 2025 Hospice Final Rule
Date Posted : 07/30/2024
Date Effective : 10/1/2024
Program: Hospice
On July 30, CMS released the FY 2025 Hospice Wage Index and Payment Rate Update, Hospice CoP Updates, and Hospice Quality Reporting Program Updates. This is scheduled to be published in the federal register August 6, 2025. Changes outlined in this final rule will be effective Oct 1, 2025, unless otherwise stated. This final rule addresses payment, quality reporting, CAHPS, the new HOPE instrument, and CoP updates.
Read MoreState: Texas
Texas – CMS announces available waivers to Texas Providers affected by Hurricane Beryl
Date Posted : 07/15/2024
Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Clinical Laboratory, Critical Care Hospital, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Home Health, Hospice, Renal Dialysis
Effective on July 15, 2024, and retroactive to July 5, 2024, the Centers for Medicare & Medicaid Services (CMS) announces resources and flexibilities available in response to Hurricane Beryl in Texas. Below is a list of the waivers. Visit the CMS Hurricanes & Tropical Storms webpage or the Section 1135 Waiver webpage for updates.
- Certain conditions of participation, certification requirements, program participation or similar requirements for individual health care providers or types of health care providers, including as applicable:
- Hospital or other provider of services.
- Physician or other health care practitioner or professional.
- Health care facility.
- Supplier of health care items or services.
- Requirements that physicians or other health care professionals hold licenses in the State in which they provide services, if they have an equivalent license from another State (and are not affirmatively barred from practice in that state, or any state, a part of which is included in the emergency area).
- Sanctions under section 1877(g) of the Act (physician self-referral law, relating to limitations on physician referral) under such conditions and in such circumstances as the CMS determines appropriate.
- Waived sanctions and penalties arising from noncompliance with the following provisions of the HIPAA privacy regulations:
- The requirements to obtain a patient’s agreement to speak with family members or friends or to honor a patient’s request to opt out of the facility directory (as set forth in 45 C.F.R. § 164.510).
- The requirement to distribute a notice of privacy practices (as set forth in 45 C.F.R. § 164.520).
- Pursuant to Section 1135(b)(5) of the Act, modified deadlines and timetables and for the performance of required activities, but only to the extent necessary, as determined by the CMS, to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the Medicare, Medicaid and CHIP programs and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of these requirements as a result of Hurricane Beryl, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse.
State: Michigan
Michigan – Provide access to quality Complex Rehabilitation Technology
Date Proposed : 06/28/2023
Date Effective : 07/23/2024
Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
The department shall establish focused policies and promulgate focused rules for complex rehabilitation technology products and services. The focused policies and rules must take into consideration the individually configured nature of complex rehabilitation technology and the broad range of services necessary to meet the unique medical and functional needs of an individual with complex medical needs.
Read MoreState: Illinois
Illinois – Pharmacy Practice Act
Date Effective : 01/1/2026
Program: Pharmacy
This rulemaking would update several sections of these rules, including the creation of a new section regarding Approved Certified Pharmacy Technicians Programs. New Rule as of January 1, 2026 - the pharmacist in charge of a nonresidential pharmacy will need to be licensed by the state of Illinois.
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Accreditation Commission for Health Care, Inc.