Programs

Regulatory Updates

Total of 185 Records Returned

State: Idaho

Idaho – Residential Assisted Living Facility Rule Update

Date Proposed : 05/26/2023

Date Effective : 07/1/2024

Date Adopted : 07/1/2024

Program: Assisted Living

Assists in streamlining the process for potential applicants for Residential Assisted Living Facilities (RALFs) while balancing the safety of residents.

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State: South Carolina

CMS Provides Resources, Flexibilities for Hurricane Debby – South Carolina, Georgia, Florida and Hawaii

Date Posted : 08/1/2024

Program: Acute Care Hospital, Ambulatory Surgical Centers (ASC), Clinical Laboratory, Critical Care Hospital, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Home Health, Home Infusion Therapy, Hospice, Pharmacy, Renal Dialysis

The Secretary of the Department of Health and Human Services (HHS) may, under section 319 of the Public Health Service (PHS) Act determine that: a) a disease or disorder presents a public health emergency; or b) that a public health emergency, including significant outbreaks of infectious disease or bioterrorist attacks, otherwise exists.

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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.

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State: 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

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State: 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.

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State: 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.
Health care providers who need additional flexibilities, which are not listed above and specific to the effects resulting from Hurricane Beryl, can submit a request to CMS here.

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