Monday Morning Rounds with CMS

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Posted By: HHS/ONC/CMS Communications July 18, 2022

ICYMI, here is recent communication from CMS.

News

CMS Proposes Rule to Advance Health Equity, Improve Access to Care, & Promote Competition and Transparency
CMS is proposing actions to advance health equity and improve access to care in rural communities by establishing policies for Rural Emergency Hospitals (REH) and providing for payment for certain behavioral health services furnished via communications technology. Additionally, in line with President Biden’s Executive Order on Promoting Competition in the American Economy, the calendar year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System proposed rule includes proposed enhanced payments under the OPPS and the Inpatient Prospective Payment System for the additional costs of purchasing domestically made NIOSH-approved surgical N95 respirators and a comment solicitation on competition and transparency in our nation’s health care system.

CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care
CMS issued the Calendar Year 2023 Physician Fee Schedule proposed rule, which would significantly expand access to behavioral health services, Accountable Care Organizations, cancer screening, and dental care — particularly in rural and underserved areas. These proposed changes play a key role in the Biden-Harris Administration’s Unity Agenda — especially its priorities to tackle our nation’s mental health crisis, beat the overdose and opioid epidemic, and end cancer as we know it through the Cancer Moonshot — and ensure CMS continues to deliver on its goals of advancing health equity, driving high-quality, whole-person care, and ensuring the sustainability of the Medicare program for future generations.

Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule – Medicare Shared Savings Program Proposals
On July 7, 2022, CMS issued the Calendar Year 2023 Physician Fee Schedule proposed rule that includes proposed changes to the Medicare Shared Savings Program (Shared Savings Program) to advance CMS’ overall value-based care strategy of growth, alignment, and equity.

Additional Resources to Improve Oversight and Ensure Access to Quality Care in Medicaid and CHIP Managed Care Programs
CMS unveiled a suite of new resources to improve CMS and state oversight of Medicaid and Children’s Health Insurance Program managed care programs. These programs provide people with health benefits and additional services through contracted arrangements with managed care plans. Released in a Center for Medicaid and CHIP Services Informational Bulletin, this new information includes tools, templates, and updates on tactics to improve states reporting on their managed care programs, which promotes access to care for millions of people enrolled in Medicaid and CHIP.

CMS Publishes Program Year 2021 Open Payments Data on Health Care Providers
CMS published Program Year 2021 Open Payments data to publicly disclose the financial relationships between applicable manufacturers and group purchasing organizations(known as reporting entities) and certain health care providers (known as covered recipients). This data publication reflects a total of 12.10 million records and $10.90 billion in publishable payments or transfers of value made to covered health care providers during PY 2021. It also includes newly submitted or updated records from previous program years.

Now Available: Revised eCQM Specification for CMS156, Use of High-Risk Medications in Older Adults for 2023 Reporting/Performance Period for Eligible Clinicians
CMS has revised the electronic clinical quality measure specification for CMS156v11, Use of High-Risk Medications in Older Adults, for the 2023 reporting/performance period for Eligible Clinician programs. CMS revised the age criteria from the previously published specification on May 5, 2022, to better align with clinical guidelines. Please note, measures will not be eligible for 2023 reporting unless and until they are proposed and finalized through notice-and-comment rulemaking for each applicable program.

Performance Period 2022 Eligible Clinician Electronic Clinical Quality Measure Education and Outreach Webinar Series
CMS developed and published webinar content from the Performance Period 2022 Eligible Clinician Electronic Clinical Quality Measure Education and Outreach Webinar Series. PDF slides and links to the webinar video recordings are available to review on the eCQI Resource Center (under “Get Started with eCQMs – Implementing eCQMs Eligible Clinicians”).

Events

Quality Payment Program

Visit the Quality Payment Program (QPP) Resource Library to Access 2023 MIPS Performance Period Self-Nomination Materials
This message is notification that the 2023 MIPS Performance Period Self-Nomination Materials (ZIP), including the below files, are now posted on the Quality Payment Program Resource Library:

  • 2023 Qualified Clinical Data Registry (QCDR) Fact Sheet
  • 2023 Qualified Registry Fact Sheet
  • 2023 Self-Nomination User Guide for QCDRs and Qualified Registries
  • 2023 QCDR Measure Development Handbook

Open and Close Dates
As a reminder, the 2023 MIPS Performance Period Self-Nomination Period will take place from 10 a.m. ET on July 1, 2022, to 8 p.m. ET on September 1, 2022.

Promoting Interoperability

The Medicare Promoting Interoperability Program Hardship Exception Application for Eligible Hospitals and Critical Access Hospitals is Now Available
On May 1, CMS opened the Hardship Exception Application period for eligible hospitals and critical access hospitals that participated in the Medicare Promoting Interoperability Program in Calendar Year 2021. For the CY 2021 reporting period, CMS required that all eligible hospitals and CAHs use (1) existing 2015 Edition certification criteria, (2) the 2015 Edition Cures Update criteria, or (3) a combination of the two in order to successfully meet the program requirements, as finalized in the CY 2021 Physician Fee Schedule final rule (85 FR 84818 through 84828). CMS mandates that downward payment adjustments be applied to eligible hospitals and CAHs that were not meaningful users of CEHRT and score below the 50-point minimum requirement and failed to report two self-selected calendar quarters of eCQMs data on four self-selected eCQMs.

Now Available: Updated eCQM Specifications and Implementation Resources for 2023 Reporting/Performance Period
CMS has posted the eCQM specifications for the 2023 reporting/performance period for the Eligible Hospitals and Critical Access Hospitals, Hospital Hybrid, Outpatient Quality Reporting, and Eligible Clinician programs. CMS updates the specifications annually to align with current clinical guidelines and code systems so they remain relevant and actionable within the clinical care setting. Measures will not be eligible for 2023 reporting unless and until they are proposed and finalized through notice-and-comment rulemaking for each applicable program.

Administrative Simplification

Updated Compliance Review Program Findings Now Available
The National Standards Group (NSG) has released an updated Compliance Review Program Findings report identifying the most common violations of standards and operating rules from compliance reviews. This report expands on the Compliance Review Program Findings report released in July 2020 and includes insights from 19 additional reviews.

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