Medicare Compliance & Reimbursement

CMS offers several rural healthcare fixes in MPFS proposed rule.

The pandemic revealed that access to safe and affordable healthcare isn’t always guaranteed. The feds continue to try to rectify these equity issues with recent funding and policy making. Read on for the scoop on three items to know.

1. Fee Schedule Aims to Bolster RHCs and FQHCs

In the Medicare Physician Fee Schedule (MPFS) proposed rule published in the Federal Register on July 29, the Centers for Medicare & Medicaid Services (CMS) offers up a few proposals to assist providers helping beneficiaries at Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).

Reminder: RHCs are Medicare-certified and offer primary care specifically in rural areas with limited healthcare options. FQHCs operate in both rural and urban locations that have provider shortages and assist patients with both primary and dental care. Both types of facilities must meet certain Medicare standards and comply with Conditions of Coverage and Certification.

First, CMS wants to make chronic pain management a priority at RHCs and FQHCs. “We are proposing to include chronic pain management services in the general care management HCPCS code G0511 [Rural health clinic or federally qualified health center (RHC or FQHC) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM), per calendar month] when these services are provided by RHCs and FQHCs,” notes the proposed rule. The expansion of G0511 would have little impact on Medicare spending “since the requirements for the new chronic pain management and behavioral health integration services are similar to the requirements for the general care management services furnished by RHCs and FQHCs” already, CMS reasons.

Two other proposals focus on telehealth provisions outlined in the Consolidated Appropriations Act, 2022 (CAA, 2022) and deal with the post-COVID-19 public health emergency (PHE) transition. CMS wants to extend telehealth flexibilities for RHCs and FQHCs for 151 days after the PHE ends.

“During this period, CMS would also continue to waive geographic and site of service requirements, allow audio-only services and waive in-person requirements for all mental health services,” explains Suzanne Michelle Joy, senior public affairs advisor, with law firm Holland & Knight LLP in online analysis.

Find the proposed rule at www.govinfo.gov/content/pkg/FR-2022-07-29/pdf/2022-14562.pdf.

2. Community Health Gets a Funding Boost

The Department of Health and Human Services (HHS) intends to improve community and public health resources for patients in underserved areas by investing more than $266 million in providers and programs.

“Patients depend on community and public health workers for care and medical information,” expounds HHS Secretary Xavier Becerra in a release. “These investments will equip community and public health workers with the skill sets needed to provide effective community outreach, increase access to care, and assist individuals with critical prevention and treatment services.”

Details: The HHS Health Resources and Services Administration (HRSA) will disperse upward of $225 million to 83 grantees via its Community Health Worker Training Program, training and supporting 13,000 workers. The health members include “promotores de salud, community health advisors, outreach workers, patient navigators and peer counselors,” who all strive to connect people and build trust in communities, HHS says.

Another $47 million is earmarked for the Public Health Scholarship Program and will be distributed to 29 grantees by HRSA, incentivizing individuals to pursue public health careers.

Read the release, with links to the various programs, at www.hhs.gov/about/news/2022/09/30/new-american-rescue-plan-funding-hhs-expands-and-strengthens-community-and-public-health-workforce.html.

3. CMS Issues RFI on Efficiency, Equity, and Burden Reduction

If you want to offer the feds your two cents on reducing regulatory burdens, CMS is soliciting input with a new Request for Information (RFI) titled “Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs.”

CMS “is committed to engaging with partners, communities, and individuals across the health system to understand their experiences with CMS payment policies and quality programs, particularly how existing and proposed CMS payment policies and quality programs impact the experience of healthcare,” the agency says on the RFI webpage.

“Through this RFI, CMS is seeking public input on accessing healthcare and related challenges, understanding provider experiences, advancing health equity, and assessing the impact of waivers and flexibilities provided in response to the COVID-19 public health emergency (PHE),” the agency explains. “CMS will use the comments received ... to identify potential opportunities for improvement and increased efficiencies across CMS policies, programs, and practices,” it adds.

“This RFI aims to gather feedback and perspectives related to ... reducing burden, and creating efficiencies across the healthcare system,” CMS says in a release.

Heads up: CMS will accept comments on the RFI through Nov. 4 at www.cms.gov/request-information-make-your-voice-heard.