CMS Issues Slew of New Rules and Policies to Improve Patient Care, Boost Reimbursements

The Centers for Medicare and Medicaid (CMS) has been busy pushing out proposed rules and policy changes that will impact healthcare providers and patients in a variety of ways.

Among the proposals it has made is a Data Driven Patient Care Strategy that puts patients at the center of healthcare and makes data more accessible and usable in a way that not only enhances efficiency, but also improves quality while also reducing cost.

As part of the strategy, CMS announced it is releasing encounter data from Medicare Advantage plans to researchers on everything from inpatient care to home health. Making the information available would allow for the creation of tools that help consumers make better health choices, according to CMS Administrator Seema Verma.

In March, Verma announced the launch of Blue Button 2.0 to allow Medicare beneficiaries to take charge of their own data by providing them access to and the ability to share their claims data in a universal and secure digital format.

“CMS is also putting patients first by ensuring that across all our efforts, strict privacy and security requirements to protect patient data are put in place from the beginning and play a prominent role in all decisions,” Verma said.

CMS also announced proposed changes that will give patients improved access to hospital price information, along with access to their electronic health records, and make it easier for providers to spend time with them.

Although hospitals already are required under guidelines developed by CMS to either make publicly available a list of their standard charges, or their policies for allowing the public to view a list of those charges upon request, CMS is updating its guidelines to specifically require that hospitals post this information.

The rule proposes updates to Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS).

Also effective immediately, CMS is re-naming the Meaningful Use program to “Promoting Interoperability.”

CMS figures the payment and policy updates— including those to operating, uncompensated care, capital and low-volume payments — will increase payments to hospitals by approximately 3.4 percent, or $4 billion, for federal fiscal year 2019 compared to 2018.

“The proposed rule would eliminate a significant number of measures acute care hospitals are currently required to report and remove duplicative measures across the five hospital quality and value-based purchasing programs. This would result in the removal of a total of 19 measures from the programs and would de-duplicate another 21 measures while still maintaining meaningful measures of hospital quality and patient safety,” according to CMS.

CMS also is proposing several other changes designed to reduce the number of hours providers spend on paperwork so that more time is spent providing care to patients, thus improving the quality of care they receive.

Finally, CMS also announced the release of a new patient-driven payment model for skilled nursing facilities that ties reimbursement to patient conditions and care and reduces the amount of paperwork.

The new payment model will increase Medicare payments rates for skilled nursing facilities for fiscal year 2019 by $850 million and create a new payment system for fiscal year 2020. The proposal moves away from reimbursement based on hours of service provided to a model designed to treat the needs of the whole patient.

CMS encourages comments, questions, or thoughts on this proposed rule and will accept comments until June 26, 2018. The proposed rule can be downloaded from the Federal Register

If you have any questions about these latest developments, the Health Law Offices of Anthony C. Vitale can assist. Contact us for additional information at 305-358-4500 or send us an email to

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