On December 17, 2021, the Facilities for Medicare & Medicaid Companies (CMS) issued a ultimate rulewith remark interval to implement the legislative modifications to Medicare direct graduate medical training (DGME) and oblique medical training (IME) funds to educating hospitals that have been contained in sections 126, 127, and 131 of the Consolidated Appropriations Act, 2021 (Pub. L. 116-260, December 27, 2020). As well as, this ultimate rule with remark interval solicits feedback on the next points to tell potential future rulemaking:
- How you can account for well being care supplied exterior of a Well being Skilled Scarcity Space (HPSA) to HPSA residents, and possible alternate options to HPSA scores as a proxy for well being disparities within the prioritization of further full-time equal (FTE) cap slots; and
- The overview course of to find out eligibility for per resident quantity (PRA) or FTE cap resets in conditions the place a hospital disagrees with the knowledge on price experiences which might be not throughout the three-year reopening interval.
This ultimate rule additionally addresses organ acquisition fee insurance policies by modifications, clarifications, and codifications relative to organ procurement organizations (OPOs), transplant hospitals, and donor group hospitals. CMS just isn’t finalizing the proposed coverage for counting organs for functions of figuring out Medicare’s share of organ acquisition prices for organs transplanted into Medicare beneficiaries presently to additional contemplate points raised in public feedback. Nevertheless, this ultimate rule with remark codifies longstanding Medicare organ acquisition fee insurance policies, with some modifications. These ultimate insurance policies will facilitate and assist organ procurement and transplantation.
Closing Gaps in Well being Fairness in Graduate Medical Training (GME)
This ultimate rule with remark interval advances key priorities to shut well being care fairness gaps and improve the well being care workforce in rural and underserved communities. The coaching and retention of physicians is vital to making sure entry to well being care in underserved communities which have traditionally skilled workforce challenges. Part 126 of the Consolidated Appropriations Act (CAA), 2021, requires the distribution of a further 1,000 new Medicare-funded medical residency positions to assist practice physicians, phased in at not more than 200 slots per yr starting in FY 2023. CMS estimates that this extra funding will complete roughly $1.8 billion from FY 2023 by FY 2031. CMS is prioritizing purposes from qualifying hospitals that serve geographic areas and underserved populations with the best want.
The ultimate rule with remark interval additionally makes further strides to shut the well being fairness hole in rural communities, which are likely to expertise well being care workforce shortages. CMS is implementing part 127 of the CAA, Selling Rural Hospital GME Funding Alternative, which permits rural educatinghospitals collaborating in an accredited rural coaching monitor (RTT) to obtain will increase to their FTE caps.
CMS can be implementing part 131 of the CAA, Medicare GME therapy of hospitals establishing new medical residency coaching packages after internet hosting medical resident rotators for brief durations prior to now. Some hospitals inadvertently restricted their skill to obtain Medicare funding for residents in a brand new coaching program by accepting residents that rotated to the hospital from different coaching packages in previous years. The ultimate rule will restore that skill to qualifying hospitals that start a brand new medical residency coaching program throughout the first 5 years after enactment. Part 131 advances well being fairness by permitting these hospitals, typically serving underserved communities, to obtain further residency positions and elevated PRAs.
Supporting Organ Procurement and Organ Transplantation
Within the FY 2022 IPPS/LTCH PPS proposed rule, CMS proposed modifications pertaining to Medicare’s share of organ acquisition prices for organs transplanted into Medicare beneficiaries, modifications pertaining to costs for providers supplied to cadaveric organ donors by donor group hospitals, and modifications to longstanding Medicare organ acquisition fee insurance policies. Within the FY 2022 IPPS/LTCH PPS ultimate rule, Half I, CMS said that as a result of quantity and nature of the feedback that we acquired on the organ acquisition fee coverage proposals we are going to handle public feedback related to these points in future rulemaking. After additional consideration of the considerations raised by commenters, CMS has determined to not finalize the proposed coverage with respect to counting organs presently and should contemplate it in future rulemaking.
CMS is finalizing the proposed coverage with modification [DECE1][DT2] requiring donor group hospitals and transplant hospitals to invoice OPOs the lesser of customary costs which might be lowered to prices, or negotiated charges, according to Medicare cheap price rules. This ultimate rule with remark additionally codifies and clarifies sure organ acquisition fee insurance policies relative to definitions, normal acquisition costs, Medicare protection of residing donor issues, Medicare as a secondary payor for organ acquisitions, and kidney paired donations.
Remedy of Sure Medicaid Part 1115 Demonstrations for Medicare Disproportionate Share Hospital (DSH) Funds
Within the FY 2022 IPPS/LTCH PPS proposed rule, CMS proposed revisions to the regulation referring to the therapy of part 1115 waiver days for functions of the DSH adjustment (86 FR 25457 by 25459). Within the FY 2022 IPPS/LTCH PPS ultimate rule, CMS said that as a result of quantity and nature of the feedback that we acquired on our proposal, we supposed to handle the general public feedback in a separate doc (86 FR 45249). CMS thanks commenters for his or her enter on the proposal. After additional consideration of the difficulty, CMS determined to not transfer ahead with the present proposal. CMS expects to revisit the difficulty of part 1115 waiver days in future rulemaking, and we encourage stakeholders to overview any future proposal on this concern and to submit feedback at the moment.
The FY 2022 IPPS ultimate rule with remark interval (CMS-1752-FC3) is displayed on the Federal Register and will be seen right here: https://www.federalregister.gov/public-inspection/present