This document outlines several key changes and initiatives from the Centers for Medicare & Medicaid Services (CMS), focusing on improving quality of care, reducing administrative burden, and advancing interoperability. Here’s a breakdown of the main points:
1. Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP) Changes:
Data Element Reduction: Too lessen the reporting burden on LTCHs, four Social Determinants of Health (SDOH) standardized patient assessment data elements will be removed from the LTCH Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) starting with Fiscal Year (FY) 2028.These include items related to Living Situation, Food, and Utilities.
Policy Amendments: The reconsideration policy and process will be amended.
Public Comment Sought: CMS received public comments on future measure concepts,revisions to data submission deadlines,and advancements in digital quality measures (dQMs) for the LTCH QRP.
2. Transforming Episode Accountability Model (TEAM) updates:
Model Description: TEAM is a mandatory, five-year episode-based payment model for selected acute care hospitals. It focuses on coordinating care for Original Medicare beneficiaries undergoing one of five surgical procedures.
Duration: The model will run from January 1, 2026, to December 31, 2030.
scope of Obligation: Participating hospitals will be responsible for the cost and quality of care from the surgery through the first 30 days post-surgery.
Key Changes:
Capturing quality measure performance using patient-reported outcomes in the outpatient setting without increasing participant burden.
Improving target price construction.
Broadening the three-day Skilled Nursing Facility (SNF) Rule waiver to offer patients more post-acute care choices and access.
Resources: Links to a TEAM model overview fact sheet and Frequently Asked Questions (FAQs) are provided.
3.Assistant Secretary for Technology Policy/Office of the National Coordinator (ASTP/ONC) Health Data,Technology,and Interoperability (HTI-4) Rider:
Focus: This rider aims to improve care delivery and reduce administrative burden by facilitating the exchange of clinical and administrative data.
ONC Health IT Certification Program Updates: The rule finalizes updates to the ONC Health IT Certification Program to enhance providers’ ability to:
Engage in electronic prescribing.
Perform real-time prescription benefit checks.
Conduct electronic prior authorization.
Goal: These capabilities build upon existing CMS policies and support the department’s efforts to ease provider burdens and ensure timely, evidence-based care for patients.
4. request for Information (RFI) on Streamlining Regulations and Reducing Administrative Burdens in Medicare:
Executive Order (EO) 14192: This RFI is in response to President Trump’s Executive Order “unleashing Prosperity Through Deregulation,” which mandates a significant reduction in the private expenditures required to comply with federal regulations.
Purpose: CMS is seeking public input on strategies and opportunities to streamline regulations and reduce administrative burdens for participants in the Medicare program.
Availability: The RFI is accessible via a provided link.
In essence,CMS is actively working to modernize its programs by reducing reporting requirements,improving payment models,promoting technological interoperability,and seeking public input to make the Medicare program more efficient and less burdensome for providers and patients alike.
