National Organization of State Offices of Rural Health



Federal Office Of Rural Health Policy (FORHP) Updates

August 2017

*FORHP’s Policy Team is ready to answer any questions you may have about these updates at RuralPolicy@.*

Quality Payment Program Hardship Exception for Meaningful Use

The Centers for Medicare & Medicaid Services (CMS) is now accepting applications from clinicians eligible for the Merit-based Incentive Payment System (MIPS) to obtain hardship exceptions from the Advancing Care Information (i.e., Meaningful Use) requirements of the program. Under MIPS scoring, MIPS-eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to 0 percent of the final score, and can submit a hardship exception application, for one of the following reasons:

1. Insufficient internet connectivity;

2. Extreme and uncontrollable circumstances; or

3. Lack of control over the availability of Certified EHR Technology.

Some MIPS-eligible clinicians will be automatically reweighted (or exempted in the case of clinicians participating in a MIPS Alternative Payment Model) and do not need to submit an application for exception. Clinicians with this special status include those in practices deemed rural by CMS.

Fiscal Year (FY) 2018 Final Rule Medicare Hospital Inpatient PPS

On August 14, CMS published its final rule for the FY 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS). The final rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care.

Overall payment changes in the rule increase IPPS payment to Medicare-participating hospitals by roughly $2.4 billion for FY 2018, including 1.3% for operating payments and 0.7% for uncompensated care payment. CMS analysis finds that urban hospitals will experience far greater increases (1.4%) than rural hospitals (0.2%). Rural-specific payment reductions account for most of this disparity, including expiration of the Medicare-dependent hospital (MDH) program (-0.9%) and implementation of the rural floor and imputed rural floor (-0.2%).

Significant proposals for rural providers include:

• Terminates MDH program as of October 1 (per MACRA), leaving all previous MDHs to be paid under IPPS and reducing overall payment to rural hospitals by 0.9%

o CMS estimate: 96 of 158 current MDHs lose $119 million

• Terminates temporary expansion of low-volume hospital (LVH) adjustment

o Reinstates pre-ACA 25% LVH adjustment for hospitals >25 miles from like hospital and ................
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