Washington, D.C. – The Centers for Medicare & Medicaid Services (CMS) has implemented a final rule aimed at streamlining the enrollment and renewal processes for the Children’s Health Insurance Program (CHIP). The new rule, set to take effect in 60 days, will provide eligible adults and children with increased protections under CHIP and Medicaid, originally established by the Affordable Care Act.
One significant change included in the final rule is the elimination of waiting periods and lifetime limits on CHIP coverage for children. Additionally, children can no longer be removed from coverage if their families are unable to afford premiums. Moreover, if a family’s income levels rise, children will automatically be transferred from Medicaid to CHIP coverage. The implementation of a 12-month continuous eligibility requirement is expected to increase average monthly eligibility for Medicaid and CHIP by 3.5%, allowing over 1 million children to benefit from at least one month of eligibility.
Moving on to another healthcare-related development, CMS has announced a proposed rule for fiscal year 2025 that will result in a pay increase for Inpatient Rehabilitation Facilities (IRFs). The proposed rule suggests a 2.8% increase in IRF payment rates based on a projected 3.2% IRF market basket percentage increase. CMS estimates that these changes will lead to a preliminary estimated increase in IRF payments of $255 million for the upcoming year. The proposed rule also includes adjustments to the outlier threshold, wage index, and transitions from rural to urban status for IRFs. Furthermore, CMS is proposing modifications to the IRF Quality Reporting Program to enhance equity and patient care.
Meanwhile, there has been a recent debate sparked by the release of Advisory Opinion 23-15 by the Office of Inspector General regarding the acceptability of gift card incentives in healthcare marketing. While the opinion approved the use of gift card incentives for referrals, caution is advised due to potential scrutiny under the Anti-Kickback Statute (AKS). Such arrangements, common in other industries, could be viewed as disguised kickbacks in the healthcare sector, especially if they involve federally reimbursable services. Healthcare providers and contractors are being urged to navigate these agreements carefully to ensure compliance with AKS and other regulations to avoid legal risks.
In conclusion, these developments in healthcare policies and regulations underscore the ongoing efforts to streamline processes, enhance patient care, and ensure compliance within the industry. The implementation of these rules and proposals is crucial in providing access to quality healthcare services for individuals and families while upholding legal and ethical standards.