What We’re Reading: Simplified CHIP Enrollment; Inpatient Rehab Facility Pay Bump; Health Care Marketing Arrangement Dangers

Final CMS Rule Simplifies CHIP Enrollment, Renewal Processes

CMS released a final rule Wednesday to help patients obtain and retain Children’s Health Insurance Program (CHIP) coverage, according to Fierce Healthcare. Eligible adults and children will gain access to increased protections in CHIP and Medicaid programs previously made possible by the Affordable Care Act. Among these, waiting periods and lifetime limits on CHIP coverage for children will be eliminated, and children cannot be removed from coverage if a family is unable to afford premiums; children will be transferred from Medicaid to CHIP coverage if a family's income levels rise. An HHS report found that average monthly eligibility for Medicaid and CHIP will increase by 3.5% under a 12-month continuous eligibility requirement. Consequently, more than 1 million children will gain at least 1 month of eligibility. This final rule will take effect in 60 days.

Inpatient Rehab Facilities to Receive Pay Bump for 2025

CMS issued a proposed rule Wednesday to update Medicare payment policies and rates under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and the IRF Quality Reporting Program (QRP) for fiscal year (FY) 2025, according to a press release. The rule suggests a 2.8% increase in IRF PPS payment rates based on the proposed 3.2% IRF market basket percentage increase. CMS estimated the proposed technical rate setting changes would result in a preliminary estimated increase in IRF payments of $255 million for FY 2025. The rule also includes updates to the outlier threshold and wage index, and it addresses transitions from rural to urban status for IRFs. Additionally, CMS proposed modifications to the IRF QRP, a pay-for-reporting program, which included the addition of assessment items related to social determinants of health categories starting in FY 2028 to enhance equity and patient care.

Hidden Dangers of Health Care Marketing Arrangements Unmasked

The recent release of Advisory Opinion 23-15 by the Office of Inspector General has sparked debate over if gift card incentives are acceptable in health care marketing, according to Reuters. Despite the recent opinion, which approved a consultant’s request to offer gift card incentives to customers who referred its services to other health care providers, caution is urged due to heightened government scrutiny; such arrangements could be seen as disguised kickbacks under the Anti-Kickback Statute (AKS). While common in other industries, such practices pose legal risks in health care, particularly if they involve federally reimbursable services, since the arrangement is intended to generate business that is payable by federal health care programs. Consequently, health care providers and contractors must navigate agreements carefully to ensure compliance with AKS and other regulations.