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To conform our regulation with the amendments made by the CAA, 2024, we propose to amend 414.1430 by revising paragraphs (a) and (b) to reflect the statutory QP and Partial QP threshold percentages for both the payment amount and patient count under the Medicare Option and the All-Payer Option with respect to payment year 2026 (performance period 2024)
Include the full code title (e.g., Alcohol dependence with psychotic disorder) in treatment notes when possible
We believe establishing a streamlined policy regarding which services are separately paid for RHCs and FQHCs versus included as part of the visit is more transparent
Lastly, we are proposing to codify seven improvement activity removal factors to establish criteria used to identify activities for potential removal or modification
In 2007, CMS issued a program instruction, [447] as permitted under section 1847A(c)(5)(C) of the Act, stating that the payment limit for a single source drug or biological will be based on the pricing information for products produced or distributed under the applicable FDA approval (such as a New Drug Application (NDA) or Biologics License Application (BLA))
