Compliance Monitor (01/24/2025)

Respiratory Illnesses Data Channel

https://www.cdc.gov/respiratory-viruses/data/index.html – This site is updated on Fridays.

What to know

• As of January 24, 2025, the amount of acute respiratory illness causing people to seek healthcare is at a high level.
• Seasonal influenza activity remains elevated across the country and is increasing in most areas.
• COVID-19 activity has increased in most areas of the country.
• RSV activity has peaked in many areas of the country

Providers and suppliers must report a change of ownership (CHOW) within 30 days of the change. For certified providers undergoing a CHOW, 42 CFR 424.550 states: 

• Both the seller and the buyer must submit enrollment applications to report the CHOW 

• If the seller fails to submit an enrollment application to report the CHOW, the seller may be sanctioned or penalized (even after the date of the ownership change)   

• If the buyer fails to submit an enrollment application containing information about the buyer within 30 days of the CHOW, the provider’s billing privileges may be deactivated 

See  Medicare Provider Enrollment for more information.  

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (the ‘‘Ryan Haight Act’’) generally requires an in-person medical evaluation prior to the issuance of a prescription of controlled substances but provides an exception to this in person medical evaluation requirement where the practitioner is engaged in the ‘‘practice of telemedicine’’ within the meaning of the Ryan Haight Act. These proposed regulatory changes would establish a Special Registration framework and authorize three types of Special Registration. This proposed rulemaking also provides for heightened prescription, recordkeeping, and reporting requirements. DEA believes such changes are necessary to effectively expand patient access to controlled substance medications via telemedicine while mitigating the risks of diversion associated with such expansion. A summary of this rule may be found at https:// www.regulations.gov/docket/DEA-2023- 0029. 

Advanced Telemedicine Prescribing Registration (Schedules II–V) Clinician Practitioner Eligibility To be eligible for the Advanced Telemedicine Prescribing Registration under proposed § 1301.11(c)(3), physicians and mid-level practitioners, as clinician practitioners, would not only need to demonstrate they have a legitimate need for the Special Registration but that such need warrants the authorization of prescribing of Schedule II controlled substances in addition to Schedules III through V controlled substances. DEA has determined that certain specialized physicians and board-certified mid-level practitioners have a legitimate need to prescribe Schedule II controlled substances via telemedicine when treating particularly vulnerable patient populations. Such authorization is reserved only for the most compelling use cases, ensuring that Schedule II prescribing via telemedicine is used only when necessary.  

DEA has determined that only certain specialized physicians and board certified mid-level practitioners have a legitimate need for the Advanced Telemedicine Prescribing Registration, in the following limited circumstances or practice specialties: (1) psychiatrists; (2) hospice care physicians; (3) palliative care physicians; (4) physicians rendering treatment at long term care facilities; (5) pediatricians; (6) neurologists; and (7) mid-level practitioners and physicians from other specialties who are board certified in the treatment of psychiatric or psychological disorders, hospice care, palliative care, pediatric care, or neurological disorders unrelated to the treatment and management of pain.  

CMS has released a Frequently Asked Questions (FAQ) Document and Methodology Report to answer key questions and provide methodological information about the Screen Positive for Health-Related Social Needs (HRSN) Indicator Confidential Feedback Report.¹ To access these and other materials relating to the Screen Positive for HRSN Indicator report, please go to the following Post-Acute Care Quality Reporting Program Training & Education pages: 

• Home Health Quality Reporting Training & Education Webpage 

¹ CMS released the initial Screen Positive for HRSN Indicator report to Home Health, Inpatient Rehabilitation Facility, and Long-Term Care Hospital providers in October 2024. CMS plans to release this report to Skilled Nursing Facility providers beginning in October 2025, when a full Fiscal Year of data (October 1, 2024 – September 30, 2025) will become available for the first time. 

In 2023, the improper payment rate for Continuous Positive Airway Pressure Devices & Accessories is 15%, with a projected improper payment amount of $157.5 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices F, G, H, K, L and N).  

Learn how to bill correctly for these services. Review the Continuous Positive Airway Pressure Devices & Accessories provider compliance tip for more information, including: 

• Billing codes 

• Denial reasons and how to prevent them 

• Refill and documentation requirements 

CMS is excited to announce the Call for Nominations for the 2025 CMS Health Equity Award. 

The CMS Health Equity Award recognizes organizations who have demonstrated a strong commitment to health equity by reducing disparities affecting vulnerable populations, such as racial and ethnic minorities, individuals with disabilities, sexual and gender minorities, individuals with limited English proficiency, members of rural, Tribal, and geographically isolated communities, and other individuals impacted by persistent poverty and inequality. 

CMS is now accepting nominations for the 2025 CMS Health Equity Award, geared toward those working to advance health equity, reduce disparities in health care access, quality, and outcomes. Nominations are due February 18. Email your form to the CMS Office of Minority Health at OMH@cms.hhs.gov; use the subject: ATTN: CMS Health Equity Award. Questions about the award can also be submitted to this mailbox. 

Please Note: The award winner will be recognized at the 2025 CMS Health Equity Conference that will take place on April 23-24, 2025. As such, the awardee is asked to participate in the free conference and be in-person to accept the award and to speak to their organization’s role in reducing disparities in health care quality, access, or health outcomes. 

Visit the award webpage for more information and to download the nomination form. 

CMS has made substantial progress on its goal for all people with Traditional Medicare to be in a care relationship with accountability for quality and total cost of care by 2030. As of January 2025, 53.4% of people with Traditional (fee-for-service) Medicare are in an accountable care relationship with a provider. This represents more than 14.8 million people and marks a 4.3 percentage point increase from January 2024, the largest annual increase since CMS began tracking accountable care relationships. This includes patients whose providers are in Accountable Care Organizations (ACOs), including the Medicare Shared Savings Program ACOs and entities participating in Center for Medicare and Medicaid Innovation (Innovation Center) accountable care models, as well as other Innovation Center models focused on total cost of care, advanced primary care, and specialty care. 

ACOs are groups of doctors, hospitals, and other health care professionals that work together to give patients high-quality, coordinated service and health care, improve health outcomes, and manage costs. 

Steadily increased participation in accountable care arrangements demonstrates that changes CMS has made over the last few years through rulemaking and Innovation Center models are connecting people to longitudinal care relationships with providers. 

Read the full fact sheet for more information. 

• Revised Surveyor Guidance: CMS is releasing the following revised guidance for nursing home surveyors: 

• Admission, Transfer & Discharge, Chemical Restraints/Unnecessary Psychotropic Medication, Resident Assessment, Nursing Services, Payroll Based Journal, Quality of Life and Quality of Care, Administration, Quality Assurance Performance Improvement (QAPI), Infection Prevention and Control, and other areas. 

• Clarifications and technical corrections have also been made throughout Appendix PP. 

CMS will publish these updates in Appendix PP of the State Operations Manual (SOM) in March, 2025 for State Survey Agencies (SAs), long-term care facilities, and the public to understand how compliance will be assessed. This guidance will also be available to surveyors in the Automated Survey Process Environment (ASPEN) system starting March 24, 2025. Surveyors will begin using the guidance to determine compliance at that time.  

• “Benefits of Quality Pathway Implementation at the CMS Innovation Center,” published in Health Affairs Forefront, details how implementation of the Center’s Quality Pathway aims to improve patient care through rapid dissemination and expansion of successful tests of models. Ultimately, the goal is to identify successful models or aspects of models that could be expanded to improve the quality of health care in the United States. 

• “Improving CMS Financial Benchmarking: Lessons Learned by the Innovation Center” also in today’s Health Affairs Forefront outlines principles the Innovation Center uses to calculate financial benchmarks, or target prices, for the majority of its Medicare models. It also describes financial considerations for setting a benchmark and lessons-learned from previous model benchmarking. 

• “The CMS Innovation Center’s Role in Addressing Greenhouse Gas Emissions” published in JAMA, discusses how the Innovation Center will assess and address the health system’s contributions to climate change in an effort to improve patient health and reduce costs. 

You can find links to all these blogs and more at the CMS Innovation Center Blogs and Publications page. 

Registration is now open for the 2025 CMS Quality Conference: Elevating Quality—Advancing Optimal Health for Individuals, Families, Caregivers, Clinicians, and Communities. 

The conference will be held over three full days from March 17 to 19 in Baltimore, MD, and is your opportunity to collaborate, hear and share ideas, listen to different perspectives, understand healthcare priorities, and contribute to excellence in quality, equity, and innovation in healthcare.  

The Centers for Medicare & Medicaid Services (CMS) has released a Health Equity Data Book looking at Medicare, Medicaid, and the Marketplace populations. The Data Book presents an overview of data at-a-glance as well as CMS data focuses on demographics, chronic conditions, behavioral health conditions, and social determinants of health. This resource can be used by researchers, public health professionals, and others. The Data Book can help find, understand, and use up-to-date health disparities data to help inform policies, programs, and regulations. 

View the Health Equity Data Book here. 

This resource builds on past work from CMS to continue improving data to advance health equity. For more information on health equity data, please visit: 

• CMS’ Resource of Health Equity-related Data Definitions, Standards, and Stratification Practices, 

• The Path Forward: Improving Data to Advance Health Equity Solutions 

• Data snapshots 

• Data highlights 

• Stratified reporting 

• Mapping Medicare Disparities Tool