IHA Daily Briefing: November 4

CMS Releases Final Rule for CY 2026 Physician Fee Schedule

On Oct. 31, the Centers for Medicare & Medicaid Services (CMS) released its Calendar Year (CY) 2026 Physician Fee Schedule final rule. A forthcoming IHA memo will provide a more detailed summary. CMS is implementing a conversion factor required by law (H.R. 2, 2015 and H.R. 1, 2025) for qualifying alternative payment model participants, and a separate conversion factor for physicians and practitioners who are not qualified participants (QP). Beginning CY 2026, the QP conversion factor will increase by 3.77% in CY 2026, while the non-QP conversion factor will increase by 3.26%.

Strongly supported by IHA, CMS finalized several telehealth coverage improvements. These include permanently allowing direct supervision to include virtual presence via audio/video real-time communications technology and allowing federally qualified health centers and rural health clinics to bill for telehealth services through 2026. Of note, the agency chose to permanently allow teaching physicians to have a virtual presence for purposes of billing for services furnished involving residents in all teaching settings. This was not proposed in the initial rule, but was strongly encouraged in IHA's Sept. 12 comment letter to CMS.

CMS also finalized changes impacting drug inflation rebates and data collection for the 340B Drug Pricing Program; the Ambulatory Specialty Model for beneficiaries with heart failure and low back pain; a new Advancing Health and Wellness subcategory within the Quality Payment Program; simplifications to the Merit-based Incentive Payment System (MIPS) to facilitate future mandatory participation in the MIPS Value Pathways; and Medicare Shared Savings Program eligibility and financial reconciliation modifications to increase assigned beneficiaries in future years. Additionally, the agency finalized several proposed changes within the Quality Payment Program, including removing the health equity adjustment to the ACO quality score and the Screening for Social Drivers of Health measure.

Informational Medicaid IMPACT Revalidations Town Hall Nov. 20

The Illinois Dept. of Healthcare and Family Services (HFS) is currently conducting IMPACT Medicaid provider revalidations. To assist providers with navigating the IMPACT enrollment system and answer questions, HFS is hosting monthly, virtual town hall meetings. IHA recommends hospitals participate in these town hall meetings if you have an upcoming revalidation. The next town hall is Nov. 20 from 3-3:45 p.m. CT. Click here to register or view the town hall meeting schedule.

IHA urges all providers to check their revalidation cycle due date and submit necessary information to complete their revalidation. To view the revalidation due dates of servicing providers affiliated with your hospitals, click here for step-by-step instructions. If you do not complete your revalidation, you will be disenrolled from IMPACT and providers can no longer bill for services provided to Illinois Medicaid enrollees, including those enrolled in managed care organizations.

Federal Legislation Would Pause Home Health Cuts for 2 Years

Home health services play a critical role in alleviating pressure on hospitals, skilled nursing facilities and family caregivers, and help prevent costly rehospitalizations by safely providing needed interventions at home, reducing the risk of complications and accidents. Approximately one in five hospitalized Medicare beneficiaries is discharged to home health.

In order to protect these essential services for Medicare beneficiaries, the bipartisan Home Health Stabilization Act (H.R. 5142) has been introduced. This important legislation establishes a two-year pause on the Centers for Medicare & Medicaid Services' (CMS) planned cuts to home health services. If passed, this legislation would provide much-needed stability for home health agencies, allowing them to sustain operations, retain staff and continue delivering high-quality care in the home.

Northwestern Study Finds Surge in Leg, Foot Amputations

A new Northwestern Medicine study found that leg and foot amputations in Illinois hospitals jumped 65% between 2016 and 2023, driven largely by the growing prevalence of diabetes and peripheral artery disease (PAD). Men, Black patients and residents of lower-income communities were disproportionately affected, according to the findings.

The study analyzed 30,834 amputation admissions from 193 Illinois hospitals during the seven-year period. Nearly 82% of cases involved patients with diabetes, and the largest increases were seen among men, non-Hispanic Black patients, and adults ages 65 to 74. Although this study focused only on Illinois patients, the study authors said dramatic increases in leg and foot amputations are likely occurring across the nation.

Researchers say the sharp rise reflects a troubling combination of growing diabetes rates and limited access to preventive care in certain populations. Once wounds or infections develop in patients with diabetes or PAD, treatment options are often limited, according to lead author Dr. Maggie Reilly, a vascular surgery resident at Northwestern. She stressed the importance of screening, early diagnosis and aggressive management of cardiovascular risk factors to reduce the need for amputations.