CMS Withdraws Rules, Ushers in Virtual Reality for Rural Healthcare

Original story posted on: November 1, 2017

CMS sets up virtual participation for rural healthcare providers in the government’s MIPS program.

New announcements from the Centers for Medicare & Medicaid Services (CMS) are important for providers to take note of moving forward.

Of particular note are the following rules that CMS has withdrawn. These include the following:

  1. A proposed rule from 2014 that modified administrative requirements under HIPPA and a proposed rule from January 2017 that specified the qualifications required for practitioners and suppliers of prosthetics and orthotics.

  2. The Medicare Part B payment model proposed rule, a two-phase model to test whether alternative drug payment designs would lead to a reduction in Medicare expenditures while preserving or enhancing the quality of care provided to beneficiaries.

  3. A rule proposed in 2014 that revised patients’ rights to ensure that same-sex spouses in legally valid marriages were recognized and afforded equal rights in Medicare- and Medicaid-participating facilities.

Virtual Reality Comes to Rural Healthcare

In other developments, CMS is creating an opportunity for rural health providers to form virtual entities to participate as solo providers or as groups in the Merit-Based Incentive Payment System (MIPS) for the 2018 performance period. Smaller provider practices, including those in rural areas, may join virtual groups to combine their MIPS reporting, thus allowing more providers to actually participate and making the MIPS program more valuable. For providers to participate and/or form a virtual group for 2018, they need to engage in an election process. The election period for virtual groups will be open from now through Dec. 1, 2017.

As previously noted, individual or small group practices with 10 or fewer eligible providers can participate in MIPS as a virtual group. Technical assistance will be available to assist providers with the election process. As CMS looks to the future, they hope that by 2020 (the third year of the proposed 2018 Quality Payment Program (QPP) rule), a more streamlined electronic election process will be in place. Until then, providers will continue to receive updates until the QPP final rule is published, perhaps as early as November 2017.

Presently, there is a two-stage election progress for virtual groups: Stage 1 for solo and independent providers or those part of a group with 10 or fewer eligible clinicians, and Stage 2 for MIPS-eligible providers that have a taxpayer identification number (TIN) size that’s not more than 10 eligible providers.

Providers that want to participate in Stage 1 may contact a local QPP technical assistance organization that can assist providers during the election process if they are eligible to join or form a virtual group. Technical assistance is available calling 866-288-8292 or 877-715-6222, or by sending an email to

Participation in Stage 2, for those providers not participating in Stage 1, will require a formal agreement and a virtual group assistance representative. The deadline for participation is Dec. 1. The contact for participation is available online at

Providers need to keep in mind that group sizes might change after virtual groups are first approved to participate, but approvals will remain valid for the whole performance year even if the group size changes.

If rural providers have additional questions on eligibility details regarding Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs), providers in larger practices with more than 15 providers, or those in health professional shortage areas (HPSAs) and medically underserved areas (MUAs), should contact Those interested in the Practice Transformation Network should contact

MIPS and MedPAC: An Update

Most of the members of the Medicare Payment Advisory Commission (MedPAC) want to repeal MIPS, which allows providers to earn performance-based adjustments to Medicare payments. Members believe that MIPS doesn’t focus enough on patient care and that the program is too burdensome to participate in and manage. It remains to be seen if their influence correlates to a direct ability to create policy, or if their efforts will actually change the program or dates.

Furthermore, members have suggested that in place of the MIPS program, a portion of payments, possibly 2 percent, could be withheld. Finally, they note that providers that aren’t participating in an Advanced Payment Model (APM) could join or participate within a group of providers whose claims data is reviewed on certain population-based health measures to see if they could actually qualify to have the withheld funds returned. It has been suggested that providers that don’t participate in an APM or the new model should actually forfeit the withheld portion.

Time will tell if a nonpartisan, legislative-branch agency that offers analysis and policy advice directly to Congress will actually have the necessary influence for Congress to vote to change one of the biggest pieces of healthcare legislation in the last 30 years.

While most providers still have angst and qualms about the flawed MIPS program, with concerns on issues ranging from activities to the reporting burdens, most recognize that the value-based world of healthcare has arrived, and it would be even more complex and burdensome to revamp. The old world of fee-for-service (FFS) care is becoming archaic.

To rural providers, there can only be hope that agreeable opportunities for participation will continue to advance their needs and growth.

Janelle Ali-Dinar, PhD

Janelle Ali-Dinar, PhD is a rural healthcare expert and advocate with more than 15 years of healthcare executive experience in many key areas addressing critical access hospitals (CAHs), rural health clinics (RHCs), physicians, and patients. Dr. Ali-Dinar is a sought-after speaker on Capitol Hill. A former hospital CEO and regional rural strategy executive, Janelle is also a past National Rural Health Association rural fellow, Rural Congress member, and Nebraska Rural Health Association president. She is currently the Nebraska DHHS chair of The Office of Minority Health Statewide Council, addressing needs of rural, public, minority, tribal, and refugee health, and she serves on the Regional Health Equity Region VII council as co-chair of Rural Health and Partnerships. Janelle holds a master’s degree and doctorate in communications and is a recent graduate in public health leadership. Janelle is currently the vice president of rural health for MyGenetx and is a member of the RACmonitor editorial board.  

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