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We note that section 1862(a)(1)(A) of the Act requires that for payment to be made for most Part A and Part B services furnished to Medicare beneficiaries, those services must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the malfunctioning of a malformed body member

Development of episode-based measures for the cost performance category must comply with section 1848(q)(2)(B)(ii) of the Act, which provides that measures and activities specified for a performance period include the measurement of resource use (cost) as provided under section 1848(p)(3) of the Act, using the methodology under section 1848(r) of the Act, to collaborate with physicians, practitioners, and other interested parties, as appropriate

Specifically related to RHCs and FQHCs, section 4113(c) of the CAA, 2023 amended section 1834(m)(8) of the Act to extend payment for telehealth services furnished by FQHCs and RHCs for the period beginning on the first day after the end of the COVID-19 PHE and ending on December 31, 2024, if the PHE ends prior to that date

Historical benchmark calculations for establishing the benchmark for ACOs beginning new agreement periods on January 1, 2025, or in subsequent years with a benchmark year that has SAHS billing activity (refer to 425.652(a))

For example, VHA is providing digital behavioral health applications as self-help tools, not independent treatment interventions