Latest News

Federal Register – CMS-3244-F; FR 5/16/12 – Final rules

The Centers for Medicare and Medicaid Services (CMS) May 10 issued a final rule, “Reform of Hospital and Critical Access Hospital Conditions of Participation” (CoPs). The revisions to the CoPs are part of the government’s response to Executive Order 13563, “Improving Regulations and Regulatory Review.” The changes include:

• One governing body will be allowed to oversee multiple hospitals in a multi-hospital system, and a member or members of the hospital’s medical staff must be included on the governing body;
• Hospitals will have the flexibility to include other practitioners as eligible candidates for the medical staff with hospital privileges to practice in the hospital in accordance with state law;
• Elimination of the requirement for authentication of verbal orders within 48 hours; authentication timeframes will be established according to state law; and
• All orders, including verbal orders, must be dated, timed, and authenticated by either the ordering practitioner or another practitioner who is responsible for the care of the patient.

CMS Issues Final Rules on Hospital Conditions of Participation

From: Washington Post – 5/15/12

SALT LAKE CITY — Utah’s chief technology officer has resigned following the theft of hundreds of thousands of online medical records from state computers by unknown hackers.

Gov. Gary Herbert on Tuesday announced a “comprehensive” response to the massive data breach, including the resignation of Stephen Fletcher, director of the state’s Department of Technology Services.

Herbert’s office said the state also is hiring a public relations firm to handle crisis communications.

Last month, hackers stole personal information of about 780,000 Medicaid recipients and participants in the Children’s Health Insurance Program, including the Social Security numbers of about 280,000 of them.

Read more here…

From CHA – 5/14/12

Gov. Brown’s May revision to the state budget for fiscal year (FY) 2012-13 includes $325 million in savings for the state General Fund that will have a direct impact on hospitals. The May revision estimates the budget deficit at $15.7 billion, up from $9.2 billion, due to a decrease in revenue, higher expenses, and decisions by courts and the federal government to block previous budget cuts from being implemented. Overall, the governor’s new budget plan proposes $4.1 billion in spending reductions, in addition to the $4.2 billion already put forward earlier this year. Budget solutions related to Health and Human Services include the following:

Hospital Fee Program – Increase payments made by private hospitals to the state for children’s health care coverage by $150 million in FY 2012-13 and $75 million in FY 2013-14. In addition, designated public hospitals would give up some of the fee-funded direct grants and managed care payments to generate $41.5 million in state General Fund savings for FY 2013-14.

Diagnosis-Related Group (DRG) Transition – Freeze base payments for FY 2012-13 with no increases to per-diem rates or non-contract cost increases. This is expected to save the General Fund $75 million in FY 2013-14. The transition to a DRG payment system would be delayed by six months to July 1, 2013.

Read more here…

From: CMS Website

CMS allows the use of the DSH data for a limited period of time.  Over the past several years we have obtained hundreds of the SSI files for use in our Medicare appeals.  Past DUAs rarely had a return date included in the form.  CMS is now working to get a handle on this outstanding information. 

For DUAs without expiration dates, CMS is sending out e-mails with a 90 day notification for action.  We have received close to two hundred of these e-mails over the past week.  If you were the original requestor, you should also be receiving these e-mails.

According to CMS instructions, action is needed to either request an extension or to close the DUA and confirm that the data is destroyed.  The extension and or closure according to the instructions must be submitted by the requestor (Hospital).  Toyon is the custodian of the SSI data.  We are in the process of developing a process to handle the DUAs.  In our particular case, virtually all of the data files being used are still active as part of our Medicare SSI appeals.  CMS is requiring that the extensions be submitted to them between 60 – 90 days from the expiration date identified in the e-mail.

We are diligently working on sorting these out and will be communicating with the requestors in the near future.  The request for extension is very simple and we will be providing the framework of the e-mail to send to CMS.

Continued use of the DSH data will need to be updated annually.  Where the data is no longer needed, all of the original files and related linked files are required to be destroyed.  A signed confirmation of the destruction of the data is required as part of the final “closure request” submission. 

For questions, please contact Glenn Bunting or Ron Knapp at 925-685-9312.

Data Use Agreement (DUA) – Extensions & Closures

From: CMS Website

CMS SSI detail for data released on March 16, 2012 is now available to be requested by hospitals.  This information is free but requires a DSH Data Use Agreement be prepared and included in the request.  The requests are now all handled on-line.

We recommend all hospitals that receive Medicare DSH entitlements request this information for review and scrutiny of the match process.  Click here to view the DUA form required to request this data.  This form is to be completed, scanned and sent by e-mail to CMS at DataUseAgreement@cms.hhs.gov.  Notification of the DUA number creations will be sent to the Requestor within 3-5 business days of receipt of the request.  The data will be shipped to the Custodian in approximately 6-8 weeks.

The SSI issue continues to be litigated particularly for CMS’s inclusion of the Medicare Advantage days now contained in the SSI ratio development.  Verification of the changes made in the match process communicated in CMS-1498-R need to be carefully reviewed to verify that the changes were actually made.

If you have any questions concerning the process please contact either Glenn Bunting or Ron Knapp at 925-685-9312.

SSI Data Available from CMS – FY 2006 – 2009

Federal Register – CMS-1588-P; FR 5/11/12 – Proposed rules

The proposed rules were officially released today for Inpatient Acute PPS services in FY 2013 (10/1/12 – 9/30/13).  Today marks the 45 day window for hospitals to request withdrawal of a wage index reclassification that is determined to be lower than their native CBSA. 

Unfortunately, the proposed rules are based on the wage information published in February 2012 and that does not contain complete information or all of the finalized wage data.  CMS posted the final wage index file updated through May 4, 2012 that will be used in the final rules issuance.  Hospitals have one more chance to review this information to confirm that data has been posted accurately.  Any errors found in this data must be reported to CMS by June 4, 2012.

We are in the process of creating an updated wage index file using the May 4^th data and will make this available in a future news you need to know distribution.

Below are links to other summaries recently released summarizing the FY 2013 proposed rules:

Powers Pyles Sutter & Verville PC – 5/4/12

King & Spalding – Hospital Medicare Update – 5/9/12

Proposed Rules – IP PPS Acute Rules FY 2013

From: California Healthline -  5/10/12

Article Excerpt: 

State officials earlier this year said they wanted to introduce a “new payment methodology” for federally qualified health centers and rural health clinics in California. Their plan included a funding cut of 10%, or about $100 million, to those centers. But Assembly and Senate budget subcommittees rejected the proposal last month, calling the plan unworkable.

Assembly budget subcommittee member Wesley Chesbro (D-Arcata) said cutting so much funding for FQHCs and rural clinics could push those community facilities to cut hours or close down altogether.  “It’s pretty clear that, for decades, in rural care the clinic system is the backbone of health care. And not just for low-income people, I might add. But due to budget cuts and delayed payments, many of them are on the brink of closure,” Chesbro said.

“Their reserves have been depleted, their credit has been exhausted, their creditors are demanding payment. And they’re maxed out,” Chesbro said.

He added, “So the question we need to ask ourselves is, ‘What will we do without them? And who will be there to treat patients when these clinics close their doors?’”

Read more…

State Loses Bid to Cut FQHC Rates, Restructure Pay System

From: The HILL’S Healthcare Blog – 5/10/12

The Health and Human Services (HHS) Department touted new rules easing the regulatory burden on hospitals and healthcare providers to the tune of more than $5 billion in savings over five years.

The changes will “cut burdensome red tape for hospitals and providers” and allow them to “improve patient care while lowering costs,” Marilyn Tavenner, acting administrator for the Centers for Medicare and Medicaid Services (CMS), said in a statement.

The first rule issued Thursday will make small revisions to the Medicare Conditions of Participation in order to give hospitals more flexibility in their operations. One change would allow “a patient or his or her caregiver to administer certain medications,” a release stated, facilitating “patient-centered care.”

The second rule would eliminate overlapping or outdated rules that govern healthcare providers.  A release added that the steps are in line with “President Obama’s regulatory reform initiative to reduce unnecessary burdens on business.”

“We are cutting red tape and improving health care for all Americans,” HHS Secretary Kathleen Sebelius said in a statement.  “Now it will be easier for health care providers to do their jobs and deliver quality care.”

Click here to view HHS Press Release.

HHS: New cuts to ‘red tape’ to save billions for healthcare providers

From: DHCS California – 5/7/12

News Release Excerpt:

 SACRAMENTO – The California Department of Health Care Services (DHCS) announced that California and 45 other states, as well as the District of Columbia, have reached a $1.5 billion civil and criminal settlement and a $100 million civil consumer protection settlement with Abbott Laboratories to settle false claim act lawsuits and federal investigations into alleged illegal acts with respect to the drug Depakote, including illegal marketing, making false and misleading statements and paying kickbacks.

Under the civil and criminal settlement, California and the United States will receive a combined $52 million plus interest. Of this amount, the United States will receive $21.3 million, and California will receive $30.7 million. Of the California amount, DHCS will receive $15.3 million as damages for the Medi-Cal program. A portion of California’s recovery will be deposited into the Attorney General’s False Claims Act Trust Fund, which is administered by the California Department of Justice’ Bureau of Medi-Cal Fraud and Elder Abuse (BMFEA) to investigate and prosecute Medi-Cal fraud. DHCS assisted BMFEA with settlement agreement language that protects the interests of DHCS and Medi-Cal. Under the separate civil consumer protection settlement, California will receive $6.7 million, the largest share of any state.

Read more…

Department of Health Care Services Announces Multimillion Dollar Settlement with Abbott Laboratories

Inpatient PPS PC Pricer Update – FY 2012

From: CMS – 5/4/12

Text of Notification

The Fiscal Year (FY) 2012 Inpatient Prospective Payment System (PPS) PC Pricer has been updated with newer provider data. The latest version is now available on the Inpatient PPS PC Pricer website in the “Downloads” section. This PC Pricer is for claims dated from October 1, 2011 to September 30, 2012.