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

Medicaid Program; Eligibility Changes under the ACA of 2010

Final Rule; Interim Final Rule; CMS-2349-F;  Filed 3/16/12; FR Publication 3/23/12

CMS Summary

This final rule implements several provisions of the Patient Protection and

Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). The Affordable Care Act expands access to health insurance coverage through improvements to the Medicaid and Children’s Health Insurance (CHIP) programs, the establishment of Affordable Insurance Exchanges (“Exchanges”), and the assurance of coordination between Medicaid, CHIP, and Exchanges. This final rule codifies policy and procedural changes to the Medicaid and CHIP programs related to eligibility, enrollment, renewals, public availability of program information and coordination across insurance affordability programs.

Medicare GME – Final Section 5506 Cap Increase List Released

From: CMS Inpatient Acute Website – 2/28/12

CMS posted the GME/IME redistribution listing on their website earlier this week.  There is a download file that contains the hospitals by provider receiving increases in the GME/IME FTE caps.  A summary of the winning States and total redistributed FTEs is presented below:

Final Rules – OPPS & ASC for CY 2012, Value-Based Purchasing, Physician Self-Referrals & Patient Notification Requirements

CMS-1525-FC Federal Register 11/30/11

The final rule federal register was released on November 30, 2011.  Click here to view our previous post about these final rules.

ACOs: What Providers Need to Know

MLN – October 2011

Fact Sheet Summary

This fact sheet is designed to provide education on Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. It includes a definition of an ACO, and information on how to participate in an ACO, how shared savings will work, how this program is aligned with other quality initiatives and how ACOs help doctors coordinate care.

Final Rules – Home Health PPS rates – CY 2012

CMS-1353-F; FR 11/4/11

CMS News Release

The Centers for Medicare & Medicaid Services (CMS) today issued a final rule to update the Home Health Prospective Payment System (HH PPS) rates for Calendar Year (CY) 2012. Payments to home health agencies (HHAs) are estimated to decrease by approximately 2.31 percent or $430 million in CY 2012, the net effect of a 1.4 percent payment update, the wage index update, and the case-mix coding adjustment.  This final rule reflects the ongoing efforts of CMS to support Medicare beneficiary access to home health services while continuing to improve payment accuracy.  

The Affordable Care Act applies a 1 percentage point reduction to the CY 2012 home health market basket amount.  As the CY 2012 market basket is equal to 2.4 percent, the payment update for HHAs in CY 2012 will be 1.4 percent. 

CMS also reduced HH PPS rates in CY 2012 to account for additional growth in aggregate case-mix that is unrelated to changes in patients’ health status.  CMS has finalized a 3.79 percent reduction to the home health PPS rates for CY 2012 and an additional 1.32 percent reduction for CY 2013. 

This rule also finalizes structural changes to the HH PPS by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes, and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same amount of total aggregate payments.  These changes are intended to increase payment accuracy and reduce the growth in aggregate case-mix that is unrelated to changes in patients’ health status. 

Under current Medicare policy, a certifying physician or an allowed non-physician practitioner must see a patient prior to certifying a patient as eligible for the home health benefit.  The rule also finalizes added flexibility to allow physicians who cared for the patient in an acute or post-acute facility to inform the certifying physician of their encounters with the patient in order to satisfy the requirement.  Finally, this rule describes planned improvements to the home health publicly reported quality measures.   

Interim Final Rule – Final Waivers in Connection with the Shared Savings Program

CMS-1439-IFC – 11/2/11

The interim final rules applicable to establishing certain waivers associated with ACOs was published in the federal register on 11/2/11.

Final Rules – Medicare Shared Savings Program: ACOs

CMS-1345-F – 11/2/11

The final rules for ACOs were published in the federal register on 11/2/11.

Final Rules – ESRD PPS & Quality Incentive Program; Ambulance Fee Schedule & Other – CY 2012

CMS-1577-F; Posted 11/1/11; FR 11/10/11

CMS Summary:

This final rule updates and makes certain revisions to the End-Stage Renal

Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2012. We are also finalizing the interim final rule with comment period published on April 6, 2011, regarding the transition budget-neutrality adjustment under the ESRD PPS,. This final rule also sets forth requirements for the ESRD quality incentive program (QIP) for payment years (PYs) 2013 and 2014. In addition, this final rule revises the ambulance fee schedule regulations to conform to statutory changes. This final rule also revises the definition of durable medical equipment (DME) by adding a 3-year minimum lifetime requirement (MLR) that must be met by an item or device in order to be considered durable for the purpose of classifying the item under the Medicare benefit category for DME. Finally, this final rule implements certain provisions of section 154 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) related to the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) Competitive Acquisition Program and responds to comments received on an interim final rule published January 16, 2009, that implemented these provisions of MIPPA effective April 18, 2009.

Final Rules -  Physician Fee Schedule, Clinical Lab Fee Schedule, Other – CY 2012

CMS1524-FC & CMS-1436-F; Posted 11/1/11; FR 11/28/11

HFMA Summary:

The Centers for Medicare & Medicaid Services issued a final rule updating the Medicare physician fee schedule for 2012 and projected that total payments to more than 1 million providers will be approximately $80 billion.

The final rule reflects cuts in physician payment rates scheduled to go into effect on Jan. 1, based on the Sustainable Growth Rate formula. Without a change in law enacted by Congress, Medicare payment rates to providers will drop by an estimated 27.4 percent in 2012, less than the 29.5 percent reduction that CMS had estimated earlier this year, according to the rule.