The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule updating inpatient rehabilitation facility (IRF) payment rates for fiscal year 2010. The proposed rule recommends a market basket update of 2.4% as well as raising the IRF outlier threshold to $9,976, which would increase IRF payments by $150 million from 2009 levels. In addition, CMS proposes to begin including Medicare Advantage patients in its assessment of compliance with the “60% Rule,” which would require IRFs to assess this additional group of patients. Comments on the proposed rule and IRF criteria will be accepted through June 29. A final rule will be issued by August 1, with provisions that take effect October 1.

The fact sheet can be accessed here.

The Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination (NCD) to expand coverage for initial testing with positron emission tomography (PET) for Medicare beneficiaries who are diagnosed with and treated for most solid tumor cancers.  This NCD removes a clinical study requirement for PET scan use in these patients.  More information about the types of cancer covered by this new policy is available in CMS’ final decision memorandum. 

Read the final decision on the CMS Web site at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=218.

The Department of Health and Human Services (HHS) has issued guidance specifying technologies and methodologies that can be used to secure protected health information from unauthorized individuals under the Health Information Technology for Economic and Clinical Health Act (HITECH). The HITECH Act defines “unsecured protected health information” to mean protected health information that is not secured through the use of a technology or methodology specified by the guidance. HHS will accept comments on the breach notification provisions through May 21.

More information is available at http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/hitechrfi.pdf.

The Department of Health and Human Services (DHHS) has named David Blumenthal, M.D., as national coordinator for health information technology. Blumenthal most recently served as director of the Institute for Health Policy at Massachusetts General Hospital/Partners HealthCare System in Boston and is a professor of medicine and health policy at Harvard Medical School. As national coordinator, he will lead the implementation of a nationwide health information technology infrastructure as called for in the American Recovery and Reinvestment Act.

A press release can be viewed at http://www.hhs.gov/news/press/2009pres/03/20090320b.html.

On April 13, the Centers for Medicare and Medicaid Services (CMS) announced the 14 communities that have been chosen to participate in the Care Transitions Project. The goal of the pilot project is to reduce preventable hospital readmissions through improved care coordination. Each of the Care Transitions communities is lead by a state quality improvement organization that will work with health care providers and other organizations to implement community-wide interventions, including those that target specific diseases or conditions and reasons for admission. The project is expected to run through July 2011.

The announcement can by found by clicking here.

The Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination (NCD) to expand coverage for initial testing with positron emission tomography (PET) for Medicare beneficiaries who are diagnosed with and treated for most solid tumor cancers.  This NCD removes a clinical study requirement for PET scan use in these patients.  More information about the types of cancer covered by this new policy is available in CMS’ final decision memorandum. 

 Read the final decision on the CMS Web site at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=218.

The Centers for Medicare & Medicaid Services (CMS) has delayed the effective date of the final rule giving state Medicaid agencies increased flexibility to impose premium and cost-sharing requirements on Medicaid beneficiaries. The effective date of the rule will be December 31, 2009. The rule, which was published last November, was set to have taken effect in April under a 60-day delay imposed by the new administration in January.

For more information, go to http://edocket.access.gpo.gov/2009/pdf/E9-7505.pdf

President Obama has issued an executive order establishing a White House Office of Health Reform that will provide leadership to the executive branch on federal health reform efforts. Nancy-Ann DeParle, who ran the Health Care Financing Administration (HCFA) under President Clinton, was appointed to direct the new office. The order also directs the Secretary of Health and Human Services to establish an Office of Health Reform, which will work with the White House office.

More information is available at http://www.whitehouse.gov/the_press_office/Executive-Order-Establishing-The-White-House-Office-Of-Health-Reform/

The Centers for Medicare & Medicaid Services (CMS) has issued a fact sheet on the General Equivalence Mappings (GEM), a tool to help health care providers and others identify equivalent codes in the ICD-9 and ICD-10 coding systems. The final rules implementing the ICD-10 code sets and updated standards for reporting health care diagnoses and procedures in electronic health care transactions took effect March 11. Hospitals and other affected entities have until October 1, 2013 to fully implement them.

In addition, CMS will host a conference call on May 19 on the GEM. For details on the 90-minute call and how to participate, see the CMS announcement at http://www.cms.hhs.gov/ICD10/Downloads/Announcment_ICD10_Implementation_and_GEMs.pdf

The fact sheet on GEM can be accessed at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10_GEM_factsheet.pdf.