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Archive for November, 2009

CMS Further Delays Medicaid Benefits Rule

Monday, November 30th, 2009

The Centers for Medicare & Medicaid Services (CMS) delayed until July 1, 2010 the effective date of a final rule giving states more flexibility in defining the benefits covered by their Medicaid programs. Published last December, the rule allows states to amend their Medicaid plans to offer alternative benefit packages called “benchmark plans,” which are either approved by the Health and Human Services secretary or equivalent to state or certain federal employee coverage. The final rule was scheduled to take effect December 31 after being delayed twice by the new administration.

More information is available at http://edocket.access.gpo.gov/2009/pdf/E9-28569.pdf

Improper Payments Increase in 2009

Friday, November 20th, 2009

On November 18, the Department of Health and Human Services and the Centers for Medicare & Medicaid Services have announced that the rate of improper payments is 7.8% for Medicare fee-for-service payments in 2009, up from 3.6% in 2008. The program for 2009 revised the medical review process used to identify improper payments. Improper payments include payments made incorrectly, however, they do not necessarily reflect fraud.

For more information, the press release can be found here.

NIH Announces First National Research Study Recruitment Registry

Wednesday, November 18th, 2009

The National Institutes of Health (NIH) announced a Website for individuals wishing to participate in clinical studies. The site, www.researchmatch.org, matches study volunteers with medical researchers affiliated with the Clinical and Translational Science Awards, an NIH program to enhance local and national efforts to translate laboratory discoveries into treatments for patients.

For more information, see the NIH news release.

Revised Guidelines for Prophylactic Use of Beta Blockers Issued

Wednesday, November 4th, 2009

On November 2, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a Focused Update to the Practice Guidelines based on new clinical trial data that summarizes and sheds light on the risks and benefits of using beta blockers to reduce cardiac events during noncardiac surgeries, and provides specific recommendations about which patients will likely benefit and in which patients there is not enough evidence to recommend their use.

The press release can be found by visiting http://www.acc.org/media/releases/highlights/2009/oct09/periop.cfm

2010 Home Health Final Rule Issued

Monday, November 2nd, 2009

On October 30, the Centers for Medicare & Medicaid Services (CMS) announced a 2.0% market basket update to Medicare’s 2010 home health prospective payment system (HH PPS) rates, as well as and modifications to the home heath outlier policy. Home health agencies (HHAs) will receive additional payments for 60-day home health  episodes of care that carry unusually high costs. In addition, CMS will continue its current policy of a 2.75% reduction to national standardized 60-day episode payment rates and non-medical supply factors.

The rule can be located at: http://federalregister.gov/inspection.aspx

2010 MPFS Final Rule Released

Monday, November 2nd, 2009

On October 30, the Center for Medicare & Medicaid Services (CMS) released the 2010 Medicare Physician Fee Schedule (MPFS) final rule. The final rule includes a decrease in Medicare payments to physicians by -21.2% as a result of issues with the sustainable growth rate (SGR) formula. Provisions will be implemented on January 1, 2010.

Key highlights of the rule: 

  • The conversion factor for the MPFS is $28.4061 but it could still change if Congress takes action to resolve the SGR issue.
  • Removed drugs from the calculation of allowed and actual expenditures used in the SGR formula so that the formula will generate less extreme updates to the rates
  • No additional codes are subject to the multiple procedure payment reduction for diagnostic imaging
  • Changed the equipment utilization rate from the current 50% to 90% for diagnostic equipment priced more than $1 million (MR and CT imaging equipment) but will phase the provision in over a four year period and will not apply this change to other expensive equipment. 
  • Updated the practice expense data used in the calculation of the physician fee schedule to include new practice expense per hour data from the Physician Practice Information Survey conducted by the AMA, which will be implemented over a four-year period. 
  • New codes bundling myocardial perfusion imaging (MPI) with wall motion and ejection fraction go into effect January 1, 2010 with payments reduced from their previous unbundled status. 
  • No changes to the payment localities were made; however, the 1.00 work GPCI floor will be removed as of January 1, 2010, as required by MIPPA of 2008.
  • CMS proposed to retain both the claims-based reporting mechanism and the registry-based reporting mechanism for the Physician Quality Reporting Initiative. In addition, CMS is implementing another mechanism to report quality measures using a qualified electronic health record program

 The final rule with comment will appear in the November 25 Federal Register. CMS will accept comments on designated provisions of the final rule with comment period until December 29, 2009.

 The display copy is available at http://www.federalregister.gov/OFRUpload/OFRData/2009-26499_PI.pdf

CMS Releases 2010 Final Rule for HOPPS/ASC

Monday, November 2nd, 2009

On October 30, the Centers for Medicare & Medicaid Services (CMS) issued the 2010 Hospital outpatient prospective payment system (HOPPS) final rule with comment period. The rule will be implemented on January 1, 2010.

Key provisions of the final rule:

  • Most hospitals will receive an inflation update of 2.1% in their payment rates. As required by Medicare law, CMS will reduce the update by twp percentage points for hospitals that did not participate in quality data reporting for outpatient services or did not report the quality data successful.
  • Ambulatory Surgical Centers (ASCs) will receive a 1.2% inflation update.
  • Implementation of provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) that extend Medicare coverage to rehabilitative and educational services intended to improve the health of patents diagnosed with certain respiratory, renal and cardiac diseases.
  • No new composite APCs were developed for CY 2010
  • Expansion of the list of surgical procedures that Medicare will cover when performed in the ASC.
  • Continued the requirement that hospitals participating in the Hospital Outpatient Quality Data Reporting Program (HOP QDRP) report the existing seven chart abstracted emergency department and perioperative measures and four existing claims-based imaging efficiency measures for the HOP QDRP for CY 2011 payment determination)
  • Revised some of the current policies for physician supervision of outpatient services. For example, CMS is proposing that nonphysician practitioners may directly supervise all hospital outpatient therapeutic services and diagnostic tests that they are able to personally perform within their state scope of practice and hospital-granted privileges. Under current policy, only physicians may provide the direct supervision of these services.

 The CY 2010 OPPS/ASC final rule with comment period was published in the November 20 Federal Register. Comments on designated provisions are due by 5:00 pm EST on December 29, 2009.

 The display copy is available at http://www.federalregister.gov/OFRUpload/OFRData/2009-26499_PI.pdf