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Archive for July, 2010

HHS Rule Implements PCIP Program

Friday, July 30th, 2010

The Department of Health and Human Services (HHS) published an interim final rule implementing a temporary program to provide affordable health insurance coverage to uninsured individuals with pre-existing conditions. Required by the Patient Protection and Affordable Care Act (PPACA), the Pre-existing Condition Insurance Plan (PCIP) program will continue until January 1, 2014, when the PPACA’s health insurance exchanges become available. The rule addresses issues such as PCIP administration, eligibility, enrollment, benefits, premiums, funding, appeals and oversight. HHS will accept comment on the rule through September 28.

The final rule is available at http://edocket.access.gpo.gov/2010/pdf/2010-18691.pdf.

IPPS and LTCH Final Rule For FY 2011 Released

Friday, July 30th, 2010

The Centers for Medicare & Medicaid Services (CMS) has issued the final rule establishing fiscal year (FY) 2011 policies and payment rates for inpatient services furnished to Medicare beneficiaries by acute care hospitals, long term care hospitals (LTCH) and certain excluded hospitals. The inpatient prospective payment system (IPPS) final rule updates the acute care hospital rates by 2.35%. This update reflects a market basket increase of 2.6% for inflation. The final rule reduces the 2.6% inflation update by 0.25%, as required by the Patient Protection and Affordable Care Act (PPACA). In addition, CMS will apply a “documentation and coding” adjustment of -2.9%. CMS estimates that payments to general acute care hospital for operating expenses will decline by 0.4% in FY 2011.

CMS is similarly updating LTCH rates by 2.5% for inflation but reducing the inflation update by 0.5 percentage points as required by the PPACA. CMS estimate that aggregate payment to LTCHs would increase by approximately 0.5%.

The final rule adds 12 measures to the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) set, and retires one current measure. However, only 10 of the new measures will be considered in determining a hospital’s FY 2012 update. The remaining 2 measures would be considered in determining the hospital’s 2013 update. Under current law, hospitals that successfully report quality measure will received the full update. Hospitals that do not participate in the quality-reporting program will receive the updates less two percentage points.

The final rule was published in the August 16 Federal Register which can be found at http://edocket.access.gpo.gov/2010/pdf/2010-19092.pdf.

Initial Set of Standards, Implementation Specifications and Certification Criteria for EHR Technology Released

Wednesday, July 28th, 2010

The Department of Health and Human Services (HHS) has issued a final rule to complete the adoption of an initial set of standards, implementation specifications and certification criteria, and to more closely align these items with final meaningful use Stage 1 objectives and measures. Adopted certification criteria establish the required capabilities and specify the related standards and implementation specifications that certified electronic health record (EHR) technology will need to include to, at a minimum, support the achievement of meaningful use Stage 1 by eligible professionals, eligible hospitals, and/or critical access hospitals (hereafter, references to “eligible hospitals” in this final rule shall mean “eligible hospitals and/or critical access hospitals”) under the Medicare and Medicaid EHR Incentive Programs. Complete EHRs and EHR Modules will be tested and certified according to adopted certification criteria to ensure that they have properly implemented adopted standards and implementation specifications and otherwise comply with the adopted certification criteria. The final rule is effective August 27, 2010.

The rule can be found by going to http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf

ESRD Rules Issued

Monday, July 26th, 2010

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule that will change how Medicare will reimburse for dialysis services for Medicare beneficiaries who have end-stage renal disease (ESRD).  In addition, CMS issued a proposed rule that would establish a new quality incentive program (QIP) to promote high quality services in dialysis facilities. This would be accomplished by linking a facility’ s payments to performance standards.   

 The final rule establishes a new prospective payment system (PPS) that provides for payment adjustment for home dialysis training when clinically appropriate.  This adjustment will help ensure that ESRD patients are learning the skills and techniques they need to properly receive their dialysis treatment at home. 

 To view the ESRD PPS Final Rule and the QIP Proposed Rule, see: http://www.ofr.gov/OFRUpload/OFRData/2010-18466_PI.pdf  or www.ofr.gov/inspection.aspx

Final Rule to Support Meaningful Use of EHR Released

Friday, July 16th, 2010

The Centers for Medicare & Medicaid Services (CMS) announced the final rule to implement the provisions of the American Recovery and Reinvestment Act (ARRA) of 2009 that provide incentive payments for the adoption and meaningful use of certified electronic health record (EHR) technology. The rule requires hospitals to comply with 14 core objectives to be deemed “meaningful users” of EHRs and eligible for Medicare and Medicaid incentive payments in 2011. It also requires providers to meet five additional meaningful use objectives, which they can choose from a “menu” of 10 objectives. 

The final rule can be access at http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf

In addition, the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology issued a final rule identifying the standards and criteria for certifying EHRs. This rule can be found at http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf

CIGNA Named MAC for Jurisdiction 15

Tuesday, July 13th, 2010

The Centers for Medicare & Medicaid Services (CMS) named CIGNA Government Services (CGS) the Medicare administrative contractor (MAC) for Part A and B fee-for-service claims in Jurisdiction 15, comprised of Kentucky and Ohio. CGS will also administer home health and hospice claims in Colorado, Delaware, the District of Columbia, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia and Wyoming. CGS will take over the work from the current fiscal intermediaries and carriers over the next several months. The contract was rebid by CMS after the Government Accountability Office (GAO) sustained a protest of the original January 2009 award to Highmark Medicare Services, Inc.

More information can be viewed at http://www.cms.gov/MedicareContractingReform/downloads/J15AwardBackgroundSheet.pdf.

Berwick Appointed CMS Administrator

Thursday, July 8th, 2010

Using his authority to make interim appointments while Congress is in recess, President Obama  has appointed Donald Berwick, M.D., as administrator of the Centers for Medicare & Medicaid Services (CMS).  Dr. Berwick was the President and Chief Executive Officer of the Institute for Healthcare Improvement, Clinical Professor of Pediatrics and Health Care Policy at the Harvard Medical School and Professor of Health Policy and Management at the Harvard School of Public Health. He is also a pediatrician, adjunct staff in the Department of Medicine at Boston’s Children’s Hospital and a consultant in pediatrics at Massachusetts General Hospital

For more information is available at http://www.whitehouse.gov/the-press-office/president-obama-announces-recess-appointments-key-administration-positions-0.

First Round of DMEPOS Competitive Bidding Awards Announced

Saturday, July 3rd, 2010

The Centers for Medicare & Medicaid Services (CMS) announced awards in the first round of Medicare’s Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies. The Medicare Improvements for Patients and Providers Act of 2008 required CMS to rebid the contracts originally awarded in the first round of the program in May 2008. The program will begin January 1 in nine areas: Cincinnati-Middletown (OH, KY and IN); Cleveland-Elyria-Mentor (OH); Charlotte-Gastonia-Concord (NC and SC); Dallas-Fort Worth-Arlington (TX); Kansas City (MO and KS); Miami-Fort Lauderdale-Pompano Beach (FL); Orlando (FL); Pittsburgh (PA); and Riverside-San Bernardino-Ontario (CA). CMS estimates that beneficiaries in those areas will see an average savings on applicable DMEPOS of 32%. Under an interim final rule issued last year, hospitals that furnish certain types of competitively bid equipment and supplies to patients are exempt from the program.

Additional information can be viewed under “Press Releases” here.

2011 Proposed Rules for HOPPS and ASC Released

Saturday, July 3rd, 2010

On July 2, the Centers for Medicare & Medicaid Services (CMS) issued the 2011 hospital outpatient prospective payment system (HOPPS) and the ambulatory surgery center services proposed rules rule on their website. CMS projects that proposed payment rates under the outpatient prospective payment system would result in a 2.15% increase in Medicare payment. CMS estimates the total increase in expenditures from proposed changes in this proposed rule, as well as enrollment, utilization, and case-mix changes under the OPPS for CY 2011 compared to CY 2010, to be approximately $3.9 billion. The final rule will be published in November of this year and will be implemented on January 1, 2011.

Key provisions of the proposed rule include:

  • Modifying the supervision requirements for outpatient therapeutic services to require direct supervision of the initiation of a service followed by general supervision for a limited set of non-surgical extended duration services, including observation services. 
  • Establishing separate APCs for partial hospitalization programs in community mental health centers (CMHCs) and for hospital-based programs. 
  • Paying for the acquisition and pharmacy overhead costs of separately payable drugs and biologics without pass-through status furnished in HOPDs at 10% of the manufacturers’ average sales price. 
  • Expanding the set of measures that must be reported by hospital outpatient departments to qualify for the full payment update in the succeeding year.

In addition, CMS also released two related documents, one with corrections to the CY 2010 outpatient and ambulatory surgery center services payments and a second document containing the final payment rates and addenda for the CY 2010 Medicare hospital outpatient and ASC payment system.

The 60-day comment period ends on August 31, 2010.

The proposed rule can be accessed at http://www.ofr.gov/OFRUpload/OFRData/2010-16448_PI.pdf.