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Archive for November, 2012

Supervision Level Reduced for 22 Outpatient Therapeutic Services

Thursday, November 29th, 2012

The Centers for Medicare & Medicaid Services (CMS) has issued a final decision reducing the supervision level for 22 outpatient services from direct to general supervision effective January 1st. This is an increase from the 15 services included in the agency’s preliminary decision in September. The seven additional services include wound care and bladder irrigation services, as well as certain flu and other drug or therapeutic injections.

A complete list of the services that may be furnished under general supervision or that are designated as NSEDTS is available on the CMS Website at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html?redirect=/HospitalOutpatientPPS/01_overview.asp.

Guidance Issued on De-identifying PHI

Tuesday, November 27th, 2012

The Department of Health and Human Services’ (HHS) Office for Civil Rights issued guidance on methods and approaches to de-identifying protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act’s (HIPAA) privacy rule. Required by the American Recovery and Reinvestment Act, the guidance explains the two methods that health care providers and other HIPAA-covered entities can use to satisfy the privacy rule’s de-identification standard.

The guidance can be viewed at http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/De-identification/guidance.html.

ACA-related Insurance Rules Released

Wednesday, November 21st, 2012

On November 20, 2012, the Department of Health and Human Services (HHS) released three proposed rules related to many of the insurance provisions contained in the Affordable Care Act (ACA). The first proposed rule prohibits health insurance companies from discriminating against individuals because of a pre-existing or chronic condition. Under the rule, insurance companies would be allowed to vary premiums within limits, only based on age, tobacco use, family size, and geography. Health insurance companies would be prohibited from denying coverage to any American because of a pre-existing condition or from charging higher premiums to certain enrollees because of their current or past health problems, gender, occupation, and small employer size or industry.

A second proposed rule outlines the policies and standards for coverage of essential health benefits in addition to providing states more flexibility to implement the ACA. Essential health benefits are a core set of benefits that would give consumers a consistent way to compare health plans in the individual and small group markets. A companion letter on the flexibility in implementing the essential health benefits in Medicaid was also sent to states.

Lastly is a proposed rule implementing and expanding employment-based wellness programs which promote health and help control health care spending, while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status.

The more information, go to

Health Benefits:  http://www.ofr.gov/OFRUpload/OFRData/2012-28362_PI.pdf

Health Insurance:  http://www.ofr.gov/OFRUpload/OFRData/2012-28428_PI.pdf

Wellness Programs: http://www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html

2013 Medicare Premiums and Deductibles Announced

Monday, November 19th, 2012

The Centers for Medicare & Medicaid Services (CMS) announced the 2013 Medicare premiums and deductibles for beneficiaries. Under Medicare Part A, which pays for inpatient hospital, skilled nursing facility, hospice and some home health care services, the deductible paid by the beneficiary when admitted as a hospital inpatient will be $1,184. This deductible represents the cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries will be responsible for daily payments for hospital stays that exceed 60 days in a benefit period.

The standard monthly Medicare Part B premium rate for enrollees will be $104.90, but is adjusted upward for higher income beneficiaries.

For more information, go to:

Part A http://www.ofr.gov/OFRUpload/OFRData/2012-28274_PI.pdf

Part B http://www.ofr.gov/OFRUpload/OFRData/2012-28275_PI.pdf

HHS Names Six to Innovation Fellows Program

Wednesday, November 14th, 2012

The Department of Health and Human Services (HHS) has named six external experts to its Innovation Fellows Program. The six fellows, who have backgrounds ranging from business and technology executives to lifelong entrepreneurs, will spend the next 6 to 12 months working with HHS internal fellows on four specific projects focused on solving critical health care problems. Project topics include accelerating clinical quality measures for the Patient Protection and Affordable Care Act (ACA), designing an electronic infrastructure to implement Medicaid and Children’s Health Insurance Program eligibility requirements under the ACA, building technology that allows people to continue using their durable medical equipment during prolonged power outages in natural disasters, and devising electronic tracking and transport of the nation’s organ transplant system.

A press release can be viewed at http://www.hhs.gov/news/press/2012pres/11/20121113a.html.

Final 2013 Home Health and ESRD Rules Published

Friday, November 2nd, 2012

The Centers for Medicare & Medicaid Services (CMS) published the 2013 final rules for the home health and end-stage renal disease (ESRD) prospective payment systems. The home health rule decreases payments by approximately $10 million in CY 2013 (about 0.01%) and includes new provisions related to the survey, certification and enforcement procedures for home health agencies. The ESRD rule increases payment rates for outpatient maintenance dialysis treatments by 2.3% in CY 2013. The rule also codifies a provision in the Middle Class Tax Extension and Job Creation Act of 2012 that reduces bad debt payments for eligible Medicare providers.

The press releases can be found by going to this link and to this link.

CMS Publishes OPPS/ASC Final Rules for 2013

Friday, November 2nd, 2012

On November 1, 2012, the Centers for Medicare & Medicaid Services (CMS) finalized the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rules updating Medicare payment policies and rates for hospital outpatient and ASC services beginning January 1, 2013. The final rule increases payment rates under the hospital OPPS by 1.8% and 0.6% for ASCs.

The OPPS rule also contains a significant change from prior policy. CMS will base relative payment weights on geometric mean costs rather than median costs. Basing the OPPS payments on mean costs better reflects average costs of services and aligns the metric used in rate-setting for the OPPS with the IPPS.

The rule made several changes to the quality-reporting program for outpatient departments. While CMS did not add any new measures to the 22 measures finalized for the CY 2014 payment determination, CMS did confirm the removal of one measure, deferred data collection for another measure, and confirmed the suspension of data collection for a third measure. In addition, CMS finalized proposed revisions to several procedural requirements that apply to the reporting of quality data.

CMS also finalized proposed revisions to the ASC Quality Reporting (ASCQR) program, including requirements for claims-based measures regarding the dates for submission, payment of claims and data completeness, and a methodology for reducing payment to ASCs that do not meet the program’s reporting requirements. CMS also adopted principles to be applied in future measure selection and development.

The rule also streamlines the operations of the Quality Improvement Organizations (QIOs), increases their transparency, and makes them more responsive to beneficiary complaints about quality of care. QIOs are organizations composed of health professionals under contract to CMS who are charged with monitoring and improving Medicare beneficiaries’ care.

Lastly, CMS finalized Inpatient Rehabilitation Facility (IRF) quality-reporting proposals, including: (1) as proposed, an application of the National Quality Forum (NQF)-endorsed catheter-associated urinary tract infection (CAUTI) measure for the IRF quality-reporting program for the FY 2014 annual payment update determination, and (2) the actual NQF-updated CAUTI measure for the FY 2015 payment determination and all subsequent fiscal year payment determinations. CMS also adopted a non-risk adjusted version of a NQF-endorsed pressure ulcer measure. The final OPPS rule stipulates that any measure selected for use in the IRF QRP will remain in effect until actively removed, suspended, or replaced.

To view the CY 2013 OPPS and ASC payment system final rule with comment period and changes to the QIO program, please visit http://www.gpo.gov/fdsys/pkg/FR-2012-11-15/pdf/2012-26902.pdf

Final 2013 MPFS Rule Released

Friday, November 2nd, 2012

On November 1, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period updating Medicare payment policies and rates for physicians. The Medicare Physician Fee Schedule (MPFS) final rule includes a statutorily required 26.5 % reduction to Medicare payment rates for more than 1 million physicians and non-physician practitioners under the Balanced Budget Act of 1997’s Sustainable Growth Rate (SGR) methodology. The conversion factor for 2013 will be $25.0008.

The MFPS final rule also includes a new policy to pay a patient’s physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility stay. Recognizing the work of community physicians and practitioners in treating a patient following discharge from a hospital or nursing facility will ensure better continuity of care for these patients and help reduce patient readmissions.

In addition, the final rule with comment period continues the careful implementation of the physician value-based payment modifier by phasing in application of the modifier and enabling physicians in larger groups to choose how to participate. The value modifier provides differential Medicare payments to physicians based on comparison of the quality of care furnished to beneficiaries and the cost of care. The statute allows CMS to phase in the value modifier over three years from 2015 to 2017.

For physicians and groups of physicians who elect to participate in 2015, common sense incentives will improve the care that beneficiaries receive; physicians with higher quality and lower costs will be paid more, and those with lower quality and higher costs will be paid less. The performance period for the application of the value modifier in CY 2015 was previously established as CY 2013 in the CY 2012 MPFS final rule.

The final rule continues efforts by CMS to align quality reporting across programs to reduce burden and complexity. The rule makes changes to the Physician Quality and Reporting System (PQRS) and the Electronic Prescribing (eRx) Incentive Program, the two quality reporting programs applicable to the MPFS, and updates the Medicare Electronic Health Records (EHR) Incentive Pilot Program

The final rule also lays out next steps to enhance the Physician Compare website, including posting names of practitioners who, as part of the Million Hearts campaign, successfully report measures to prevent heart disease. These are recommended measures under PQRS as well.

Among other changes, the final rule also expands access to services that can be provided by non-physician practitioners. The rule allows Certified Registered Nurse Anesthetists (CRNAs) to be paid by Medicare for providing all services that they are permitted to furnish under state law. This change will allow Medicare to pay CRNAs for services to the full extent of their state scope of practice. The rule also allows Medicare to pay for portable x-rays ordered by nurse practitioners, physician assistants and other non-physician practitioners.

Finally, the rule explains how Medicare will pay for molecular pathology services—the next innovation in clinical laboratory tests that will foster the development of personalized medicine. These tests will be paid under the Clinical Laboratory Fee Schedule with 2013 payment set by the gap filling method.

The final rule is available at http://www.gpo.gov/fdsys/pkg/FR-2012-11-16/pdf/2012-26900.pdf