 |
| REGULATORY UPDATES |
|
| February 2010 |
CMS Announces Structural Reorganization
The Centers for Medicare and Medicaid Services (CMS) plans its first structural reorganization in nearly 10 years. Acting CMS Administrator Charlene Frizzera recently advised CMS staff that the agency will undergo a “proposed modest realignment, consolidating and integrating functions which allow the Agency to better focus on three key areas: beneficiary services, program integrity, and strategic planning.” The effective date of the realignment is expected to occur within the next 60 days.
|
CMS RAI MDS 3.0 Updated Chapters 2, 4 and Appendix C
Chapter 2 - Assessments for the RAI
Chapter 4 - CAA - Process and Care Planning
Appendix C - CAA Resources |
| CMS RAI Conference Dates |
GAO Report
Addressing the Factors Underlying Understatement of Serious Care Problems Requires Sustained CMS and State Commitment |
CMS Expands FY 2010 RAC ADR limits to all Institutional Providers
The limits announced in December 2009 applied only to requests for DRG validation purposes; the same methodology will now be used for reviews of all institutional claim types.In response to feedback from the RACs, providers/suppliers and their associations, CMS has modified the additional documentation request limits for the RAC program in FY 2010 for institutional providers. These limits will be set by each RAC (CMS) on an annual basis to establish a cap per campus on the maximum number of medical records that may be requested per 45-day period. |
| January 2010 |
|
RAC Targets Skilled Nursing Facilities' Consolidated Billing |
MDS 3.0 RAI Manual Update - Chapter 6
The Centers for Medicare and Medicaid Services (CMS) released chapter 6 of the RAI User’s Manual for the MDS 3.0. This chapter details the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS). Chapters 2, 4 and appendix C are scheduled to be posted later in January. |
| Temporary Delay In Part B Fee Schedule Rate Change |
| December 2009 |
| Getting Started
With
Internet-based Provider Enrollment, Chain and Ownership System
(PECOS) |
| Guidelines for Isolation Precautions |
| November 2009 |
FDA’S SAFE USE INITIATIVE: Collaborating to Reduce Preventable Harm
From Medications |
|
SNF-LTC Open Door Forum – November 10, 2009 |
|
Ambulance Services Rendered to Beneficiaries in Part A Skilled Nursing Facility Stays |
| October 2009 |
| OIG Workplan FY 2010 |
| SNF-LTC Open Door Forum- October 15, 2009 |
Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Rates for 2010
BENEFICIARY RESPONSIBILITY FOR 2010
EFFECTIVE DATE: January 1, 2010.
Part A Deductible = $ 1,100.00
Daily Hospital Coinsurance for days 61-90 = $275.00 and $550.00 for lifetime reserve days.
Daily SNF Coinsurance for days 21-100= $137.50
Standard Monthly Part B Premium = $ 110.50
Part B Deductible $155.00
A beneficiary who has to pay an income-related monthly adjustment may have to pay a total monthly premium of roughly 35, 50, 65 or 80 percent of the total cost of Part B coverage.
Medicare Part A
Medicare Part B |
Senate Finance Committee approves reform bill
The Senate Finance Committee voted 14-9 to approve a sweeping, $829 billion overhaul of the U.S. healthcare system, with only one Republican joining all 13 Democrats to advance the measure.
The bill requires almost all U.S. residents to buy some level of health insurance, offering $461 billion in federal subsidies to help them do so. It also expands Medicaid eligibility to those making 133% of the federal poverty level, or roughly $29,327 for a family of four. Additionally, the legislation also cuts Medicare payments to almost every type of provider while it establishes a number of pilot programs to help better coordinate care and boost its quality.
|
Measure and Instrument Development and Support (MIDS), Development of New Nursing Home Quality Measures
The Centers for Medicare & Medicaid Services (CMS) has contracted with RTI International to develop several new nursing home quality measures for public reporting for both short-stay and long-stay nursing home residents. The purpose of the project is to develop measures that can be used as metrics for care quality provided to Medicare beneficiaries.
A Technical Expert Panel (TEP) of approximately 15-20 individuals will recommend whether the individual new measures drafted by RTI International have merit based on the four measure evaluation criteria (importance, scientific acceptability, feasibility, and usability).
QMIS_TEP Non-Disclosure Form
QMIS Users Guide |
Influenza Vaccine Payment Allowances - Annual Update for 2009-2010 Season
This Change Request provides the payment allowances for the seasonal influenza virus vaccines that are updated on an annual basis effective September 1 of each year. The attached Recurring Update Notification applies to Publication 100-04, Chapter 17, section 20.5.9. |
| September 2009 |
Revisions to Appendix PP Interpretive Guidelines for Long-Term Care Facilities, Tag F441
*Transmittal 51, dated July 17, 2009, is being rescinded and replaced by Transmittal 52, dated September 25, 2009 because there was an error in Tag 441 in the manual instruction. All other information in this instruction remains the same.
I. SUMMARY OF CHANGES: This instruction combines F Tags 441, 442, 443, 444 and 445, and incorporates the guidance into F441. This was done to bring everything that relates to infection control into one location to best utilize the surveyors time and resources. |
Skilled Nursing Facility (SNF) Provider Enrollment Revalidation
The Centers for Medicare & Medicaid Services will begin a limited provider revalidation effort in fiscal year (FY) 2009. This revalidation effort will focus on the top 50 skilled nursing facility (SNF) billers within each State for each contractor’s identification number. Consistent with the Federal Regulations found at 42 CFR 424.515 and Pub. 100-08, Medicare Program Integrity Manual, chapter 10, section 9, providers are required to revalidate their enrollment information every 5 years. |
Clarification of Survey Agency Responsibilities in Obtaining Information
For Civil Rights Clearances for Initial Certifications and Changes of
Ownership (CHOWs)
Purpose: The purpose of this letter is to remind State survey agencies (SAs) of their role in the Office for Civil Rights (OCR) clearance process;
Regulation: A health care provider that applies for participation in the Medicare Part A program must receive a civil rights clearance from OCR, as set forth in the regulation at H42 CFR 489.10(b)
Initial Enrollment or CHOW: SAs are to include the OCR Civil Rights Certification Information Request Packet (Civil Rights Packet) with their initial enrollment package that is sent to a potential provider or to a provider undergoing a CHOW;
To read more, click on the link above |
Payments for Ambulance Transportation Provided to Beneficiaries in Skilled Nursing Stays
Covered Under Medicare Part A in Calendar Year 2006
Executive Summary
Ambulance suppliers did not always comply with consolidated billing requirements in calendar year (CY) 2006. Under the prospective payment system, some ambulance transportation provided by outside suppliers to skilled nursing facility (SNF) residents is included in the SNFs' Medicare Part A payments and is subject to consolidated billing. Of the 114 claims that we reviewed, 61 claims totaling $27,000 were incorrectly billed to Medicare Part B. As a result, the Medicare program paid twice for the ambulance transportation: once to the SNF under the Part A prospective payment system and again to the ambulance supplier under Part B.
Based on our sample results, we estimated that Medicare Part B carriers made a total of $12.7 million in potential overpayments to ambulance suppliers for transportation provided to beneficiaries in Part A SNF stays in CY 2006. |
| August 2009 |
State Attorneys General Question Five-Star Quality Rating System for Nursing Homes
Thirty-one state attorneys general sent a letter to Health and Human Services Secretary Kathleen Sebelius last Thursday, which highlighted the alleged weaknesses of CMS' Five-Star Quality Rating System for nursing homes and requested the feds suspend or revise the system.
The Five-Star Quality Rating System, which uses data from surveys, staffing rates, and quality measures to rate nursing homes on a scale of one to five stars, has faced opposition since its introduction in December 2008. Many industry leaders, associations, and long-term care providers have voiced concerns that the rating system is based on a flawed survey system and provides inaccurate information to consumers. |
Surveyor Roles in Facilities That Use Electronic Health Records (EHR)
CMS has issued a memorandum regarding facilities that use Electronic Health Records (EHR). This memorandum focuses on:
EHR Goal,
Provider Choice,
Access to Records by Surveyors,
Surveyor Role |
CMS ANNOUNCES MORE ACCURATE PAYMENT RATES FOR MEDICARE SKILLED NURSING FACILITIES IN FISCAL YEAR 2010
The Centers for Medicare & Medicaid Services (CMS) today announced adjustments to fiscal year (FY) 2010 payment rates to better reflect the cost of caring for Medicare beneficiaries in nursing homes.
The final rule calls for payments to Medicare skilled nursing facilities to be reduced by $360 million, or 1.1 percent lower than payments for FY 2009. This adjustment to nursing facility payments is an effort to rebalance an earlier adjustment to the case-mix indexes (CMIs) and better align Medicare payments with costs. |
| July 2009 |
SPECIAL PRESENTATION- 5 Star Quality Rating System
Review of developments and current issues related to 5-star.
• Helpline will now only be available on a quarterly basis to coincide with the updates
to the quality measure data-July, October, January and April. Facilities can still email
questions/concerns to www.bettercare@cms.hhs.gov at any time.
• 12-14 days prior to posting the updated 5-star rating-facilities will be able to preview
their ratings. (This occurs monthly)- was previously 5 days prior to posting. |
Revisions to Appendix PP – “Interpretive Guidelines for Long-Term Care Facilities,” Tag F441”
This instruction combines F Tags 441, 442, 443, 444 and 445, and incorporates the guidance into F441. This was done to bring everything that relates to infection control into one location to best utilize the surveyors time and resources. |
CMS proposes 21.5% payment cut for physicians in 2010
The Centers for Medicare & Medicaid Services today issued a proposed rule cutting Medicare payment rates for physicians by 21.5% in calendar year 2010. However, in anticipation of similar action by Congress, CMS proposes to remove physician-administered drugs from the annual payment update formula, which CMS projects will raise the payment update in future years. CMS also proposes reducing physician fee schedule payments for advanced imaging services in order to promote reduced utilization, and requiring certain providers of the technical component of advanced imaging services to be accredited by 2012, as stipulated in the 2008 Medicare Improvements for Patients and Providers Act. These providers include physician offices, mobile units and independent diagnostic testing facilities. The proposed rule will be published in the July 13 Federal Register, with comments accepted through Aug. 31. |
| June 2009 |
Release of Report “Evaluation of the Quality Indicator Survey (QIS)”
CMS announces the release of the “Evaluation of the Quality Indicator Survey (QIS)” and the posting of the Executive Summary on the Centers for Medicare & Medicaid Services’ (CMS) Website.
As part of their ongoing program management and quality improvement initiatives, CMS embarked on a phased evaluation of the QIS. In the research phase, the basic objectives, concepts, processes, and protocols were developed and a “Phase I” formative evaluation then informed the design process to make refinements in the system. CMS then alpha and beta tested the QIS using mock surveys, with subsequent modifications and refinements. |
Triple Check Process
This review is due monthly before Medicare Part A can be billed. Therapy, Billing,
Medical Records, MDS, and Social Services should complete as a team. Any missing
data identified in this audit should be recorded and tracked, requesting it form the
responsible department and obtained before billing can be completed. |
Use of Civil Money Penalty (CMP) Funds by States and Reporting of CMP Funds Returned to the State
CMS has issued a memorandum in response to requests to clarify how CMP's may be directed and used by States, and share suggestions of innovative projects and activities that have already been undertaken with CMP funds in some States. It has also been suggested that CMS publicly report the CMP amounts that have been collected and returned to States. |
CMS issued Final Revisions to Appendix PP related to Quality of Life Ftags
Most changes are designed to promote culture change and to de-institutionalize the care practices and environment. Some changes related to environment have long term impact on how NHs are designed, room set up, fixtures, furniture, and decorating practices. CMS states in the guidance for 252 Homelike that "Many facilities cannot immediately make these types of changes, but it should be a goal or all facilities that have not yet made these types of changes to work toward them." |
Five-Star Quality Rating System - June News
The Five-Star provider preview reports are beginning Wednesday, June 17, 2009. Providers can access the report from the Minimum Data Set (MDS) State Welcome pages available at the State servers for submission of Minimum Data Set data.
Provider Preview access information: Visit the MDS State Welcome page available on the State servers where you submit MDS data to review your results.
For more information, please click the link |
Contractor's Responsibility Prior to Submission of Cost Reports
CMS has redesigned the Provider Statistical and Reimbursement (PS&R) system. The new PS&R will be used for all cost reports ending January 31, 2009 and later. Chapter 8 has been updated to include modifications due to the implementation of the new system. |
Recent analysis of Comprehensive Error Rate Testing (CERT) feedback
A Recent analysis of Comprehensive Error Rate Testing (CERT) feedback reveals a trending for correction of Skilled Nursing Facility (SNF) Resource Utilization Grouper (RUG) levels due to inaccurate capture of information on the Minimum Data Set (MDS). Additionally, all MDS information should be reviewed prior to submission for potential keying errors. It is important all information captured on the MDS is clearly supported in the documentation. If the information is not clearly supported in the documentation, medical reviewers correct the MDS based on the submitted documentation, which can result in a change in the RUG category billed. |
Obama Wants Final Health Reform Bill by October
Shortly before President Barack Obama met Tuesday afternoon with one Independent and 23 Democratic senators, he said that healthcare reform "is something that has to be done." His target date remains October for when he wants to see a completed comprehensive healthcare reform bill approved by Congress and on his desk for his signature.
His comments at the White House reflect some of the findings from his Council of Economic Advisors' report, The Economic Case for Health Care Reform, that was released on Tuesday. In the report, the White House appears to be gearing up to promote healthcare reform among legislators and the public. |
Clarification of F371 (SC Letter 09_39)
CMS releases memorandum which clarifies that:
1) The language at 42 CFR 483.35(i), Tag F 371 'Procure food from sources approved or considered satisfactory by Federal, State or local authorities' is intended solely for the foods procured by the facility. A revision has been made to the interpretive guidelines at F371 to further clarify this intent;
2) Foods accepted by residents from visitors, family, friends, or other guests are not subject to the regulatory requirement at F 371; and 3) Residents have the right to choose to accept food from visitors, family, friends, or other guests according to their rights to make choices at 483.15, F 242, Self Determination and Participation. |
May 2009 |
| MAC Update: First Coast Service Options |
Part B Hospice Modifiers GV & GW
|
CMS releases draft version of MDS 3.0 for nursing homes
|
| MDS 3.0 Draft Item Set |
Special Facility Focus Initiative May 2009
|
Healthcare Fraud Prevention and Enforcement
|
CMS releases new Medicare Secondary Payer Fact Sheet (April 2009)
|
Polaris Pulse Newsletter 
Top of page
