This week in Medicare updates–04/20/2016
Implementing payment changes for Frontier Community Health Integration Project (FCHIP)
On April 7, CMS rescinded Transmittal 131, dated December 4, 2015, and replaced it with Transmittal 143 to change the effective and implementation date. All other information remains the same. The original transmittal was regarding CMS modifying Medicare payment rules for specified critical access hospitals (CAH) and ambulance services in Montana, Nevada, and North Dakota. CMS will select the participating CAHs prior to August 1. CMS will identify for the MAC all providers that will be subject to the respective payment changes for ambulance services, long term care services, and cost based reimbursement for telehealth services.
Effective date: August 1, 2016
Implementation date: August 1, 2016
View Transmittal R143DEMO.
Policy clarification on acceptable control materials used when quality control (QC) is performed in laboratories
On April 8, CMS provided clarification regarding the policy on acceptable control materials. Acceptable control materials will now include on-board controls, i.e., ampules or cartridges containing the same QC material that would traditionally be considered as external QC. Instrument/electronic function checks and procedural controls do not fulfill the regulatory requirement for control materials. The laboratory director is responsible for the determination of what control materials to use in his or her laboratory. Surveyors will ensure that the laboratory is following its own established policies, specifically its QC procedures, in the context of the Outcome Oriented Survey Process.
View the survey and certification letter.
Computed Tomography (CT) compliance clarifications under Section 218(a)(1) of the Protecting Access to Medicare Act
On April 8, CMS shared a clarification with state and federal surveyors as information only. Surveyors will not be expected to determine compliance with Advanced Diagnostic Imaging requirements. CMS is providing compliance and payment clarifications based on stakeholder questions regarding National Electrical Manufacturers Association XR-29 Standard. The FAQs attached with this policy memorandum aim to clarify stakeholders questions regarding oversight and include aspects of payment reductions if CT systems are found non-compliant.
View the survey and certification letter.
Comprehensive Primary Care Plus (CPC+) fact sheet
On April 11, CMS posted a fact sheet and press release introducing the CPC+ model. CPC+ integrates many insights from the CPC initiative, including the critical role of practice readiness, aligned payment reform, actionable performance-based incentives, and robust data sharing.
View the fact sheet.
View the press release.
2016 Compendium of Unimplemented Recommendations
On April 12, the OIG posted the 2016 edition of its Compendium of Unimplemented Recommendations. It focuses on the top 25 unimplemented recommendations that, on the basis of OIG's professional opinion, would most positively impact HHS programs in terms of cost savings and/or quality improvements and should, therefore, be prioritized for implementation. The recommendations come from OIG audits and evaluations and are generally grouped according to the underlying HHS program or operation; thus, they are not internally ranked and so do not reflect relative priority among the 25. The Appendix includes a comprehensive list of OIG's significant unimplemented recommendations, including the top 25 unimplemented recommendations as well as other open recommendations that are not in the top 25 list.
View the compendium.
Tracking sheet for percutaneous image-guided lumbar decompression for lumbar spinal stenosis NCA
On April 13, CMS posted a tracking sheet regarding percutaneous image-guided lumbar decompression. Two studies have been approved on this topic.
View the tracking sheet.
FY 2017 IPPS proposed rule
On April 18, CMS released the FY 2017 IPPS proposed rule. It contained updates to several quality initiatives and a reversal of the agency’s 0.2% payment reduction instituted along with the 2-midnight rule in the FY 2014 rule. CMS is proposing the Medicare Outpatient Observation Notice (MOON), a standardized notice that hospitals would be required to give Medicare patients receiving observation services under the Notice of Observation Treatment and Implication for Care Eligibility Act. CMS also announced the expected changes to MS-DRGs 469 and 470 and their relative weights related to the Bundled Payments for Care Improvement Initiative. Comments are due June 16.
View the proposed rule.
View the fact sheet.