This week in Medicare updates–08/10/2016
Update to inpatient psychiatric facilities PPS (IPF PPS) FY 2017
On August 1, CMS released a change request identifying changes that are required as part of the annual IPF PPS update from the FY 2017 IPF PPS Notice, published on July 28, 2016. These changes are applicable to IPF discharges occurring during fiscal year October 1, 2016, through September 30, 2017. This recurring update applies to Chapter 3, Medicare Claims Processing Manual, section 190.4.3 and 190.7.3.
Effective date: October 1, 2016
Implementation date: October 3, 2016
View Transmittal R3575CP.
View MLN Matters article MM9732.
Comprehensive Primary Care Plus (CPC+) region announcement
On August 1, CMS posted a fact sheet revealing the 14 regions that were selected for CPC+. Eligible practices in these regions may apply to CPC+ from August 1 to September 15, 2016.
View the fact sheet.
View the press release.
IPPS final rule
On August 2, CMS posted the IPPS final rule and an accompanying fact sheet. It updates payment policies and annual payment rates for long-term care hospitals and provides the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017, in addition to updating the hospital inpatient payment rates.
View the final rule.
View the fact sheet.
View the FY 2017 IPPS final rule homepage.
Advancing care coordination through Episode Payment Models; Cardiac Rehabilitation Incentive Payment Model; and changes to the Comprehensive Care for Joint Replacement Model (CJR)
On August 2, CMS posted a proposed rule in the Federal Register proposing to implement three new Medicare Parts A and B episode payment models under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-for-service beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. CMS believes this model will further its goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures. This proposed rule also includes several proposed modifications to the CJR model. Comments due October 3.
View the proposed rule in the Federal Register.
Leave a comment.
Timely reporting of provider enrollment information changes
On August 3, CMS released a special edition MLN Matters article stating that, in accordance with 42 CFR section 424.516(d), all physicians, non-physician practitioners, and physician and non-physician practitioner organizations must report certain changes in their enrollment information to their MACs via the Internet-based Provider Enrollment, Chain and Ownership System or the CMS 855 paper enrollment application within 30 days of the following changes: a change in ownership, an adverse legal action, or change in practice location. Providers must report all other changes to their MAC within 90 days of the change.
View MLN Matters article SE1617.
Announcement of the Provider Enrollment Moratoria Access Waiver Demonstration of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in moratoria-designated geographic locations
On August 3, CMS posted a notice in the Federal Register announcing the Provider Enrollment Moratoria Access Waiver Demonstration of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in six states. The demonstration is being implemented in accordance with section 402 of the Social Security Amendments of 1967 and gives CMS the authority to grant waivers to the statewide enrollment moratoria on a case-by-case basis in response to access to care issues, and to subject providers and suppliers enrolling via such waivers to heightened screening, oversight, and investigations.
View the notice in the Federal Register.
Implementation and extension of temporary moratoria on enrollment of Part B non-emergency ground ambulance suppliers and home health agencies in designated geographic locations and lifting of temporary moratoria on enrollment of Part B emergency ground ambulance suppliers in all geographic locations
On August 3, CMS posted a notice in the Federal Register announcing the extension of temporary moratoria on the enrollment of new Medicare Part B nonemergency ground ambulance suppliers and Medicare home health agencies, subunits, and branch locations in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse. It also announces the implementation of temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance suppliers and Medicare HHAs, subunits, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey on a statewide basis. In addition, it announces the lifting of the moratoria on all Part B emergency ground ambulance suppliers. These moratoria, and the changes described in this document, also apply to the enrollment of HHAs and non-emergency ground ambulance suppliers in Medicaid and the Children’s Health Insurance Program.
View the notice in the Federal Register.
Frontier Community Health Integration Project (FCHIP) Demonstration
On August 4, CMS posted a fact sheet stating that 10 critical access hospitals (CAH) are participating in the FCHIP Demonstration, which aims to test new models of healthcare delivery in the most sparsely populated rural counties with the goal of improving health outcomes and reducing Medicare expenditures. CMS received applications representing CAHs in Montana, Nevada, and North Dakota (though eligible to apply, CAHs in Alaska and Wyoming did not apply). This demonstration lasts three years and began on August 1, 2016.
View the fact sheet.
View the press release.
Request for nominations for members for the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC)
On August 5, CMS posted a notice in the Federal Register announcing the request for nominations for membership on the MEDCAC. Among other duties, the MEDCAC provides advice and guidance to the secretary of HHS and the administrator of the CMS concerning the adequacy of scientific evidence available to CMS in making coverage determinations under the Medicare program.
View the notice in the Federal Register.