This week in Medicare updates–11/16/2016

Implementation Plans for the Emergency Preparedness Regulation

On October 28, the CMS Survey and Certification Group published a Memorandum regarding the implementation plans for the new Emergency Preparedness Rule. The information addresses the implementation date for providers and suppliers, the development of Interpretive Guidelines (IG), surveyor training and resources available to assist in the implementation of this regulation.

Implementation date: November 15, 2017.

 

Transplant Centers: Clinical Experience Requirements

On October 28, CMS released a Memorandum regarding noncompliance of Transplant Centers in terms of clinical experience. The Transplant Center Conditions of Participation (CoP) at 42 CFR 482.80(b), Clinical Experience, require transplant programs to generally perform 10 transplants over a 12 month period to qualify for Medicare certification. For re-approval, certified transplant programs must generally perform an average of 10 transplants per year during the prior three years.

 

Fiscal Year 2015 Minimum Data Set Focused Survey Summary

On November 4, CMS released a Memorandum regarding the results from the Minimum Data Set (MDS) 3.0 Focused Surveys conducted in FY 2015. These surveys also included a review of facility compliance with the requirements for nurse staffing posting.

 

Provider Enrollment Application Fee Amount for Calendar Year 2017

On November 7, CMS posted a Notice in the Federal Register announcing the 2017 application fee amount of $560.00 for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children’s Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new Medicare practice location.

Effective date: January 1, 2017

 

TrustSolutions, LLC, Claimed Unallowable Medicare Pension Costs for 2007 Through 2009

On November 7, the OIG published a report on TrustSolutions, LLC, which claimed unallowable pension costs of $62,000 for Medicare reimbursement between 2007 and 2009.

 

Provider Self-Disclosure Settlement and CIA Reportable Event Settlement Updates

On November 8, the OIG posted updates to the Provider Self-Disclosure Settlements and CIA Reportable Event Settlements websites. Updates include WakeMed Health & Hospitals’ agreement to pay $146,235.38 for allegedly violating the Civil Monetary Penalties Law provisions applicable to physician self-referrals and kickbacks and an agreement with Memorial Hermann Health System (MHHS) in Texas, to pay $5,652,628.00 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MHHS improperly submitted claims to Federal healthcare programs for certain outpatient services that automatically appended modifiers -59 or -91 to CPT codes.

 

Comment request: Cost-Sharing Reduction Reconciliation Information Collection

On November 8, CMS issued a Comment Request in the Federal Register regarding Cost-Sharing Reduction Reconciliation. Qualified health plan issuers will receive estimated advance payments of cost-sharing reductions throughout the year, and are then subject to a reconciliation process at the end of the benefit year.

 

Town Hall Meeting on the FY 2018 Applications for New Medical Services and Technologies Add-On Payments

On November 9, CMS published a Notice in the Federal Register to discuss fiscal year (FY) 2018 applications for add-on payments for new medical services and technologies under the hospital inpatient prospective payment system (IPPS). The Town Hall will be held on Tuesday, February 14, 2017.

 

California Physical Therapy Practice Claimed Unallowable Medicare Part B Reimbursement for Outpatient Therapy Services

On November 9, the OIG released a Report regarding unallowable claims for outpatient physical therapy services provided by Sierra Injury & Sports Rehab, Inc., of Yuba City, California. Of the 100 beneficiary days in the OIG’s random sample, the practice improperly claimed Medicare reimbursement for 64 beneficiary days, consisting of 62 beneficiary days that had therapy services that were not medically necessary and 2 beneficiary days that did not meet Medicare documentation requirements. The OIG estimates that the practice received at least $583,000 in unallowable Medicare reimbursement.

 

CMS Announces $66.1 Million to Support Zika Prevention & Treatment Services

On November 9, CMS released a press release regarding up to $66.1 million available to support prevention activities and treatment services for health conditions related to the Zika virus. Funds will be available to applicants for healthcare services related to family planning, diagnostic testing, screening and counseling, medical care, case management and treatment, and improving provider capacity and capability.

 

Revisions to State Operations Manual (SOM), Appendix PP-Revised Regulations and Tags

On November 9, CMS released a Memorandum regarding revisions to the State Operations Manual (SOM), Appendix PP-Revised Regulations and Tags due to the September 28, 2016, revisions of the Requirements for Participation for Medicare and Medicaid-certified nursing facilities. Most regulations groups were re-designated and have new numbers. Interpretive Guidance will be released at a later date.

 

New York Could Improve Security Controls For Its Health Insurance Exchange Website

On November 10, the OIG issued a Report providing overview of the results of its audit of the information security controls at New York's health insurance exchange.

 

OIG Releases 2017 Work Plan

On November 10, the OIG released its 2017 Work Plan detailing various projects to be addressed during the fiscal year. The OIG has added the following Medicare Parts A and B topics for review activities in 2017:

• Hyperbaric Oxygen Therapy Services – Provider Reimbursement in Compliance with Federal Regulations

• Incorrect Medical Assistance Days Claimed by Hospitals

• Inpatient Psychiatric Facility Outlier Payments

• Case Review of Inpatient Rehabilitation Hospital Patients Not Suited for Intensive Therapy

• Nursing Home Complaint Investigation Data Brief

• Skilled Nursing Facilities – Unreported Incidents of Potential Abuse and Neglect, Facility Reimbursement, and Facility Adverse Event Screening Tool

• Medicare Hospice Benefit Vulnerabilities and Recommendations for Improvement, Review of Hospices Compliance with Medicare Requirements, and Hospice Home Care Frequency of Nurse Onsite Visits to Assess Quality of Care and Services

• Comparing HHA Survey Documents to Medicare Claims Data

• Part B Services during Non-Part A Nursing Home Stays: Durable Medical Equipment

• Medicare Market Share of Mail-Order Diabetic Testing Strips: April 1–June 30, 2016 – Mandatory Review

• Positive Airway Pressure Device Supplies – Supplier Compliance with Documentation Requirements for Frequency and Medical Necessity

• Monitoring Medicare Payments for Clinical Diagnostic Laboratory Tests – Mandatory Review

• Medicare Payments for Transitional Care Management

• Medicare Payments for Chronic Care Management

• Data Brief on Financial Interests Reported under the Open Payments Program

• Power Mobility Devices Equipment – Portfolio Report on Medicare Part B Payments

• Drug Waste of Single Use Vial Drugs

• Potential Savings from Inflation-Based Rebates in Medicare Part B

• Medicare Payments for Service Dates After Individuals’ Dates of Death

• Management Review: CMS's Implementation of the Quality Payment Program

The OIG has also added plans to review CMS Action on CERT Data.

 

2017 Medicare Parts A & B Premiums and Deductibles Announced

On November 10, CMS released a press release announcing the 2017 premiums for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

 

CMS and Indian Health Service expand collaboration to improve health care in hospitals

On November 11, CMS released a press release announcing that Indian Health Service Hospitals are now included in the nationwide Hospital Improvement and Innovation Networks contract for public and private sector hospitals to reduce adverse events by 20% and hospital readmissions by 12%.