This week in Medicare updates—8/3/2022
CLIA Fees: Histocompatibility, Personnel, and Alternative Sanctions for Certificate of Waiver Laboratories
On July 26, CMS published a Proposed Rule in the Federal Register regarding updates to CLIA fees and clarification of certain CLIA regulations. Proposals include a biennial two-part increase of CLIA fees and incorporating limited/specific lab fees including fees for follow-up surveys, substantiated complaint surveys, and revised certificates. The rule also proposes distributing administrative overhead costs of test complexity determinations for waived tests and test systems with a nominal increase in Certificate of Waiver fees. The rule includes amendments for histocompatibility and personnel regulations under CLIA that are obsolete and amendments to provisions governing alternative sanctions.
CMS published a Fact Sheet on the rule on July 22. Comments on the rule are due by August 25.
CMS Launches Enhanced Nursing Home Five-Star Quality Rating System
On July 27, CMS published a Press Release to announce it launched an enhanced version of the Nursing Home Five-Star Quality Rating System, which adds data on nursing home weekend staffing rates and information on annual turnover among nurses and administrators. The data was included in the latest update to the Care Compare website. CMS is also adding four new measures to the rating system effective with this July release, and it will only add a star to the overall rating for facilities with a five-star staffing rating rather than facilities with a four-star or higher staffing rating.
CMS published a Fact Sheet to accompany the Press Release. Additional details about the staffing rating methodology are included in the updated Nursing Home Five-Star Quality Rating Technical Users’ Guide.
FY 2023 Hospice Payment Rate Update Final Rule
On July 27, CMS published a draft version of the FY 2023 Hospice Payment Rate Update Final Rule, which was published in the Federal Register on July 29. CMS finalized a 3.8% increase in hospice payments for 2023 and an aggregate cap amount of $32,486.92. CMS also finalized a permanent cap on negative wage index changes greater than a 5% decrease from the previous year. The rule includes an update on the development of a patient assessment instrument (HOPE) as well as other quality reporting program changes.
CMS published a Fact Sheet on the rule on the same date. The regulations are effective October 1, 2022.
FY 2023 Inpatient Rehabilitation Facilities (IRF) Prospective Payment System (PPS) Final Rule
On July 27, CMS published a draft copy of the FY 2023 IRF PPS Final Rule, which was published in the Federal Register on August 1. CMS is updating IRF PPS payments by 3.2%. CMS also finalized a permanent 5% cap on wage index decreases. The rule codifies the IRF teaching status adjustment policy and clarifies certain teaching status adjustment policies similar to how the IPPS indirect medical education adjustment works.
CMS published a Fact Sheet on the final rule on the same date. The regulations are effective October 1, 2022.
FY 2023 Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) Final Rule
On July 27, CMS published a draft copy of the FY 2023 IPF PPS Final Rule, which was published in the Federal Register on July 29. CMS estimates IPF payments will increase by 2.5% for 2023. It also finalized a cap on negative wage index changes at no greater than a 5% decrease from the previous year for FYs 2023 and beyond. The rule did not include any changes to the IPF Quality Reporting Program for FY 2023.
CMS published a Fact Sheet on the rule on the same date. The regulations are effective October 1, 2022.
ICD-10-CM FY 2023 Present on Admission (POA) Exempt Codes
On July 27, the CDC published the ICD-10-CM POA Exempt Codes file for FY 2023 on their website.
CMS Reported Collecting Just Over Half of the $498 Million in Medicare Overpayments Identified by OIG Audits
On July 28, the OIG published a Review of whether CMS collected Medicare overpayments identified in OIG audit reports and what types of actions CMS took in response to a 2012 audit on the extent to which CMS had collected sustained overpayments from OIG audits at that time. This most recent review looked at the collection of overpayments from OIG audits conducted between October 1, 2014 - December 31, 2016. The OIG found that CMS reported it had collected 55% of the overpayments discovered in those audits, and the OIG was only able to find documentation proving CMS collected 44% of that amount it said it collected. The OIG also stated that CMS did not take full corrective actions in response to the recommendations in the 2012 audit. While CMS had agreed to implement four of the recommendations from that report, it only implemented two, partially implemented one, and did not implement another recommendation from the audit.
The OIG issued nine recommendations as a result of this review to ensure CMS collects and documents the collection of overpayments to protect the fiscal integrity of the Medicare trust fund. CMS generally did not concur with the OIG’s findings or recommendations. The disagreements between the OIG and CMS are detailed fully in the report. They include a disagreement about the extent to which MACs are responsible for collecting and documenting overpayments, how readily available data is on overpayments, whether CMS provided MACs with sufficiently specific guidance on what documentation is needed to support the collection of an overpayment, and more.
Certain Nursing Homes May Not Have Complied with Federal Requirements for Infection Prevention and Control and Emergency Preparedness
On July 29, the OIG published a Review of whether certain nursing homes which had not provided a plan of correction for deficiencies as of March 26, 2020, complied with federal requirements for infection prevention and control and emergency preparedness. The OIG found that 28 of the 39 nursing homes had possible deficiencies, with 48 instances of possible noncompliance with infection prevention and control requirements at 25 of those nursing homes and 18 instances of possible noncompliance with emergency preparedness at 18 of those nursing homes.
The OIG recommends CMS instruct state survey agencies to follow up with the 28 nursing homes identified in the report to ensure they have taken corrective actions, issue updated phase 3 interpretive guidance as soon as possible, provide training to state survey agencies on the updated phase 3 interpretive guidance, and consider updating regulations to make it clear that nursing homes must include emerging infectious diseases as a risk on their facility- and community-based all-hazards risk assessments. CMS concurred with the first three recommendations and said that it would consider including the fourth recommendation in future rule-making.
FY 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule
On July 29, CMS published a draft copy of the FY 2023 SNF PPS Final Rule, which is scheduled to be published in the Federal Register on August 3. CMS finalized a two-year phase-in of a 4.6% Patient-Driven Payment Model (PDPM) parity adjustment, which is intended to correct for an unintended increase in payments since the implementation of PDPM in 2019. CMS will apply a 2.3% parity adjustment in FY 2023 and a 2.3% parity adjustment in FY 2024 to reduce the unintended SNF spending while also attempting to mitigate the financial impact of this adjustment on providers. CMS estimates that Part A payments for SNFs will increase by 2.7% overall for FY 2023.
As in other PPS rules for FY 2023, CMS is finalizing a permanent 5% cap on annual wage index decreases. It also finalized changes to PDPM ICD-10 code mappings, several quality reporting changes, and SNF value-based purchasing program changes.
CMS published a Fact Sheet and Press Release on the proposed rule on the same date. The rule is effective October 1, 2022.
Corrections to Rural Health Clinic Cost Report Form
On July 29, CMS published Provider Reimbursement Manual Transmittal 3 regarding revisions, clarifications, and corrections to the RHC Cost Report form. Changes include new edits, revised instructions to align with the sequestration adjustments made by the Protecting Medicare and American Farmers from Sequester Cuts Act of 2021, and more.
Effective date: Cost reporting periods ending on or after July 31, 2022.