This week in Medicare updates—8/8/2018
Recovery Audit Program website update
On July 30, CMS redesigned the Recovery Audit Program page on its website. The new design features contact information for each region’s RAC as well as a list explaining what information will be included for all proposed and approved review topics posted on the website.
Final Rule: Skilled Nursing Facility Prospective Payment System
On July 31, CMS published the display copy of the 2019 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule. This rule will implement a new case-mix classification system, the SNF Patient-Driven Payment Model (PDPM), which was developed based on feedback to an earlier proposal to create the Resident Classification System, Version I model, a system that was never finalized. The PDPM focuses on incentives to treat the needs of the whole patient instead of focusing on volume only. This portion of the rule will be effective October 1, 2019, to allow time for education and training as SNFs prepare for the new model.
Other provisions of the final rule include adopting an additional factor when determining whether to remove a measure from the SNF Quality Reporting Program set that will allow for consideration of costs, and the rule includes multiple changes to the Value-Based Purchasing Program. The SNF market basket update for 2019 will be 2.4% as required by the Bipartisan Budget Act of 2018.
CMS published a Fact Sheet on July 31 to accompany the final rule. The rule is scheduled to be published in the Federal Register on August 8, 2018.
Effective date: October 1, 2018
Implementation date: The implementation date for revised case-mix methodology, PDPM, and associated policies discussed in section V is October 1, 2019.
Final Rule: Inpatient Rehabilitation Facility Prospective Payment System
On July 31, CMS published the 2019 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) final rule. Major provisions of the rule include revising certain coverage requirements to allow the post-admission physician evaluation to count as one of the face-to-face physician visits, allowing the rehabilitation physician to lead interdisciplinary team meetings remotely without additional documentation requirements, and removing the admission order documentation requirement effective for all IRF discharges beginning on or after October 1, 2018. The rule also removes the Functional Independence Measure (FIM™) instrument and associated Function Modifiers from the IRF Patient Assessment Instrument (IRF-PAI) beginning in FY 2020.
CMS published a Fact Sheet on July 31 to accompany the final rule. The rule is scheduled to be published in the Federal Register on August 6, 2018.
Effective date: October 1, 2018
Implementation date: Updated IRF prospective payment rates are applicable for IRF discharges occurring on or after October 1, 2018, and on or before September 30, 2019 (FY 2019). Revisions to certain IRF coverage requirements to reduce the amount of required paperwork in the IRF setting and the updated measures and reporting requirements under the IRF QRP are applicable for IRF discharges occurring on or after October 1, 2018. The removal of the FIM™ instrument and associated Function Modifiers from the IRF-PAI and refinements to the case-mix classification system are applicable for IRF discharges occurring on or after October 1, 2019.
Final Rule: Inpatient Psychiatric Facilities Prospective Payment System
On July 31, CMS published a display copy of the 2019 Inpatient Psychiatric Facilities (IPF) Prospective Payment System (PPS) final rule. The major provisions of the rule include updating the IPF payment rate by 1.35% for FY 2019 and removing five measures from the IPF quality reporting program, which is three fewer than the eight measures suggested for removal in the proposed rule. Due to overwhelming feedback, CMS said it will not remove the following three measures:
- Hours of physical restraint use
- Hours of seclusion use
- Tobacco use treatment provided or offered at discharge and tobacco use treatment at discharge, TOB-3 and TOB-3a
CMS published a Fact Sheet on July 31 to accompany the final rule. The rule is scheduled to be published in the Federal Register on August 6, 2018.
Effective date: These regulations are effective on October 1, 2018.
Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: Top Unimplemented Recommendations
On July 31, the OIG published a Booklet on the top 25 unimplemented recommendations to reduce fraud, waste, and abuse in HHS programs. Of the 25 recommendations, 16 were related to the Medicare and Medicaid programs.
Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity
On July 31, the OIG published a Report regarding key vulnerabilities in the Medicare hospice program and included recommendations for protecting beneficiaries and improving the program. These vulnerabilities range from quality of care issues (in which hospices did not always provide needed services or effective management of symptoms for patients) to patient information issues (such as not giving families and caregivers necessary information to help them make informed decisions about their care) to inappropriate billing and a number of fraud schemes. To address this wide range of issues, the OIG made 15 specific recommendations across seven areas for improvement, all of which are detailed in the report.
CMS Clarification of Psychiatric Environmental Risks
On August 1, CMS published a Memorandum to state survey agency directors regarding the proposed psychiatric task force that was intended to address environmental risks associated with the care of psychiatric inpatients. CMS has decided that this task force is not the most appropriate vehicle to foster necessary changes and therefore will not convene this task force as originally planned. CMS said the efforts by The Joint Commission’s Suicide Panel to clarify and refine issues involving ligature and safety risks will be incorporated into revisions of interpretive guidance. Until CMS’ comprehensive ligature risk interpretive guidance is released, the state survey agencies and accrediting organization should use their judgment as to the identification of ligature and other safety risk deficiencies.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the State/Regional Office training coordinators within 30 days of this memorandum.
Clarification of the Operation of Multiple Laboratories at the Same Location and the Discontinued Use of the Term “Shared Laboratory”
On August 1, CMS published a Memorandum to state survey agency directors to clarify the operation of multiple laboratories at the same location and the discontinued use of the term “shared laboratory” related to the Clinical Laboratory Improvement Amendments of 1988 (CLIA) Certification. The memo clarifies that multiple laboratories with separate CLIA numbers can operate at one location as long as each laboratory can demonstrate that it is operating as a separate and distinct entity. Multiple laboratories at the same location or in the same suite should not be referred to as “shared laboratories.” That term was used solely for the purpose of identifying and properly registering laboratories during the early implementation of the CLIA program who sought to register multiple CLIA numbers at a single location. This memo supersedes all prior guidance regarding registration of shared laboratories for CLIA.
Effective date: Immediately. This information should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of the memorandum.
Final Rule: FY 2019 Hospice Wage Index and Payment Rate Update
On August 1, CMS published a display copy of the Hospice Wage Index and Payment Rate Final Rule, which is scheduled to be published in the Federal Register on August 6, 2018. The rule will increase hospice payments by 1.8% in 2019 with a statutory cap amount of $29,205.44. The rule also will change the definition of a hospice attending physician to include physician assistants effective January 1, 2019, as required by the Bipartisan Budget Act of 2018.
CMS published a Fact Sheet on August 1 to accompany the final rule.
Effective date: October 1, 2018
Final Rule: FY 2019 Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital (LTCH) Prospective Payment System
On August 2, CMS published a display copy of the IPPS Final Rule, which is scheduled to be published in the Federal Register on August 17, 2018. The rule will provide acute care hospitals with an average payment increase of 2.9%. CMS also finalized several proposals, including:
- Removing the requirement that a written inpatient admission order be present in the medical record as a specific condition of Part A payment.
- Eliminating 18 measures from CMS quality and value-based purchasing programs and de-duplicating another 25 measures.
- Introducing a new performance-based scoring methodology for the Promoting Interoperability Program (formerly known as the EHR Incentive Programs) with a smaller set of objectives to make the program less burdensome for eligible hospitals and critical access hospitals.
- Approving new technology add-on payments for FY 2019 for 10 of the 11 applications from the proposed rule, including a new technology add-on payment for Chimeric Antigen Receptor (CAR) T-cell therapy. CMS will also assign CAR T-cell therapy to an MS-DRG and rename the MS-DRG “Autologous Bone Marrow Transplant with CC/MCC or T-cell Immunotherapy.”
- Requiring hospitals to publicly list their standard charges via the internet in a machine readable format that is updated at least annually, or more frequently as appropriate.
CMS issued a Press Release and Fact Sheet on the final rule on the same date.
Effective date: October 1, 2018
Qualified Medicare Beneficiary Program – FAQ on Billing Requirements
On August 2, CMS published an Updated FAQ on the billing requirements for the Qualified Medicare Beneficiary Program. The document was updated to include information on Advance Beneficiary Notices that was discussed during a Medicare Learning Network call in June.
Announcement of the Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations
On August 2, CMS published a Notice in the Federal Register to announce the extension of statewide temporary moratoria on the enrollment of new Part B non-emergency ground ambulance providers and suppliers and Medicare home health agencies and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey.
Effective date: Applicable July 29, 2018.
System Changes to Implement Epoetin Alfa Biosimilar, Retacrit for End Stage Renal Disease (ESRD) and Acute Kidney Injury (AKI) Claims
On August 3, CMS published Medicare Claims Processing Transmittal 4105 regarding system changes for ESRD and AKI claims. This transmittal updates the list of supplies, drugs, and labs included in the ESRD consolidated billing list, which is therefore included in the base rate payment for AKI. This includes erythropoietin stimulating agents billed with both the ESRD-specific or non-ESRD specific HCPCS code.
On August 3, CMS published Medicare Benefit Policy Transmittal 245 regarding an update to the Medicare Benefit Policy Manual with the same system changes for ESRD and AKI claims as listed in Transmittal 4105.
Effective date: January 1, 2019
Implementation date: January 7, 2019
October 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
On August 3, CMS published Medicare Claims Processing Transmittal 4107 regarding the quarterly update to the ASP and Not Otherwise Classified (NOC) drug pricing files for Medicare Part B drugs.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2019
On August 3, CMS published Medicare Claims Processing Transmittal 4104 regarding changes required as part of the annual IPF PPS update as established in the 2019 IPF PPS final rule.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Quarterly Influenza Virus Vaccine Code Update - January 2019
On August 3, CMS published Medicare Claims Processing Transmittal 4100 to provide the quarterly update to payment and edits in the Common Working File and Fiscal Intermediary Shared System to include and update new or existing influenza virus vaccine codes.
Effective date: January 1, 2019
Implementation date: January 7, 2019