The week in Medicare updates
Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for solid tumors (This change request rescinds and fully replaces CR8468/TR2873 dated February 6, 2014)
On May 28, CMS released a change request to rescind and replace Transmittal 166, dated April 18, with Transmittal 168. This change request was to make a technical correction to delete information in Pub. 100-03, the National Coverage Determinations Manual, that should not have been included. All other information remains the same.
View Transmittal R168NCD.
Revision to the Program Integrity Manual, Chapter 15
On May 30, CMS released a change request to revise various sections of CMS Pub.100-08, the Program Integrity Manual, Chapter 15. These revisions do not establish any new CMS policies; they merely recite various regulatory provisions (as well as material from CMS Pub. 100-02, the Medicare Benefit Policy Manual, Chapter 15) in the Program Integrity Manual.
Effective date: July 31, 2014
Implementation date: July 21, 2014
View Transmittal R519PI.
CMS releases annual update to data on hospital charge variation
On June 2, CMS released its first annual update to data on hospital charges. The data includes inpatient and outpatient hospital charge data for 2011 and 2012, and shows what different hospitals in all 50 states and Washington, D.C. charge for similar services. The data show significant variation in average charges from hospital to hospital—including those within the same community—for inpatient services that may be provided in connection with a given inpatient stay.
View the fact sheet.
National Coverage Analysis (NCA) for Screening for Hepatitis C Virus (HCV) in Adults
In a decision posted June 2, CMS stated it will cover screening for HCV with the appropriate FDA approved/cleared laboratory tests. It must be consistent with FDA-approved labeling and in compliance with CLIA regulations, and must be ordered by the beneficiary's primary care physician or practitioner within the context of a primary care setting. It can be performed by an eligible Medicare provider for beneficiaries who meet one of certain conditions.
View the decision.
Notification of closure of teaching hospital and opportunity to apply for available slots
On June 4, CMS announced the closure of one teaching hospital and the initiation of an application process for hospitals to apply to CMS to receive Long Beach Medical Center’s full time equivalent resident cap slots.
View the notice in the Federal Register.
Privacy Act of 1974; Report of New System of Records (SOR)
On June 5, CMS announced it is establishing a new SOR titled “Open Payments,” System No. 09–70– 0507, to implement requirements in the Patient Protection and Affordable Care Act of 2010 (Pub. L. 111–148), which added section 1128G to the Social Security Act. The Open Payments program requires applicable manufacturers and Group Purchasing Organizations (GPO) to report payments and other transfers of value to covered physician recipients as defined by 42-CFR 403.902, as well as certain ownership or investment interests held by physicians and/or their immediate family members in such applicable manufacturers and/or applicable GPOs.
View the notice in the Federal Register.
Vulnerabilities in Medicare's Interrupted-Stay policy for long-term care hospitals (LTCH)
On June 3, OIG posted a report regarding the LTCH interrupted-stay policy, which is intended to save money by treating time spent at an LTCH before and after an interruption as a single stay, rather than two separate stays. Several vulnerabilities in the program were identified, including inappropriate payments, financial incentives to delay readmissions, and potential overpayments to co-located LTCHs.
View the report.
Infection control breaches which warrant referral to public health authorities
If State Survey Agencies (SA) or Accrediting Organizations identify any of breaches of generally accepted infection control standards, they should refer them to appropriate state authorities for public health assessment and management. SAs should consult with their state’s Healthcare Associated Infections Prevention coordinator or state epidemiologist on the preferred referral process.
View the survey and certification letter.
Revisions to Chapter 9 State Operations Manual (SOM) exhibits
On June 6, CMS released revisions to various exhibits concerning deemed status providers and suppliers; Rural Health Clinics (RHC) and swing bed hospitals; and hospital reports of deaths associated with restraint or seclusion. Exhibit 25, Model Letter to RHC Regarding Scheduling a Survey, is being deleted since all surveys must be announced. The updates accurately reflect current survey and certification policy established in the SOM.
Effective date: June 6, 2014
Implementation date: June 6, 2014
View Transmittal R117SOMA.
Revised Appendix A to the SOM, Interpretive Guidelines for Hospitals
On June 6, CMS clarified various provisions of 42 CFR 482.23(c), concerning medication administration, and 42 CFR 482.51(b)(4), concerning post-operative patient care of the SOM.
Effective date: June 6, 2014
Implementation date: June 6, 2014
View Transmittal R116SOMA.