This week in Medicare updates – 1/3/2018
Initiative to Address Facility-Initiated Discharges that Violate Federal Regulations
On December 22, CMS published a Memorandum for state survey agency directors regarding a new initiative to examine and mitigate facility-initiated discharges from nursing homes when the discharges violate federal regulations. CMS will review facility-initiated discharges in nursing homes to help determine whether interventions such as surveyor and provider training, intake and triage training, Civil Monetary Penalty (CMP)-funded projects, and additional enforcement could help mitigate the issue. CMS encourages states to consider CMP reinvestment proposals that would utilize funds to prevent improper facility-initiated discharges.
Effective date: Immediately. The memorandum should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of the memorandum.
Revised Rural Health Clinic (RHC) Guidance--State Operations Manual (SOM) Appendix G - Advanced Copy
On December 22, CMS published a Memorandum for state survey agency directors regarding updated guidance in SOM Appendix G for RHCs. The update addresses the following topics:
- Addition of a survey process component
- Reorganized guidance to include Automated Survey Processing Environment (ASPEN) Tag numbers
- Renumbered tags
- Updated and clarified guidance on Conditions for Certification
- Timing of ASPEN changes
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 the memorandum.
Interim Final Rule: Medicare Shared Savings Program: Extreme and Uncontrollable Circumstances Policies for Performance Year 2017
On December 26, CMS published an Interim Final Rule with Comment Period in the Federal Register regarding policies for assessing the financial and quality performance of the Medicare Shared Savings Program Accountable Care Organizations (ACOs) affected by extreme and uncontrollable circumstances during the 2017 performance year. Comments on the interim final rule are due no later than 5 p.m. on February 20, 2018.
Effective date: These regulations are effective on January 20, 2018.
Comment Request: Appointment of Representative
On December 26, CMS published a Comment Request in the Federal Register regarding the Appointment of Representative information collection. Comments on the information collection are due by February 26, 2018.
Correction: Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems and Quality Reporting Programs Final Rule
On December 26, CMS published a Correction in the Federal Register to the OPPS final rule. The correction addresses numerous technical errors in the final rule, including:
- A correction to the OPPS weight scalar based on the conforming Ambulatory Payment Classification (APC) assignment of HCPCS code 93880 in APC 5522 to APC 5523
- A correction to the list of APCs excepted from the 2 times rule for 2018 due to the corrected OPPS APC geometric mean cost as a result of the conforming policy correction to the imaging without contrast APCs
- The inclusion of vaccines assigned to OPPS status indicator “F” from the 340B payment adjustment exclusion
- The reassignment of 17 HCPCS codes in Addendum B to OPPS status indicator “A” instead of status indicator “Q4”
The corrections apply to the amended version of the OPPS final rule published in the Federal Register on December 14, 2017. The original version of the OPPS final rule, printed in the Federal Register on November 13, 2017, mistakenly omitted a section of the document due to a printing error.
CMS also published a Correction Notice to their website with corrected versions of the downloadable Addendum, HCPCS Offset file, and Cost Statistics file.
Effective date: January 1, 2018
2019 Medicare Advantage Part 1 Advance Notice - Risk Adjustment
On December 27, CMS published a Fact Sheet regarding Part 1 of the 2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies. The Advance Notice contains information about proposed updates to the Part C Risk Adjustment Model and the use of encounter data. There will be a 60-day comment period for the policies introduced in Part 1 of the Advance Notice.
Comments are due by March 2, 2018.
Correction: Medicare Program Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-For-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program
On December 28, CMS published a Correction in the Federal Register to the Contract Year 2019 Policy and Technical Changes proposed rule. The correction addresses minor technical and typographical errors in the proposed rule, including inadvertently omitted regulations text requiring MA plans and Part D Sponsors to provide certain information by the first day of the annual enrollment period.
Texting of Patient Information among Healthcare Providers
On December 28, CMS published a Memorandum for state survey agency directors regarding the agency’s policy on texting of patient information among healthcare providers. The memorandum notes that texting patient information among members of the healthcare team is permissible if it is done through a secure platform, but texting of patient orders is prohibited regardless of platform. The memorandum also notes that the preferred method of order entry is via Computerized Provider Order Entry (CPOE).
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 the memorandum.
Updated Civil Monetary Penalties and Affirmative Exclusions
On December 29, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusion agreements reached in December, including:
- Greenville Hospital Corporation d/b/a L.V. Stabler Memorial Hospital (L.V. Stabler), of Greenville Alabama, entered into a $20,000 settlement with the OIG on December 4 to resolve allegations that it violated the Emergency Medical Treatment and Labor Act by failing to provide an adequate medical screening examination and stabilizing treatment to a 16-year-old pregnant patient, who later delivered a stillborn infant at a hospital 55 miles away from L.V. Stabler.
Update to Chapter 15 of Pub. 100-08
On December 29, CMS published Medicare Program Integrity Transmittal 762 to clarify requirements for issuing revalidation approval letters and releasing information to callers over the phone.
Effective date: January 29, 2018
Implementation date: January 29, 2018
Revisions to State Operation Manual (SOM) Appendix A - Survey Protocol, Regulations, and Interpretive Guidelines for Hospitals
On December 29, CMS published State Operations Provider Certification Transmittal 176 regarding revisions to Appendix A of the manual. These revisions are directed at hospitals and revise current interpretive guidelines regarding the assessment of ligature risks to patients.
Effective date: December 29, 2017
Implementation date: December 29, 2017
Method of Cost Settlement for Inpatient Services for Rural Hospitals Participating Under the Rural Community Hospital Demonstration
On December 29, CMS published One-Time Notification Transmittal 1991 regarding the expansion of the Rural Community Hospital Demonstration. The transmittal provides the newest payment methodology for the current round of the demonstration, the list of previously participating and newly selected hospitals, the periods of performance for all hospitals (previously and newly participating), the methodology for establishing enhanced interim payments for the newly participating hospitals, and requirements for the MACs collaborating with a separate audit contractor.
Effective date: May 1, 2015
Implementation date: January 29, 2018