This week in Medicare updates—01/27/2016
Effectiveness of hyaluronic acid in the treatment of severe degenerative joint disease (DJD) of the knee
On January 19, CMS posted a technology assessment regarding the effectiveness of using hyaluronic acid when treating severe DJD, often called osteoarthritis, of the knee.
View the technology assessment.
Final notice of modification and termination of OIG Advisory Opinion No. 08-17
On January 20, the OIG posted an opinion regarding Advisory Opinion No. 08-17, which it issued on October 14, 2008, and subsequently modified on October 27, 2010 and April 4, 2012. In OIG Advisory Opinion No. 08-17, as modified, the OIG concluded that: (i) the foundation’s then-proposed arrangement to provide financial assistance to financially needy patients with cystic fibrosis who have insurance coverage, including coverage under Medicare and Medicaid, but who cannot afford the costs associated with their prescription drug coverage, would not constitute grounds for the imposition of civil monetary penalties; and (ii) although the arrangement could potentially generate prohibited remuneration under the federal anti-kickback statute if the requisite intent to induce or reward referrals of federal healthcare program business were present, the OIG would not impose administrative sanctions on the foundation.
View the opinion.
Terminated Advisory Opinion No. 10-06
On January 20, the OIG posted an opinion regarding Advisory Opinion No. 10-06, which was issued on May 20, 2010. In OIG Advisory Opinion No. 10-06, the OIG concluded (i) the corporation’s arrangement to provide financial assistance to financially needy patients in connection with premium and cost-sharing obligations associated with their prescription drug coverage would not constitute grounds for the imposition of civil monetary penalties; and (ii) although the arrangement could potentially generate prohibited remuneration under the federal anti-kickback statute if the requisite intent to induce or reward referrals of federal healthcare program business were present, the OIG would not impose administrative sanctions on the corporation.
View the opinion.
Interim report on national background check program for long term care employees
On January 20, the OIG posted a report describing the overall implementation status and states' results from the first four years of the national background check program for long term care employees. This report also provides CMS with information that may assist its ongoing administration of this program. OIG also plans to issue a final evaluation of the grant program after its completion.
View the report.
Off-campus provider based department modifier -PO FAQ
On January 20, CMS posted a document with FAQs and the answers to those questions. The FAQs are regarding off-campus provider based department use of modifier -PO.
View the frequently asked questions.
CMS rescinds home health face-to-face special edition MLN Matters article
On January 20, CMS announced that Special Edition MLN Matters Article SE1405 “Documentation Requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounter” was rescinded. It did not identify a reason for rescinding the article or indicate if or when it would be replaced.
Covered outpatient drugs final rule with comment
On January 21, CMS posted a fact sheet and press release detailing the Covered Outpatient Drugs final rule with comment period, which addresses key areas of Medicaid drug reimbursement and changes made to the Medicaid Drug Rebate Program by the Affordable Care Act. This final rule assists states and the federal government in managing drug costs, establishes the long term framework for implementation of the Medicaid drug rebate program, and creates a fairer reimbursement system for Medicaid programs and pharmacies.
View the fact sheet.
View the press release.
Reviewers' credentials, notifying the provider, CARC code update
On January 22, CMS issued a change request to instruct MACs that they shall maintain a record of their medical reviewers' credentials and furnish them to providers upon request and also include them in the Appeal administrative files. CMS’ Center for Program Integrity has added an additional requirement to the post payment review results letter.
Effective date: April 22, 2016–the effective date is the process date
Implementation date: April 22, 2016
View Transmittal R634PI.
Issuing continuing compliance letters to specific providers and suppliers
On January 22, CMS issued a change request stating that, per 42 CFR §424.516(d) and (e), providers/suppliers are required to report changes in practice locations within 30 or 90 calendar days of the change, depending on provider/supplier type. If changes are not reported and providers/suppliers are found to be out of compliance, revocation actions are initiated. CMS is revising part of the revocation process for certain selected providers/suppliers to correct a noncompliance violation prior to proceeding with the revocation process.
Effective date: February 22, 2016
Implementation date: February 22, 2016
View Transmittal R1595OTN.
Explanation of FY 2004 outlier fixed-loss threshold as required by court rulings
On January 22, CMS posted a clarification in the Federal Register providing further explanation of certain methodological choices made in the FY 2004 fixed-loss threshold determination, in accordance with court rulings in cases that challenge the federal FY 2004 outlier fixed-loss threshold rulemaking.
View the notice in the Federal Register.