This week in Medicare Updates – 12/20/17

Memo: Clarification of Ligature Risk Policy

On December 8, CMS issued a Memorandum to state survey agency directors regarding the drafting of comprehensive ligature risk interpretive guidance to provide more clarity and direction for regional offices, state survey agencies, and accrediting organizations. The memo reviews the definition of a ligature risk and provides interim guidance on processes for dealing with ligature risks. The memo also details CMS’s plan and timeline for creating the new comprehensive ligature risk interpretive guidance.

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.

 

Medicare Quarterly Provider Compliance Newsletter October 2017

On December 8, CMS posted the Medicare Quarterly Provider Compliance Newsletter for October 2017. This edition of the newsletter provides education on how to avoid compliance issues related to the following:

• Insufficient documentation for arthroscopic rotator cuff repair
• Improper payments for hospital outpatient services
• Local coverage determination (LCD) conflicts for lower limb suction valve prosthetics

 

Inpatient Rehabilitation Facility (IRF) Medical Review Changes

On December 11, CMS issued Special Edition MLN Matters 17036 to reiterate policies for claims submitted for services provided to Medicare beneficiaries in IRFs. The article identifies the documentation necessary to support an IRF claim under the Medicare IRF benefit, the requirements for post-admission physician evaluations associated with an IRF stay, and the time allotted to therapy in covered stays.

Effective date: N/A

Implementation date: N/A

 

Medicare Care Choices Model (MCCM): The First Two Years

On December 11, CMS published a Fact Sheet reviewing the first two years of the MCCM program, which allows beneficiaries who qualify for the Medicare hospice benefit to have the option to receive curative treatment for their terminal condition while also receiving hospice care. The fact sheet reviews enrollment data and changes to eligibility requirements from the first two years of the program.

 

Advisory Opinion on Collaboration Between Pharmaceutical Manufacturer, Trade Association, Medicare Advantage Plan, and Hospital System

On December 11, the OIG posted Advisory Opinion 17-07 regarding a pharmaceutical manufacturer’s proposal to collaborate with a trade association, a Medicare Advantage plan, and a hospital system to implement, fund, and evaluate a pilot program providing new technology to Medicare Advantage plan pharmacists. This technology would allow for the pharmacists to receive real-time electronic access to patient discharge information. The submitter sought an opinion on whether the arrangement would violate the exclusion authority or civil monetary penalty provisions of the Social Security Act.

The OIG concluded that, while the arrangement could generate prohibited remuneration under the anti-kickback statute depending on intent, the OIG would not impose sanctions in that specific case due to the number of safeguards in place to reduce risk of improper remuneration, the lack of interference the program would pose to pharmacists’ clinical decision-making, the possibility of improving patient quality of care, and the relatively small scope of the arrangement.

 

Inpatient Rehabilitation Facility (IRF) Compare Website - New Measures Added

On December 12, CMS published a Fact Sheet regarding the IRF Compare website and the new quality measures added as of December 12. These quality measures include:

• Percent of Residents or Patients Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccination (NQF #0680)
• Influenza Vaccination among Healthcare Personnel (NQF #0431)
• National Healthcare Safety Network (NHSN) Facility-Wide Inpatient Hospital-Onset Methicillin resistant Staphylococcus aureus Bacteremia Outcome Measure (NQF #1716)
• NHSN Facility-Wide Inpatient Hospital-Onset Clostridium difficile Infection (CDI) Outcome Measure (NQF #1717)

The fact sheet also includes information on measures currently displayed on IRF Compare, relevant data, and resources available to providers.

 

Long-Term Care Hospital (LTCH) Compare Website - New Measures Added

On December 12, CMS published a Fact Sheet regarding the LTCH Compare website and the new quality measures added as of December 12. These quality measures include:

• Percent of Residents or Patients Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccination (NQF #0680)
• Influenza Vaccination among Healthcare Personnel (NQF #0431)
• National Healthcare Safety Network (NHSN) Facility-Wide Inpatient Hospital-Onset Methicillin resistant Staphylococcus aureus Bacteremia Outcome Measure (NQF #1716)
• NHSN Facility-Wide Inpatient Hospital-Onset Clostridium difficile Infection (CDI) Outcome Measure (NQF #1717)

The fact sheet also includes information on measures currently displayed on LTCH Compare, relevant data, and resources available to providers.

 

Extension of Prior Authorization for Repetitive Scheduled Non-Emergent Ambulance Transports

On December 12, CMS published a Notice in the Federal Register to announce a one-year extension of the Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport. The extension applies to the following locations:

• Delaware
• District of Columbia
• Maryland
• New Jersey
• North Carolina
• Pennsylvania
• South Carolina
• Virginia
• West Virginia

Effective date: The extension begins December 5, 2017 and ends December 1, 2018. Prior authorization is available upon provider, supplier, or beneficiary request for dates of service between December 2, 2017 and December 4, 2017.  

 

Final Rule Republication: Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System and Quality Reporting Programs

On December 14, CMS republished a Final Rule in the Federal Register for the OPPS and ASC Payment System and Quality Reporting Programs. One section was omitted from the original final rule, which was published in the Federal Register on November 13, 2017, due to a printing error. The republication of the final rule on December 14 contains the corrected document in its entirety.

Effective date: January 1, 2018 unless otherwise noted    

 

Updated Corporate Integrity Agreement Documents

On December 14, the OIG published information on a new Corporate Integrity Agreement with East Central Oklahoma Family Health Center, Inc., of Wetumka, OK.

 

Follow-up Review: CMS’s Management of the Quality Payment Program (QPP)

On December 14, the OIG published a Report on a follow-up review of CMS’s management of the QPP. The OIG found that CMS has made progress toward implementing the QPP in regards to preparing and deploying IT systems needed for data submission by January 1, 2018, and CMS has conducted outreach toward clinicians who will be participating in the program.

However, the OIG also concluded that there are two vulnerabilities which are critical for CMS to address in 2018. These include providing sufficient technical assistance to clinicians in order to prevent clinicians from encountering difficulty or declining to participate due to technical matters, and developing and implementing a comprehensive program integrity plan for the QPP.

 

CMS Adds New Quality Information to the Physician Compare Website

On December 14, CMS published a Fact Sheet regarding updates to the Physician Compare website. Beginning in December 2017, CMS will start publicly reporting certain 2016 performance information on Physician Compare. The fact sheet contains information on which types of clinical care measures will be added, how 2016 data will be reported, and how star ratings work on the website.

 

CMS strengthens federal support to California residents affected by wildfires

On December 15, CMS published a Press Release to announce administrative actions it is taking to assist the California residents displaced by and recovering from wildfires within the state. These actions include:

• Waivers for skilled nursing facilities and assistance for hospitals and other healthcare facilities
• Special enrollment opportunities and Medicare flexibilities
• Alternative locations for dialysis care
• A healthcare provider hotline for non-certified Part B suppliers, physicians, and non-physician practitioners assisting in recovery efforts who will need temporary Medicare billing privileges  

Additional information on CMS assistance with wildfire recovery is available on CMS’ emergency webpage.

 

Advisory Opinion on Nursing Facility Discounts

On December 15, the OIG posted Advisory Opinion 17-08 regarding a proposal to develop a statewide network of nursing facilities that would provide discounts on the daily rates they charge to private long-term care insurers and the insurers’ policyholders. The submitter sought advice on whether the arrangement would violate civil monetary penalty provisions.

The OIG concluded that, while the arrangement could generate prohibited remuneration under the anti-kickback statute depending on intent, the OIG would not impose sanctions in that specific case due to the following reasons:

• There is always uncertainty as to whether affected beneficiaries would need follow-up care in the form of a federally reimbursable stay
• The beneficiary would not be required to receive federally reimbursable items or services from that specific nursing facility to receive the discount
• The arrangement would not unfairly affect competition among nursing facilities
• The arrangement does not constitute the highly problematic steering arrangements structured to “leapfrog” or bypass providers equipped to provide quality medical care
• There are other considerations unrelated to the discount offered in this arrangement which influence a beneficiary’s decision-making process about where to reside

 

Update to OIG Work Plan

On December 15, the OIG updated its Work Plan to include the following reviews:

• Impact of the Indian Health Service's Delivery of Information Technology/Information Security Services and Opioid Prescribing Practices
• Prescription Opioid Drug Abuse and Misuse Prevention - Prescription Drug Monitoring Programs
• Review of CMS Systems Used to Pay Medicare Advantage Organizations

 

Calendar Year (CY) 2018 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

On December 15, CMS published Medicare Claims Processing Transmittal 3934 regarding a recurring update notification which provides instructions for the CY 2018 clinical laboratory fee schedule, mapping for new codes for clinical laboratory tests, and updates for laboratory costs subject to the reasonable charge payment.

Effective date: January 1, 2018

Implementation date: January 2, 2018