Medicare Update

CMS to Hold Home Health, Hospice & DME Open Door Forum

The Centers for Medicare & Medicaid Services (CMS) will hold the next Home Health, Hospice & DME Open Door Forum at 2:00 p.m. (EDT) on May 13, 2008.  There are 2 ways to participate in the Open Door Forum.   

To participate by telephone, one must dial 1-800-837-1935 and reference conference ID 41864430.  To participate in person, RSVP and security clearance is required.  Further, one must RSVP by 2:00 p.m. (EDT) on May 9, 2008 to HOMEHEALTH_HOSPICE_DMEODF-L@cms.hhs.gov, and include your name, organization, phone number, and the words “Home Health” in the subject line.  The Open Door Forum will take place at the Hubert H. Humphrey Building, 200 Independence Avenue S.W., Washington, D.C. 

Starting 2 hours after the Open Door Forum, CMS will also make an audio recording available.  To access the audio recording, one must dial 1-800-642-1687 and enter the conference ID.  The recording will expire after 3 business days.

CMS Proposes 2009 Medicare Hospice Wage Index Changes

On April 28, 2008, the Centers for Medicare & Medicaid Services (CMS) posted a display copy of a Proposed Rule that would update and revise the Medicare hospice wage index for fiscal year (FY) 2009. 

According to the Proposed Rule, CMS proposes to phase-out the Medicare hospice budget neutrality adjustment factor (BNAF) over 3 years, reducing it by 25 percent in FY 2009, by 75 percent for FY 2010, and eliminating it completely for FY 2011.  However, CMS indicates that it may determine that a different percentage reduction in the BNAF, or a different phase-out time frame, would be more appropriate. Nevertheless, CMS projects that the elimination of this adjustment will save the Medicare program approximately $2.29 billion over 5 years.

In the Proposed Rule, CMS also seeks to clarify 2 wage index issues pertaining to the definition of rural and urban areas and to multi-campus hospital facilities. The Proposed Rule is scheduled to appear in the Federal Register on May 1, 2008.  CMS reports that a final rule will be published in August 2008. For additional information, CMS has published a Fact Sheet on the proposed changes.

CMS Updates Nursing Home Compare and Releases Quality Action Plan

On April 24, 2008, the Centers for Medicare & Medicaid Services (CMS) issued a Press Release announcing that the Nursing Home Compare website now provides information regarding whether a nursing home is or has been on CMS' special focus facility (SFF) list. 

According to CMS, the SFF initiative was created because a number of facilities were consistently providing poor quality of care, yet were periodically instituting enough improvement to pass one survey only to fail the next.  As of April 2008, CMS reports that there are 134 SFFs out of approximately 16,000 active nursing homes.  Once a nursing home is selected as a SFF, a state survey agency will conduct twice the number of standard surveys and apply progressive enforcement until the nursing home:

• significantly improves and graduates from the SFF initiative;
• is granted additional time due to promising developments; or
• is terminated from the Medicare and/or Medicaid programs.

In conjunction with the Nursing Home Compare changes, CMS has also released a 2008 Action Plan for Further Improvement of Nursing Home Quality (Action Plan).  CMS reports that the Action Plan consists of 5 inter-related and coordinated approaches to improving quality.  In brief, those approaches include:

• Consumer Awareness & Assistance. CMS intends to provide an increasing array of information about long-term care that will be written in an easy-to-understand format and be available at www.medicare.gov.
• Survey, Standards & Enforcement Processes.  During 2008, CMS intends to undertake initiatives to improve the effectiveness of annual nursing home surveys and investigations prompted by complaints. CMS also plans to work with the states to improve current enforcement efforts.
• Quality Improvement. CMS will focus on a number of key quality areas, including reductions in the use of physical restraints, reductions in the prevalence of preventable pressure sores, and greater emphasis on developing individualized care plans.
  
• Quality Through Partnerships. CMS intends to continue and strengthen its partnerships with non-governmental organizations that are committed to quality improvement in nursing homes.
• Value-Based Purchasing. CMS intends for the Nursing Home Value-Based Purchasing Demonstration to augment and reinforce other quality efforts.

CMS Releases Proposed Inpatient Rehabilitation Payment Rule for Fiscal Year 2009

On April 21, 2008, the Centers for Medicare & Medicaid Services (CMS) issued a Press Release announcing the release of a display copy of a proposed rule (Proposed Rule) that would update the prospective payment rates for inpatient rehabilitation facilities (IRF) for fiscal year (FY) 2009. In brief, the proposed changes include:

• CMG Relative Weights.  The current case mix group (CMG) relative weights are based on FY 2003 data.  For FY 2009, CMS proposes to update the CMG relative weights and average length of stay values using FY 2006 data. 
• Outlier Threshold.  For FY 2009, CMS proposes an outlier threshold of $9,191, which is estimated to maintain outlier payments equal to 3.0 percent of the total estimated payments for FY 2009.
• Wage Index Adjustment. To determine FY 2009 rates, CMS proposes to continue using the pre-reclassification and pre-floor hospital wage indexes. 
• Policy Clarifications. In the Proposed Rule, CMS also seeks to clarify policies regarding "New England deemed counties" and multi-campus hospitals to be consistent with IPPS and other post acute care settings.  CMS will update the IRF wage index tables based on the OMB bulletins used to update the hospital wage data.
  
• MMSEA. The Proposed Rule would implement aspects of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) by setting the compliance percentage at 60 percent for cost reporting periods beginning on or after July 1, 2006 and by continuing to count comorbidities when determining IRF compliance with the threshold. CMS would also update the IRF payment rates by 0 percent for FY 2009.

According to CMS, the Proposed Rule is expected to result in a decrease in aggregate IRF payments of $20 million for FY 2009.  The Proposed Rule is scheduled to be published in the Federal Register on April 25, 2008.  CMS expects to publish a final rule on or before August 1, 2008.

CMS Releases Proposed IPPS Rule for Fiscal Year 2009

The Centers for Medicare & Medicaid Services (CMS) recently released a display copy of a proposed rule (Proposed Rule) that would make payment and policy changes to the Medicare hospital inpatient prospective payment system (IPPS) for fiscal year (FY) 2009. In brief, the proposed changes include:

• Market Basket Update.  For FY 2009, CMS projects that the market basket update will be 3.0 percent. However, hospitals that do not successfully report on the quality measures in FY 2009 would receive a market basket update of 1.0 percent.
• Quality Measures.  CMS proposes to add 43 new measures, and retire 1 measure, for the FY 2009 reporting period.  If adopted, the total number of measures for reporting for the FY 2010 update would be 72.  CMS has released a Fact Sheet on these proposed changes.
  
• Hospital Acquired Conditions.  CMS proposes to add additional categories of conditions that when acquired in the hospital will no longer lead to higher Medicare payment, including at least 1 from the National Quality Forum "never events" list that is associated with hypoglycemia.  CMS has released a Fact Sheet on these proposed changes.
• Relative Weights.  As part of the 3-year transition to cost-based weights, CMS proposes to base relative weights 100 percent on costs in FY 2009.  CMS also proposes to add a cost center to the cost report to allow costs and charges for relatively inexpensive medical supplies to be reported separately from the costs and charges of more expensive devices.
• Behavioral Offset.  Pursuant to the TMA, Abstinence Education and QI Programs Extension Act of 2007, CMS proposes to reduce the payment rates by -0.9 percent for FY 2009.
• MS-DRG Classifications.  CMS proposes changes to certain MS-DRG classifications for FY 2009, including MS-DRG 245 (AICD Lead and Generator Procedures).
• Outlier Threshold.  Based on current data, CMS proposes an outlier threshold of $21,025 for FY 2009, which would be lower than the threshold for FY 2008 ($22,185).
• Post-Acute Transfer Policy.  For FY 2009, CMS would apply the post-acute transfer policy to 273 MS-DRGs.
• New Technology Add-On Payments. Among other things, CMS would set July 1 of each year as the deadline by which new technology applicants must receive FDA approval or clearance to allow CMS enough time to fully consider all new technology add-on criteria in time for publication of the annual IPPS final rule.
• Wage Index and Data.  For FY 2009, CMS proposes a national average hourly wage of $32.2252, which would be an increase of 4.2 percent over the figure for FY 2008.  CMS also proposes to apply a statewide (rather than a nationwide) rural and imputed floor budget neutrality adjustment to the wage index beginning in FY 2009. CMS has released a background document addresses some of these changes.
• Geographic Reclassification.  CMS proposes to change the average hourly wage (AHW) comparison criteria that a hospital must satisfy for the Medicare Geographic Classification Review Board to approve a geographic reclassification.  For instance, CMS proposes that an urban hospital seeking reclassification have an AHW of at least 88 percent (rather than 84 percent) of the AHW for the area to which it seeks reclassification.
• EMTALA.  CMS proposes changes to the Emergency Medical Treatment and Labor Act (EMTALA) requirements, including changes that would allow hospitals to comply with the on-call list requirement by participating in a formal community call plan.  CMS also proposes to clarify the EMTALA obligations of hospitals with specialized capabilities.

In the Proposed Rule, CMS proposes to modify the physician self-referral "stand in the shoes" provisions to accommodate certain financial transactions between physicians and academic medical centers or integrated healthcare delivery systems.  CMS also solicits public comment on gainsharing arrangements and on a mandatory "Disclosure of Financial Relationships Report" that would collect information about the financial relationships between hospitals and physicians. 

The proposed IPPS changes would be applicable to discharges occurring on or after October 1, 2008.  With CMS' release of the display copy of the Proposed Rule, CMS also released a Fact Sheet addressing some of the proposed IPPS payment and policy changes for FY 2009.  The Proposed Rule is scheduled to appear in the Federal Register on April 30, 2008.

Senators Commend CMS Changes to Physician Quality Reporting Initiative

On April 18, 2008, Senate Finance Committee Chairman Max Baucus and Ranking Member Charles Grassley issued a Press Release commending the Centers for Medicare & Medicaid Services' (CMS) recent improvements to the Physician Quality Reporting Initiative (PQRI). In fact, in the Press Release, Chairman Max Baucus states:

"Expanding the physician quality reporting initiative will improve care and encourage the development of more meaningful, evidence-based ways to measure quality...The improvements CMS is making will drive the creation of better models for collecting and analyzing clinical information. This move is a step in the right direction on the long, careful path toward linking physician payments to the quality of care they provide.  We still have a ways to go, but I applaud CMS for its efforts..."

On April 17, 2008, CMS issued a Press Release announcing the steps that it has taken to encourage physicians and other eligible professionals to take part in PQRI. Some of those steps arise from the Medicare, Medicaid and SCHIP Extension Act of 2007, which authorized CMS to establish alternative reporting criteria and reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.

CMS to Host Hospital/Hospital Quality Open Door Forum

The Centers for Medicare & Medicaid Services (CMS) will hold the next Hospital/Hospital Quality Open Door Forum (Forum) at 2:00 p.m. (EDT) on April 24, 2008.

There are 2 ways to participate in the Forum.  To participate by telephone, one must dial 1-800-837-1935 and reference conference ID 37603711.  To participate in person, one must RSVP to CMS HOSPITALODF-L@cms.hhs.gov by 2:00 p.m. (EDT) on April 22, 2008, and include "Hospital/Hospital Quality" in the subject line, your name, organization/representation and telephone number. The Forum will be held at the Hubert H. Humphrey Building, 200 Independent Avenue S.W., Washington, DC. 

Beginning April 28, 2008, CMS will also make an audio recording of the Forum available.  To access the audio recording, one must dial 1-800-642-1687 and reference the conference ID.  The audio recording will be available for 3 business days.

CMS Releases Alternative PQRI Reporting Periods and Criteria

On April 18, 2008, Centers for Medicare & Medicaid Services (CMS) released a document establishing alternative reporting periods and criteria for satisfactorily reporting quality measures for the 2008 Physician Quality Reporting Initiative (PQRI).  The Medicare, Medicaid and SCHIP Extension Act of 2007 authorized CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.  The release of the document follows CMS' recent announcement that it will host a national provider conference call on the 2008 PQRI on April 30, 2008.

CMS to Host Conference Call on 2008 Physician Quality Reporting Initiative

The Centers for Medicare & Medicaid Services (CMS) recently announced that it will host a national provider conference call on the 2008 Physician Quality Reporting Initiative (PQRI).  The conference call will take place from 1:30 p.m. - 3:30 p.m. (EDT) on April 30, 2008.

The Medicare, Medicaid and SCHIP Extension Act of 2007 (Act) authorized CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.  The Act also removed the cap on incentive payments. During the conference call, CMS is expected to address its new authority, including alternative reporting criteria and alternative reporting periods. Following the CMS presentation, callers will have an opportunity to ask questions.

CMS reports that materials for the conference call will be posted on the CMS website prior to the call in the Educational Resources section on the PQRI webpage. To participate in the conference call, registration is required. Registration will close at 1:30 p.m. (EDT) on April 29, 2008 or when available space has been filled.  For those unable to participate in the conference call, a replay of the call will be accessible from 3:30 p.m. (EDT) on April 30, 2008 until 11:59 p.m. (EDT) on May 7, 2008.  To access the replay, one must call 1-800-642-1687 and use passcode 42860144.

On April 17, 2008, CMS also issued a Press Release announcing the steps that it has taken to encourage physicians and other eligible professionals to take part in PQRI.

OIG Publishes Draft Supplemental Compliance Program Guidance for Nursing Facilities

On April 15, 2008, the Department of Health and Human Services' Office of Inspector General (OIG) released Draft OIG Supplemental Compliance Program Guidance (CPG) For Nursing Facilities.  The draft supplemental CPG for nursing facilities is intended to supplement the OIG's original CPG for nursing facilities, which was published in the Federal Register on March 16, 2000.  In fact, the OIG reports that the 2 documents "collectively offer a set of guidelines that nursing facilities should consider when developing and implementing a new compliance program or evaluating an existing one." The Draft OIG Supplemental Compliance Program Guidance (CPG) For Nursing Facilities is expected to appear as a Proposed Notice in the Federal Register on April 16, 2008.