Medicare Update

CMS to Host End Stage Renal Disease Open Door Forum

The Centers for Medicare & Medicaid Services (CMS) will hold the first End Stage Renal Disease (ESRD) Open Door Forum of 2008 at 2:00 p.m. (EDT) on April 17, 2008.  The focus of the Open Door Forum will be the ESRD conditions for coverage Final Rule that CMS released on April 3, 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 30068679.  To participate in person, one must RSVP by 2:00 p.m. (EDT) on April 15, 2008 to ESRDODF-L@cms.hhs.gov, and include your name, organization, phone number, and “ESRD” 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. 

Beginning on April 21, 2008, 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 Releases Final Rule for ESRD Facilities

On April 3, 2008, the Centers for Medicare & Medicaid Services (CMS) issued a Press Release announcing that it has released a display copy of a Final Rule, which establishes new conditions for coverage that dialysis facilities must satisfy to be certified under the Medicare program. According to CMS, the Final Rule reflects advances in dialysis technology and standard care practices since the existing conditions for coverage were issued in 1976.  CMS has posted a Fact Sheet on the CMS website.  The Final Rule is expected to appear in the Federal Register  during April 2008.

CMS Revises CMS-855 Medicare Enrollment Applications

The Centers for Medicare & Medicaid Services recently posted revised CMS-855 Medicare enrollment application forms on the CMS website.  With the exception of providers enrolling as a specialty hospital, a MLNMatters article indicates that Medicare contractors will continue to accept the 2006 version of the Medicare enrollment application through June 2008. However, the MLNMatters article indicates that providers and suppliers should begin to use the new Medicare enrollment applications immediately.  For more information (including information on significant revisions), see the MLNMatters article and the revised CMS-855 Medicare enrollment application forms.   

CMS Releases List of Special Focus Facility Nursing Homes

On February 12, 2008, the Centers for Medicare & Medicaid Services (CMS) issued a Press Release announcing that it has posted a broader list of the nursing homes identified as part of the Special Focus Facility (SFF) initiative. 

In November 2007, CMS released a list of 54 SFF nursing homes that had failed to improve significantly after being given an opportunity to do so. The broader list reportedly includes all nursing homes in the SFF initiative and identifies the facilities by category, including:

• New Additions:  Nursing homes added within approximately the past 6 months.
• Not Improved:  Nursing homes that have failed to improve significantly in at least 1 survey after being named as a SFF nursing home.
• Improving: Nursing homes that have significantly improved on the most recent survey, including no findings of harm to any resident and no systematic potential for harm.
• Recently Graduated: Nursing homes that have sustained significant improvement for about 12 months, indicating an upward trend in quality improvement compared to the nursing home's prior history of care.
• No Longer in Medicare & Medicaid: Nursing homes that were either terminated by CMS from participation in Medicare within the past few years or voluntarily chose not to continue participation.

According to the Press Release, CMS intends to add cross links between the individual nursing home pages on the nursing home compare website with the full SFF list in April 2008.  In August 2008, CMS also expects to provide more information on methods by which SFFs may access additional technical assistance to improve their quality of care.

In 1998, CMS created the SFF initiative in response to the number of facilities that were consistently providing poor quality of care and periodically instituting enough improvement to pass one survey, only to fail the next. 

CMS reports that there are currently about 131 active facilities identified as SFFs.  According to CMS, about 50 percent of the nursing homes identified as SFFs significantly improve their quality of care within 24-30 months.  However, CMS reports that about 16 percent are eventually terminated from the Medicare and Medicaid programs.

CMS Extends Timeline for ESRD Facility Final Rule

On February 4, 2008, the Centers for Medicare & Medicaid Services (CMS) published a Notice in the Federal Register extending the timeline for publishing the "Medicare and Medicaid Programs; Conditions of Coverage for End Stage Renal Disease Facilities" final rule.   

On February 4, 2005, CMS published a Proposed Rule in the Federal Register that would establish new certification requirements for Medicare coverage of dialysis facilities. According to CMS, the proposed revisions would reflect advances in dialysis technology and standard care practices that have been developed since the requirements were last revised in 1976. 

In October 2007, CMS reported that a final rule had been drafted, was in the approval process, and would be published by February 4, 2008.  However, CMS now reports that an extension of the publication timeline is necessary and appropriate to ensure that it is able to address all comments and issues raised in response to the Proposed Rule.  According to the Notice, CMS has extended the timeline for the publication of the final rule until February 4, 2009.

CMS Extends Medicare Participation Decision Period for Physicians

Due to the enactment of the Medicare, Medicaid and SCHIP Extension Act of 2007 (Act), the Centers for Medicare & Medicaid Services (CMS) reports that it is extending the participation decision period an additional 45 days. 

The Medicare Physician Fee Schedule Final Rule for 2008 provided for a 10.1 percent reduction in the Medicare payment rate for physician services beginning January 1, 2008.  The Act prevented the 10.1 percent reduction from taking effect on January 1, 2008 and replaced it with a 0.5 percent increase through June 30, 2008.  Due to this late change, CMS reports that the participation decision period will now run through February 15, 2008, instead of ending on December 31, 2007.  However, all participating status changes will be effective January 1, 2008.

CMS Releases List of Poor Performing Nursing Homes

On November 29, 2007, the Centers for Medicare & Medicaid Services (CMS) announced in a Press Release that it has released a list of 54 poor performing nursing homes as part of the "Special Focus Facility" (SFF) initiative.

According to the Press Release, the list was prompted by the number of facilities that were consistently providing poor quality of care, yet were periodically instituting enough improvement to pass one survey only to fail the next.  Further, CMS reports that its effort to identify poor performing nursing homes is intended to "promote more rapid and substantial improvement in the quality of care" and "end the pattern of repeated cycles on non-compliance."

In recent testimony before the Senate Special Committee on Aging, the Acting CMS Administrator stated that:

"Nursing homes on the Special Focus list represent those with the worst survey findings in the country, based on the most recent three years of survey history.  The selection methodology takes into account for the severity of deficiencies and the number of deficiencies.  Deficiencies identified during complaint investigations are also included in the computation.  Each state selects its Special Focus nursing homes from a CMS candidate list of approximately 15 eligible nursing homes in their own State, using additional information available to the State regarding the nursing homes' quality of care in order to make the final selection."

Once a nursing home is selected as a SFF, CMS reports that a state survey agency will conduct twice the number of standard surveys and apply aggressive enforcement until the nursing home: significantly improves and is no longer identified as a SFF; is granted additional time due to promising developments; or is terminated from the Medicare and/or Medicaid programs.

In the Press Release, CMS indicates that nursing homes typically achieve improved survey results after being selected for the SFF initiative, with about 50 percent significantly improving their quality of care within 24-30 months.  However, CMS also reports that about 16 percent are terminated from the Medicare and Medicaid programs. 

Additional information on the SFF initiative can be found in a December 16, 2004 memorandum and November 2, 2007 memorandum to State Survey Agency Directors.

CMS Gives Survey of New Providers Lower Priority

In a November 5, 2007 memorandum to State Survey Agency Directors (Memorandum), the Centers for Medicare & Medicaid Services (CMS) recently addressed CMS's Medicare survey and certification priorities.

In the Memorandum, CMS directs states to prioritize the survey function in four tiers, and gives a lower priority (Tier 4) to the initial survey for providers and suppliers seeking to participate in the Medicare program for the first time. In fact, CMS reports that longstanding CMS policy makes complaint investigations, recertifications and core infrastructure work for existing Medicare providers a higher priority than the certification of new providers.

However, CMS points out that many provider and supplier types (e.g., hospitals, ambulatory surgery centers, hospices and home health agencies) have the option of becoming Medicare certified on the basis of accreditation by a CMS-approved accreditation organization rather than CMS or state survey.  CMS believes that such providers and suppliers have an alternative route to Medicare certification and suggests that it may be the fastest route to certification.

As part of the Memorandum, CMS also refines its policy on initial surveys to allow providers and suppliers to apply to the state survey agency for CMS consideration to grant an exception to the priority assignment of the initial survey if the lack of Medicare certification would cause "significant access-to-care problems for beneficiaries." There is no special form required to make such an exception request. However, the Memorandum indicates that a provider or supplier must provide data or other evidence that establishes the probability of serious, adverse beneficiary health care access consequences if the provider or supplier is not enrolled to participate in the Medicare program. 

In the Memorandum, CMS cites a number of reasons why the initial survey of new providers and suppliers has become more challenging, including federal budgetary constraints, the increase in the number of providers seeking to participate in the Medicare program, additional survey responsibilities, and recent anti-fraud initiatives.