April 2011

On May 5, 2011, the Centers for Medicare & Medicaid Services (CMS) is publishing its proposed rule to update Medicare inpatient prospective payment system (IPPS) hospital and long-term care hospital prospective payment system (LTCH-PPS) payment and other policies for FY 2012. Overall, CMS estimates that FY 2012 payments to general acute care hospitals for operating expenses would decrease by $498 million (0.5%) under the proposed rule, while Medicare payments to LTCHs are projected to increase by $95 million (1.9%). CMS addresses a wide variety of policies in the more than 1000-page advance version of the rule. 

Highlights of the proposal are available after the jump.Continue Reading CMS Proposes Medicare Inpatient Hospital/LTCH Payment Policies for FY 2012

On April 29, 2011, CMS released its final rule to implement a Hospital Value-Based Purchasing (VBP) program, as mandated by the ACA. The VBP program will build on the current pay-for-reporting program by tying Medicare payments to the quality of hospital services. Specifically, under the rule, starting in FY 2013 (which begins October 1, 2012)

On April 28, 2011, CMS released its proposed update to Medicare skilled nursing facility (SNF) PPS rates and policies for FY 2012. CMS sets forth two very different options under consideration for revising rates for 2012. The first option, applying the standard rate update methodology, would increase rates by 1.5% ($530 million) as a result

On April 29, 2011, CMS published a proposed rule to update Medicare IRF PPS rates and policies for FY 2012. The proposal would increase IRF PPS rates by 1.5% ($120 million nationwide), reflecting a 2.8% market basket increase (using a revised and rebased index) that is partially offset by a 1.3 percentage point rate

On April 28, 2011, CMS released a proposed rule updating the Medicare hospice wage index for FY 2012.  When a projected 2.8% market basket update is factored in, CMS expects Medicare hospice payments to increase by $310 million overall in FY 2012 (while the market basket update and updated wage data would increase payments by

CMS has issued a proposed rule that would provide states with additional flexibility in obtaining waivers to offer Medicaid HCBS. Among other things, the rule would: allow states to combine more than one target population in a single waiver if certain conditions are met; promote person-centered service and support plans; describe characteristics of settings

On May 6, 2011, CMS is publishing a final rule updating PPS rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs) for discharges occurring during rate year (RY) 2012, which begins July 1, 2011. CMS estimates that the rule would increase overall IPF PPS payments by approximately $120 million, reflecting a $130

CMS has adopted a final rule that increases federal funding for certain Medicaid eligibility determination and enrollment activities under the ACA and updates regulations to reflect other Medicaid eligibility and business process changes. Under the rule, states may qualify for an enhanced 90% federal matching rate for design and development of new eligibility determination systems and

This post was written by Paul Sheives. The Food and Drug Administration (FDA) has published a final rule entitled “Revision of the Requirements for Constituent Materials.” The rule allows FDA to approve exceptions or alternatives to the regulation for constituent materials in biologics (i.e., ingredients, preservatives, diluents, adjuvants, extraneous protein, and antibiotics

The HHS Secretary has submitted a report to Congress outlining the Department’s plan to implement a value-based purchasing (VBP) program for Medicare payments to ambulatory surgical centers (ASCs), as mandated by the ACA. The report describes current efforts to improve quality and payment efficiency in ASCs, and examines steps required in designing and implementing a

CMS has released new statistics on the Medicare Fee-for-Service Recovery Audit Contractor (RAC) program, under which CMS contractors are tasked with detecting and correcting past improper Medicare payments. In the first three months of 2011 alone, RACs corrected $184.6 million in total payments, including $162 million in provider overpayments and $22.6 million in underpayments. This

CMS recently released updated data on payments to providers under two Medicare pay-for-reporting programs. Specifically, 119,804 physicians and other eligible professionals in 12,647 practices that satisfactorily reported data on Medicare quality measures received a total of more than $234 million in Physician Quality Reporting System (PQRS) incentive payments in 2009. The average bonus payment was $1,956

This post was written by Paul Sheives

FDA has released a guidance document entitled “30-Day Notices, 135-Day Premarket Approval (PMA) Supplements and 75-Day Humanitarian Device Exemption (HDE) Supplements for Manufacturing Method or Process Changes.” The guidance addresses the manufacturing method or process changes FDA believes may qualify for the 30-day notice of changes in

The OIG has issued a report entitled Medicare Payments for Diagnostic Radiology Services in Emergency Departments.” According to the OIG, because of insufficient documentation, Medicare erroneously allowed 19% ($29 million) of claims for interpretation and reports for computed tomography and magnetic resonance imaging, along with 14% ($9 million) of claims for interpretation and reports