On March 10, 2014, CMS issued a final memorandum outlining the criteria it will use to determine payment responsibility for drugs for Medicare hospice beneficiaries, effective May 1, 2014. CMS cites the statutory requirement that the hospice cover all drugs or biologicals for the palliation and management of the terminal and related conditions; these drugs

CMS has launched a new Medicare Care Choices Model (Model) to allow Medicare beneficiaries with certain medical conditions to receive palliative care services from selected hospice providers without forgoing curative care services. The initiative will allow CMS to study whether access to curative services results in improved quality of care and patient and family satisfaction

On December 27, 2013, CMS published a proposed rule that would establish national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers to ensure that they can meet the needs of patients and residents during emergency situations, both natural and man-made. The proposed requirements cover four aspects of emergency preparedness:

  • Risk assessment and planning: Providers

CMS is inviting comments on a recent memo clarifying the criteria for determining Medicare payment responsibility for drugs for hospice beneficiaries. CMS notes that hospice providers are expected to cover virtually all drugs for hospice beneficiaries during the hospice election. For prescription drugs to be covered separately under Part D when the enrollee has

On June 27, 2013, CMS published a final rule that revises the requirements that an institution must meet to qualify as a skilled nursing facility (SNF) in the Medicare program, or as a nursing facility (NF) in the Medicaid program with regard to hospice services. Specifically, the rule requires SNFs and NFs that chose

The Medicare Payment Advisory Commission (MedPAC) has released its June 2013 Report to the Congress on Medicare and the Health Care Delivery System. The report examines a number of potential ways to reform Medicare, including the following:

  • Redesigning the Medicare benefit. MedPAC continues to discuss the concept of competitively determined plan contributions (CPC), under which

Two recent OIG reports examine Medicare policies involving hospice services. The first report concentrates on hospice general inpatient care (GIP), under which short-term pain control or symptom management that cannot be managed in other settings is provided in an inpatient facility (a Medicare-certified hospice inpatient unit, a hospital, or a SNF). Medicare paid $1.1 billion

MedPAC has released its annual report to Congress on Medicare Payment Policy, including payment update recommendations for all the major Medicare FFS payment systems and limited Medicare Advantage (MA) recommendations. The report also includes data on the status of the MA and Medicare Part D programs, including information about enrollment, plan options, and beneficiary cost-sharing. Note that while MedPAC’s recommendations are not binding, Congress and CMS often take into account MedPAC’s assessments when updating Medicare payment policies. Major recommendations include the following (many of which were included in previous reports):
Continue Reading MedPAC’s March 2013 Report to Congress

CMS published two notices on January 25, 2013 announcing the development of surveys of patient care experiences to support the Administration’s National Quality Strategy. First, CMS is designing a Hospice Survey to help CMS understand: (1) patient experiences throughout their hospice care, as reported by bereaved family members or close friends of patients who died

CMS is requesting public comments on possible additional data collection on hospice claims, including visit length data on hospice team members and information on non-labor costs (e.g., drugs, DME, and medical supplies). CMS also is considering collecting the National Provider Identifier (NPI) of any nursing facility, hospital, or hospice inpatient facility where the patient

CMS is requesting public comments on possible additional data collection on hospice claims, including visit length data on hospice team members and information on non-labor costs (e.g., drugs, DME, and medical supplies). CMS also is considering collecting the National Provider Identifier (NPI) of any nursing facility, hospital, or hospice inpatient facility where the patient

Medicare home health rates will be largely unchanged in 2013 under a CMS final rule published November 8, 2012. Specifically, under the final rule, Medicare home health PPS (HH PPS) rates will be cut by approximately 0.01%, or a total of $10 million compared to 2012 levels. This reduction results from a 2.3% market basket

On July 27, 2012, CMS published a notice announcing that Medicare hospice rates will increase by 0.9% in FY 2013. This update is based on a 2.6% market basket increase, which is reduced under the ACA by a 0.7 percentage point productivity adjustment/reduction and an additional 0.3 percentage point reduction, and further reduced by 0.7

Medicare home health rates would decrease by 0.1% – or $20 million – in CY 2013 under a proposed rule published by CMS on July 13, 2012. CMS anticipates a 2013 home health market basket update of 2.5%, but this increase would be offset by a 1% reduction mandated by the ACA, a 1.32% reduction

The OIG has issued a report entitled "Medicare Could Be Paying Twice for Prescription Drugs for Beneficiaries in Hospice.”  Under the Medicare Part A hospice benefit, prescription drugs related to beneficiaries’ terminal illnesses are covered under the per diem payments made to hospice organizations, based on the level of care received by the individual

CMS has sent several major calendar year 2013 proposed Medicare payment rules to the White House Office of Management and Budget (OMB) for final regulatory clearance. Rules under consideration include the proposed Medicare outpatient hospital, ambulatory surgical center (ASC), end-stage renal disease, and home health prospective payment system rules for calendar year (CY) 2013, along

On June 15, 2012, CMS issued instructions to state survey agencies on the “Safe Use of Single Dose/Single Use Medications to Prevent Healthcare-Associated Infections.” While CMS is not changing its policy regarding the reuse of single-dose vials or single use vials (collectively referred to as “SDVs”), CMS outlined conditions under which certain health