Corporate Compliance

The week in Medicare updates

Medicare Insider, May 20, 2014

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The Advisory Panel on Hospital Outpatient Payment (HOP Panel) summer meeting
CMS announced the summer meeting of the HOP Panel for 2014. The second semi-annual meeting is scheduled for August 25 and August 26.
View the notice in the Federal Register.

Regulatory provisions to promote program efficiency, transparency, and burden reduction; Part II
This final rule, posted on May 12, reforms Medicare regulations that CMS has identified as unnecessary, obsolete, or excessively burdensome on healthcare providers and suppliers, as well as certain regulations under the Clinical Laboratory Improvement Amendments of 1988. It also increases the ability of healthcare professionals to devote resources to improving patient care, by eliminating or reducing requirements that impede quality patient care or that divert resources away from providing high quality patient care.
View the notice in the Federal Register.
Request for an exception to the prohibition on expansion of facility capacity under the Hospital Ownership and Rural Provider Exceptions to the Physician Self-Referral Prohibition
CMS received a request from a physician-owned hospital for an exception to the prohibition against expansion of facility capacity, and is soliciting comments on the request from individuals and entities in the community in which the physician-owned hospital is located.
View the notice in the Federal Register.
View the comment docket. Comments due by June 11.
Announcement of application from a hospital requesting waiver for Organ Procurement Service Area
On May 8, it was posted that a hospital has requested a waiver of statutory requirements that would otherwise require the hospital to enter into an agreement with its designated Organ Procurement Organization (OPO).
View the notice in the Federal Register.  Comments are due by July 11.
Fraud and abuse; revisions to the Office of Inspector General’s Civil Monetary Penalty Rules
Posted May 13, this proposed rule would amend the civil monetary penalty (CMP) rules of the OIG to incorporate new CMP authorities, clarify existing authorities, and reorganize regulations on civil money penalties, assessments and exclusions to improve readability and clarity.
View the notice in the Federal Register.
View the comment docket. Comments are due by July 11.
Updates resulting from the Protecting Access to Medicare Act of 2014
CMS updated their Inpatient Hospital Review page to include information from the Protecting Access to Medicare Act. As of May 12, MACs have completed most first probe reviews for providers within their jurisdiction, and are beginning to provide educational information related to the first probe period findings.
View the update.
Mandatory reporting of an 8-digit clinical trial number on claims
On May 14, CMS released a change request to inform providers and suppliers that effective January 1, 2014, it will be mandatory to report a clinical trial number on claims for items and services provided in clinical trials that are qualified for coverage as specified in the Medicare National Coverage Determination Manual, Publication 100-03, section 310.1.
Effective date: January 1, 2014
Implementation date: January 6, 2014
View Transmittal R2955CP.
View MLN Matters article MM8401.
Aprepitant for chemotherapy-induced emesis
On May 13, CMS issued technical correction to Appendix A of the Decision Memo.
View the document.

Proposed decision memo for transcatheter mitral valve (TMV) procedures
On May 15, CMS posted a proposed decision memo to cover transcatheter mitral valve repair (TMVR) under Coverage with Evidence Development (CED) with some conditions.
View the memo.
Prospective payment system and consolidated billing for skilled nursing facilities for FY 2015–Nursing Home Civil Monetary Penalties
CMS posted a notice of proposed rule-making regarding Nursing Home Civil Monetary Penalties. The proposed rule provides clarification of statutory requirements under Section 6111 of the Affordable Care Act regarding the approval and use of Civil Money Penalties imposed by CMS against nursing facilities. 
View the survey and certification letter.
Hospital restraint/seclusion deaths to be reported using Form CMS-10455, Report of a Hospital Death Associated with Restraint or Seclusion
Hospitals must use Form CMS-10455 to report those deaths associated with restraint and/or seclusion that are required by 42 CFR §482.13(g) to be reported directly to their CMS Regional Office. This requirement also applies to rehabilitation or psychiatric distinct part units in CAHs.
View the survey and certification letter
Long-term care hospital moratorium – preliminary instructions
On May 9, CMS posted a new statutory moratorium that prohibits, with certain exceptions outlined in a proposed rule, the establishment of new long-term care hospitals (LTCH) or new LTCH satellites of existing LTCHs. Additionally, the moratorium prohibits, with no exceptions, an increase in the number of an LTCH’s certified beds. The moratorium is effective April 1, 2014 to September 30, 2017.
View the survey and certification letter.
Single use device reprocessing under Tag F441, revisions to Interpretive Guidance in Appendix PP, SOM on Infection Control  
On May 16, CMS posted that nursing homes may purchase reprocessed single use devices (SUD) when these devices are reprocessed by an entity or a third-party reprocessor that is registered with the FDA. A SUD is a device that is intended for one use on a single patient during a single procedure. A reprocessed SUD is an original device that has previously been used on a patient and has been subjected to additional processing and manufacturing for the purpose of an additional single use on a patient.
View the survey and certification letter.

Implementation of a Prospective Payment System (PPS) for Federally Qualified Health Centers (FQHCs)
On May 9, CMS released a change request regarding the PPS for FQHC.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R1383OTN.
Revisions and deletions to the Internet Only Manual, Publication 100-06, Chapter 4, Debt Collection
On May 14, CMS released a change request regarding overpayments, which are payments a provider has received in excess of amounts due and payable under the statute and regulations. Once an overpayment is discovered and a final determination is made, an initial demand letter is sent. This change will clarify, update, and include new instructions to Chapter 4.
Effective date: July 7, 20014
Implementation date: July 7, 2014
View Transmittal R235FM.
Comment period for business proposal forms
On May 16, CMS announced an opportunity for the public to comment on CMS’ intention to collect information from the public regarding business proposal forms for Quality Improvement Organizations and Independent Rural Health Clinic/Freestanding Federally Qualified Health Center Cost Report. Comments must be received by July 15.
View the notice in the Federal Register.

Agency information collection activities: submission for OMB review; comment request
On May 16, CMS posted a notice that it is requesting comments regarding Medicare Health Outcomes Survey.
View the notice in the Federal Register.

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