Corporate Compliance

This week in Medicare updates

Medicare Insider, April 21, 2015

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National Coverage Analysis (NCA) for screening for the Human Immunodeficiency Virus (HIV) infection
On April 13, CMS posted a final decision memorandum expanding coverage in section 210.7 of the Medicare National Coverage Determinations (NCD) Manual. CMS has determined evidence is adequate to conclude that screening for HIV infection for all individuals between the ages of 15 and 65 years, as is recommended with a grade of A by the U.S. Preventive Services Task Force, is reasonable and necessary for the early detection of HIV and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B. CMS shall cover screening for HIV with the appropriate FDA-approved laboratory tests and point-of-care tests, used consistent with FDA-approved labeling and in compliance with the CLIA regulations, when ordered by the beneficiary’s physician or practitioner within the context of a healthcare setting and performed by an eligible Medicare provider or supplier for these services, for beneficiaries who meet certain conditions.
View the final decision memorandum.
April 2015 update of the hospital OPPS
On April 14, CMS rescinded and replaced the April quarterly OPPS update transmittal to correct the payment rate for C9447 found in table 11, attachment A. There was also a correction made to the business requirement 9097.3. CMS also removed references to HCPCS codes J0365 and J7180 from section 4 of the Business Requirements document and deleted table "Drugs and Biological with Revised Status Indicators" from attachment A. All other information remains the same.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3235CP.
Electronic health record incentive program modifications to Meaningful Use in 2015–2017
On April 15, CMS posted a proposed rule in the Federal Register that would change the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program reporting period in 2015 to a 90-day period aligned with the calendar year. CMS also proposed aligning the EHR reporting period in 2016 with the calendar year. In addition, this proposed rule would modify the patient action measures in the Stage 2 objectives related to patient engagement. It would also streamline the program by removing reporting requirements on measures that have become redundant, duplicative, or topped out through advancements in EHR function and provider performance for Stage 1 and Stage 2 of the Medicare and Medicaid EHR Incentive Programs. Comments are due June 15.
View the notice in the Federal Register.
View the fact sheet.
Leave a comment.
Hospital Compare star ratings
On April 15, CMS posted a fact sheet regarding the Hospital Compare website. Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide care to their patients. This information can help consumers make informed decisions about healthcare. Hospital Compare allows consumers to select multiple hospitals and directly compare performance measure information related to heart attack, heart failure, pneumonia, surgery, and other conditions.
View the fact sheet.
View the press release.
Proposed decision memorandum for screening for cervical cancer with Human Papillomavirus (HPV) testing
On April 16, CMS posted a proposed decision memorandum stating evidence is sufficient to add HPV testing once every five years as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries aged 30 to 65 years in conjunction with the pap smear test. CMS will cover screening for cervical cancer with the appropriate FDA-approved/cleared laboratory tests, used consistent with FDA-approved labeling and in compliance with the CLIA regulations.
View the proposed decision memorandum.
Proposed FY 2016 payment and policy changes for IPPS hospitals and LTCHs
On April 17, CMS issued a proposed rule outlining proposed FY 2016 Medicare payment policies and quality initiatives under the IPPS and for long-term care hospitals (LTCH). The rule proposes to revise the Medicare hospital IPPS for operating and capital-related costs of acute care hospitals for FY 2016 and to update the payment policies and annual payment rates for the Medicare PPS for inpatient hospital services provided by LTCHs for FY 2016.
The rule also proposes new or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) participating in Medicare, including related proposals for eligible hospitals and critical access hospitals participating in the Medicare EHR Incentive Program, and policies related to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the HAC Reduction Program.
View the proposed rule and accompanying tables and data files.
View the fact sheet.
Proposed FY 2016 payment and policy changes for Medicare skilled nursing facilities
On April 20, CMS issued a proposed rule outlining proposed FY 2016 Medicare payment policies and quality initiatives for SNFs. This proposed rule would update the payment rates used under the PPS for SNFs for FY 2016. In addition, it includes a proposal to specify a SNF all-cause, all-condition hospital readmission measure, as well as a proposal to adopt that measure for a new SNF Value-Based Purchasing (VBP) Program. There is also a discussion of SNF VBP Program policies CMS is considering for future rulemaking to promote higher quality and more efficient healthcare for Medicare beneficiaries. Additionally, this proposed rule suggests implementing a new quality reporting program for SNFs as specified in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). It also would amend the requirements that a long-term care facility must meet to qualify to participate as a SNF in the Medicare program or a nursing facility in the Medicaid program. These requirements implement the provision in the Affordable Care Act regarding the submission of staffing information based on payroll data.
View the proposed rule.
View the fact sheet.

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