CMS Issues Proposed Rule for Long-Term Care Facilities

On July 13, CMS issued a 403-page proposed rule that if finalized would be the most comprehensive set of revisions to long-term care facilities since 1991.  The proposed regulations would affect a wide range of issues including hospital admissions, initiatives to prevent infections, the expansion of residents’ choices in mealtimes and living conditions, new credentialing requirements that mandate physicians be licensed to practice medicine in the state, visitation rights and new standards on mental health care. 

The rule would also require patients to receive an in-person evaluation by a qualified medical professional before being transferred to a hospital and that a patient’s physician be notified before the resident is sent to a different facility.

The long-term care industry estimates the average cost of complying with the new rules would be over $46,000 in the first year for each of the 15,691 long-term care facilities affected by the rule.  A comprehensive summary of the proposed rule can be found in this article published by Hall Render.

CMS Announces Fraud Prevention System Saves $820M in Improper Medicare Payments

In a July 14 report, CMS announced their Fraud Prevention System (“FPS”) identified or prevented $820 million in inappropriate Medicare payments in the program’s first three years.  The FPS was created in 2010 by the Small Business Jobs Act to help protect Medicare trust funds and prevent fraudulent payments before they happen.

According to the CMS report, $454 million in inappropriate payments were identified in 2014, resulting in charges against 2,000 providers.  The agency said that administrative actions taken against providers included revocation of billing privileges and suspension of payments, prepayment review edits, requests for the return of overpayments and referrals to law enforcement.  CMS also said that it plans to expand the FPS to identify low-level noncompliant providers who could benefit from education or data transparency programs.

House Extends Medicare Home Care Demonstration Program

On July 15, the House passed a bill aimed at extending a Medicare pilot program for treating patients with chronic illnesses at home.  With the Senate already passing the same measure in April, the bill now goes to the President.

The bill extends the Medicare Independence at Home Medical Practice Demonstration Program for two more years.  Seventeen practices are currently trying to deliver better care for less money by keeping chronically ill patients out of the hospital and caring for them at home.  The bill, sponsored in the Senate by Finance Committee ranking member Ron Wyden (D-OR) and in the House by Rep. Michael Burgess (R-TX), cleared the House under a simple approval process reserved for non-controversial bills.

In June, CMS found that the practices had saved an average $3,070 for each participating Medicare beneficiary.  The agency awarded nearly $12 million in incentive payments to nine practices that both reduced expenditures and met designated quality goals.

CMS Releases Home Health Star Ratings

On July 15, CMS published star ratings for home health care agencies on its website.  The star ratings, which are based on a 1 to 5 scale, encompass the home health agency’s relative performance on 9 of the 29 quality measures.  The ratings are calculated by using information from patient assessments performed by the home health agency and from Medicare claims submitted by the agencies.

CMS intends to update the ratings each quarter as more recent data becomes available.  Star ratings are also currently displayed for nursing homes, doctors, dialysis facilities and hospitals.

Health-Related Bills Introduced This Week

Rep. Marsha Blackburn (R-TN) introduced a bill that would require all public and private payers, including CMS, to accept ICD-9 and ICD-10 claims for six months.  The bill, H.R. 3018, was introduced a few days after CMS announced a one-year grace period during which it will not deny provider claims over ICD-10 codes that aren’t sufficiently specific.

Rep. Charles Boustany (R-LA) introduced a bill that would amend Title XVIII of the Social Security Act to permit review of certain Medicare payment determinations for disproportionate share hospitals.

Sen. Rob Portman (R-OH) introduced a bill (H.R. 1757) that seeks to promote health care technology innovation and access to medical devices and services that patients choose to self-pay under Medicare.

Next Week in Washington

Both chambers return on Tuesday. House and Senate Republicans are nearing their July 24 budget imposed deadline to report reconciliation language. As of this week, none of the relevant committees have held hearings on reconciliation or scheduled markups of reconciliation language.  Reconciliation is a fast-track process that would allow ACA repeal to pass the Senate with 51 votes instead of the usual 60.  Despite the deadline for Republicans to develop a reconciliation plan, the Senate could still use reconciliation until the end of the congressional session in 2016.

On July 22, the Ways and Means Subcommittee on Health will hold a hearing with MedPAC to discuss hospital payment issues, rural health issues and beneficiary access to care.