Proposed CMS Rules Allows Remote Patient Monitoring for Home Health

CMS has proposed new reimbursement rules intended to modernize home health care in a number of ways. One of the more significant changes is to allow the cost of remote patient monitoring to be reported as allowable costs on the Medicare cost report form. The proposed Rule would also implement a new Patient-Driven Groupings Model (PDGM) for home health payments, eliminating ”therapy thresholds” in determining payments, and change the “episodes of care” standard from 60 days to 30 days. “Today’s proposals would give doctors more time to spend with their patients, allow home health agencies to leverage innovation and drive better results for patients,” said CMS Administrator Seema Verma. “The redesign of the home health payment system encourages value over volume and removes incentives to provide unnecessary care.” More information on the proposal can be found here.

New HIPAA Guidance on Research Disclosure Authorizations

The Office for Civil Rights of U.S. Department of Health and Human Services has issued new guidance on individual authorizations of uses and disclosures of PHI for research purposes. The guidance addresses requirements relating to the description of the scope of the disclosure and use, the term and expiration of the authorization, and the right to revoke the authorization. The content of the new guidance can be found here.

Rural Hospitals Seek SCOTUS Review of Medicare “Tax Refund” Ruling

A group of critical access hospitals (CAHs) in Kentucky is seeking SCOTUS review of a Sixth Circuit ruling upholding a U.S. Department of Health and Human Services (DHHS) policy which treats Medicaid disproportionate share hospital payments as “tax refunds” which may be off-set against the hospitals’ Medicare payments. The policy is tied to the practice of Kentucky and many other states of charging hospitals an assessment tax which is used, in part, to draw down federal funds. If upheld, the DHHS policy would have a significant negative financial impact on CAHs and other providers that are reimbursed on a cost basis. The high Court is expected to take up the petition for review in September, 2018. The case is Breckinridge Health, Inc. v. Azar, U.S., No. 17-1408.

CMS Issues Request for Information Regarding the Stark Physician Self-Referral Law 

The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services has published a Request for Information (RFI) seeking public comments and suggestions on how to address “any undue regulatory impact and burden” under the Stark Physician Self-Referral Law. The purpose and intent of the RFI is to facilitate, or at least not hamper, alternative payment models (APMs) and other cost-reduction reforms encouraged by the Affordable Care Act, MACRA, and other federal enactments. The RFI describes the intent as follows: “The Department of Health and Human Services (HHS) is working to transform the healthcare system into one that pays for value. Care coordination is a key aspect of systems that deliver value. Removing unnecessary government obstacles to care coordination is a key priority for HHS.” The RFI was published on June 25, 2018 of the Federal Register. The comment period remains open until August 24, 2018. Comments may be submitted electronically here.

New CMS Medicaid Fraud Initiatives Focus on States’ Compliance

The Centers for Medicare and Medicaid Services (CMS) has announced new initiatives to combat fraud and enhance program integrity in the Medicaid program. The new initiatives will include increased scrutiny in state audits of the amounts spent on clinical services and quality improvement versus administration and profit, review of state rate-setting, and the utilization of advanced analytics and other innovative solutions to improve Medicaid eligibility and payment data. CMS Administrator Seema Verma said in a press release “Beneficiaries depend on Medicaid and CMS is accountable for the program’s long-term accountability. As today’s initiatives show, we will use the tools we have to hold states accountable as we work with them to keep Medicaid sound and safeguarded for beneficiaries.” The announcement on June 26, 2018 was followed by hearings before the Senate Committee on Homeland Security and Governmental Affairs on June 27.