Federal Regulations

Final Rules: Community First Choice Option

Final rules published by CMS for the May 7, 2012 Federal Register implementing Section 2401 which establishes a new State option to provide home and community-based attendant services and supports.

Effective Date: July 7, 2012

Proposed Rule: Hospital Readmission Reduction Program

On May 11, 2012, CMS will publish proposed rules in the Federal Register entitled Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals’ Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory Surgical Centers. These proposed rules include implementation of provisions of the Hospital Readmission Reduction Program including the methodology to calculate the adjustment factor, the portion of the hospital’s payment that is reduced by the adjustment factor, and the process under which the hospitals have the opportunity to review and submit corrections for their readmissions information prior to the information being posted on the Hospital Compare website. The link is an excerpt from the proposed rule with the text on Section 3025.

Comment Period: Comments must be submitted no later than June 25, 2012.

Proposed Rule: Extension of Certain Payment Rules for Long-Term Care Hospital Services

On May 11, 2012, CMS will publish proposed rules in the Federal Register entitled Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals’ Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory Surgical Centers. These proposed rules include extending the existing delay of the full implementation of the 25-percent payment adjustment threshold for an additional year; that is, for cost reporting periods beginning on or after October 1, 2012, and before October 1, 2013. The link is an excerpt from the proposed rule with the text on Section 3026.

Proposed Rules: Hospital Value-Based Purchasing Program

On May 11, 2012, CMS will publish proposed rules in the Federal Register entitled Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals’ Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory Surgical Centers. These proposed rules include added requirements for the FY 2015 Hospital Inpatient VBP Program; specifically, the addition of one additional clinical process of care measure, AMI-10: Statin Prescribed at Discharge, and two additional outcomes measures--an AHRQ Patient Safety Indicators composite measure and CLABSI: Central Line- Associated Blood Stream Infection. The link is an excerpt from the proposed rule with the text on Section 3001.

Proposed Rules: Long-Term Care Hospital Quality Reporting Program

On May 11, 2012, CMS will publish proposed rules in the Federal Register entitled Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals’ Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory Surgical Centers. These proposed rules include program measures for the FY 2014 payment determination and subsequent fiscal years payment determinations; retention of previously adopted finalized measures for the LTCHQR program FY 2014 payment determination; and LTCHQR program quality measures for the FY 2016 payment determinations and subsequent fiscal years payment determinations. The link is an excerpt from the proposed rule with the text on Section 3004.

Final Rule: Documentation on Referrals to Programs at High Risk of Waste and Abuse

On April 27, 2012, CMS published final rules in the Federal Register entitled Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements. These final rules include provisions to implement Section 6406 requiring physicians to retain necessary documentation and provide access to records for orders, referrals, and certifications for home health services, DMEPOS, and other items and services upon request The link is an excerpt from the final rule with the text on Section 6406.