CMS Publishes Final Rule on Part D and Medicare Advantage Rule

The Centers for Medicare & Medicaid Services (CMS) has issued the final version of a rule regarding Medicare Advantage and Medicare prescription drug programs that will impose a number of new requirements on providers. The rule will save a purported $1.6 billion over ten years and aims to curb fraud and abuse. Upcoming requirements include new disclosures of pricing methods, price concession transparency, and new rules mandating record disclosure to CMS. Furthermore, CMS will now have the capacity to take action against physicians it deems to have exhibited an abusive pattern of prescribing, those who represent a potential harm to Medicare beneficiaries, or those who have not satisfied other Medicare requirements.

Proposed Rule to Extend Certified Electronic Health Record Technology Implementation Deadline

CMS has proposed a rule that would allow eligible participants in the Medicare and Medicaid Electronic Health Care Record (EHR) Incentive Programs an additional year to update from the 2011 Edition to the 2014 Edition. Industry concern was cited as motivating the proposed move to extend the deadline, as health care providers struggled to implement the required technology in time. Eligible parties would be permitted to use the 2011 Edition criteria, the 2014 Edition criteria, or a combination of both for a full EHR reporting period if delays in the availability of the 2014 Edition affect their implementation timeline. CMS noted, however, that the 2014 Edition Certified Electronic Health Record Technology criteria would be required for the 2015 reporting period, pending further rulemaking.

Supreme Court Denies Review in Caregiver Case

The United States Supreme Court denied review on June 9 of a Fifth Circuit decision regarding whether or not group home caregivers qualified as employees or independent contractors. Were such caregivers to be classified as employees, they would then be entitled to obtain overtime pay under the Fair Labor Standards Act (FLSA). Review was sought on the basis of a perceived circuit split between the Fifth and Eleventh Circuits whereby each circuit came to the opposite conclusion as to whether such caregivers were entitled to overtime pay.

The Fifth Circuit case, Chapman v. A.S.U.I. Healthcare and Development Center, held that despite signed employment documents indicating the contrary, the caregivers were in fact employees entitled to overtime pay. Furthermore, the Fifth Circuit held that the companions’ services exemption was not applicable to the case as the two employees of A.S.U.I. did not work in private homes for the purposes of the FLSA. However, the Eleventh Circuit held the opposite in Buckner v. Florida Habilitation Network, Inc., and ruled that such caregivers were not employees but independent contractors and, as such, were not entitled to overtime pay.

CMS Reveals Plan to Introduce Rating System for Certain Providers

CMS plans to institute a five-star rating system available on Medicare.gov for hospitals, home health agencies, and dialysis providers. The rating system is meant to supplement websites already in existence to help consumers compare providers based on services and quality of care. Currently, the rating system is available for Medicare Advantage plans and nursing homes, with plans to expand it to physicians. CMS expects that the rating system will come into effect later this year and into early 2015.

CMS Allows ‘Incident-To Basis’ Billing for Pharmacist Services

CMS has moved to allow medical practices to bill Medicare for in-house pharmacist services. Practices may now bill for services of a pharmacist in the same manner as a physician would for services incident to the diagnosis or treatment of a patient, according to CMS Administrator Marilyn Tavenner, ending a period of ambiguity on the legality of the practice.