CMS Releases Hospital Outpatient Payment Rule

On July 8, 2013, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule implementing changes to the Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2014.  According to CMS, relative to payments in 2013, Medicare payments for outpatient services are expected to increase 9.5 percent, or $4.37 billion, in CY 2014, and payments to ASCs are expected to increase by 3.5 percent, or $133 million.

Comments on the proposed rule are due September 6, 2013.  A copy of the proposed rule is available here and will be published in the Federal Register on July 19, 2013.  A CMS fact sheet on the proposed rule is available here.

CMS Releases Physician Payment Rule

On Monday, July 8, 2013, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule implementing changes to the Medicare Physician Fee Schedule for calendar year (CY) 2014.  CMS estimates that absent Congressional action, physicians who treat Medicare beneficiaries will face a 24.4 percent cut in their reimbursement due to the Sustainable Growth Rate (SGR).  More information on the SGR is available here.

As part of this proposed rule, CMS is also proposing several changes to the Physician Quality Reporting System (PQRS), the Medicare Electronic Health Record (EHR) Incentive Program, the physician compare website, and the physician value-based payment modifier.  A CMS fact sheet on these proposed changes is available here.

Comments on the proposed rule are due on September 6, 2013.  A copy of the proposed rule is available here and will be published in the Federal Register on July 19, 2013.  A CMS fact sheet highlighting the proposed rule is available here.

CMS Releases ESRD Payment Rule

On Monday, July 1, 2013, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule implementing payment and other policy changes to the Medicare End-Stage Renal Disease (ESRD) Prospective Payment System (PPS).  The proposed rule seeks to implement the ESRD payment reductions provided under the American Taxpayer Relief Act (ATRA) enacted earlier this year.  (More information on the ATRA is available here.)

In addition, CMS also proposes changes to the ESRD Quality Incentive Program (QIP).  A CMS fact sheet highlighting the proposed changes to the QIP is available here.

Comments on the proposed rule are due on August 30, 2013.  A copy of the proposed rule is available here.  A CMS fact sheet highlighting the proposed rule is available here.

Home Health Payment Rule Released

On Thursday, June 28, 2013, Medicare released its proposed rule implementing fiscal year (FY) 2014 payment rates for the Home Health Prospective Payment System.  The rule proposes to cut home health payment rates by 1.5 percent relative to FY 2013 payment rates.  In its March 2013 report to Congress, the Medicare Payment Advisory Commission (MedPAC) urged Congress to reduce home health payments.  A copy of the relevant MedPAC chapter is available here.

A copy of the 123-page proposed rule is available here.  Comments are due to CMS no later than 5:00 pm on Monday, August 26, 2013.

Final Workplace Wellness Rule Released

Today the Department of Health and Human Services (HHS) released the final rules implementing the Affordable Care Act (ACA) provisions on workplace wellness.  The ACA created incentives for employers to offer workplace wellness programs and support healthier workplaces.  These new rules apply to group health plans beginning on or after January 1, 2014.

Here is a link to the HHS fact sheet on the issue.  Here is a link to the 123-page final rule.

CMS Releases Proposed IRF Payment Rule

On Thursday, May 2, 2013, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule implementing fiscal year (FY) 2014 Medicare payment rates and policies for the inpatient rehabilitation facilities (IRFs) prospective payment system and changes to the IRF quality reporting system.  The proposed rule calls for aggregate payment increases to IRFs of 2 percent.

A copy of the proposed rule is available here and will be published in the Federal Register on May 8th.  A CMS fact sheet describing the proposed rule is available here.  CMS will be accepting comments on the proposed rule until July 1, 2013.

CMS Proposed Rule on Medicare Payments to SNFs

On Wednesday, May 1, 2013, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining fiscal year (FY) 2014 Medicare payments to skilled nursing facilities (SNFs).  Under the proposed rule, SNFs will see a 1.4 percent increase in their Medicare reimbursement compared to FY 2013 payment rates.

A copy of the proposed rule is available here and will be published in the Federal Register on May 6, 2013.  A CMS fact sheet on the proposed rule is available here.  Comments are due to CMS by July 1, 2013.

CMS Releases Proposed Rule on Hospice

On Monday, April 29, 2013, CMS released a proposed rule updating payment rates for hospices serving Medicare beneficiaries.  A copy of the fact sheet is available here and the 113-page proposed rule is available here.  The proposed rule will be published in the May 13th Federal Register.  Comments are due at the end of June.

Under the proposed rule, hospices would receive a 1.1 percent payment increase for fiscal year (FY) 2014.  The proposed rule also promulgates the ACA requirements that hospices that fail to meet certain quality standards will be subject to a two percent reduction in their reimbursement.

This proposed rule follows CMS’ Friday release of the inpatient prospective payment system (IPPS) and Long Term Care Hospital Prospective Payment System (LTCH PPS) – more information on that proposed rule is available here.  Stay tuned as DBR continues to provide updates as CMS releases its annual Medicare payment rules.

CMS Released Medicare Proposed Rule

Late Friday, April 26, 2013, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the hospital inpatient prospective payment system (IPPS) and long term care hospital (LTCH) PPS for fiscal year (FY) 2014 (which begins October 1, 2013).  A copy of the 1,424 page proposed rule is available here and is expected to be published in the Federal Register on May 10, 2013.  A CMS fact sheet on the proposed rule is available here.  Comments are due to CMS by 5:00 pm on June 25, 2013.

Under the proposed rule, in FY 2014, inpatient PPS rates would increase by 0.8 percent relative to FY 2013 rates.  FY 2014 LTCH payment rates would increase by 1.1 percent compared to FY 2013 payment rates.  The proposed rule also seeks to implement the document and coding offset provided under the American Taxpayer Relief Act of 2012 (more information on the legislation is available here) and seeks to implement the disproportionate share hospital (DSH) payment cuts provided under the Affordable Care Act (ACA).

This proposed rule contains policies related to the hospital acquired condition reduction program, which was created under the ACA to begin in FY 2015, and provides financial incentives to hospitals to prevent hospital-acquired conditions.  The proposed rule also provides additional policies for the hospital readmissions reduction program, including the addition of two new readmissions measures.

Essential Health Benefits Rule Finalized

Today, HHS released its final rule outlining the essential health benefits insurers must provide for health plans operating in the health insurance exchanges.  A copy of the final rule is available here.

Why are these rules important?  Under the Affordable Care Act (ACA), beginning in 2014 every state will have a health insurance exchange – a marketplace in which individuals and employers will be able to purchase comprehensive health insurance.  Plans participating in the exchanges must provide certain benefit (“essential health benefits”) within 10 specific categories:  prescription drugs; ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; rehabilitative and habilitative services; laboratory services; preventive and wellness services; and pediatric services, including dental and vision care.  The final rules issued today provide additional guidance on standards related to these essential health benefits.

For more information, check out these links:

The press release is live here:  http://www.hhs.gov/news/press/2013pres/02/20130220a.html

The rule is live here:  http://www.ofr.gov/(X(1)S(vp32o25ckyhpvspfpzx3owe4))/OFRUpload/OFRData/2013-04084_PI.pdf

The ASPE Issue Brief is live here: http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm

The EHB fact sheet is live here: http://cciio.cms.gov/resources/factsheets/ehb-2-20-2013.html

And the Tri-Dept FAQs are live here: http://cciio.cms.gov/resources/factsheets/aca_implementation_faqs12.html