Between August 24 and August 31, 2007, the Centers for Medicare and Medicaid Services (CMS) issued or announced a number of proposed or final rules. In addition to the "Stark Phase III" physician self-referral final rules, CMS:
- Issued a final rule governing the Medicare Integrity Program
- Issued a final rule on the Medicaid and SCHIP Payment Error Rate Measurement program
- Issued the Fiscal Year 2008 Medicare hospice wage index and modifications to the Medicare hospice regulations
- Issued an interim final rule on Medicare conditions of participation for hospital laboratories
- Issued a proposed rule on Ambulatory Surgery Center Medicare conditions for coverage
Proposed a Medicaid State Plan option to allow State Medicaid programs to cover non-emergency medical transportation
Final Rule On The Medicare Integrity Program
On August 24, 2007, CMS issued a final rule on the Medicare Integrity Program (MIP). Among other provisions, the rule clarifies the role of current Fiscal Intermediary and Carrier contractors, defines the role of a "MIP contractor," and explains the process for awarding MIP contracts.
Final Rule On Medicaid And SCHIP Payment Error Rate Measurement Program
On August 31, 2007, CMS issued a final rule on the Payment Error Rate Measurement (PERM) program, which is designed to aid CMS in measuring the number of erroneous payments made under the Medicaid and SCHIP programs. PERM samples Medicaid and SCHIP claims in 17 States each year for each program on a rotating basis to determine how many claims were correctly paid under each program. Among other changes, the final rule clarifies some of the PERM claim review criteria.
Hospice Wage Index
On August 31, 2007, CMS issued a final rule on the fiscal year (FY) 2008 Medicare Hospice Wage Index. Among other changes, the rule adjusts the way the wage index will be calculated depending upon the location of the hospice facility, amends the hospice regulations to clarify that hospice services payments will be based upon the geographic location in which the services were furnished, and amends the hospice regulations to align educational requirements for hospice nurse practitioners with the requirements for Medicare Part B nurse practitioners. The rule also clarifies certain terms and CMS’s interpretation of existing regulations.
Interim Final Rule on Hospital Laboratory Conditions of Participation
On August 24, 2007, CMS issued an interim final rule on Medicare conditions of participation for certain hospital laboratories. Among other requirements, the interim final rule establishes procedures that Medicareparticipating hospital laboratories must follow to prevent the transmission of hepatitis C, including patient notification procedures, and "increases the medical record retention period from 5 to 10 years" for certain blood-related records. The interim final rule is generally effective February 20, 2008, subject to OMB approval of certain provisions and comments that CMS receives from the public by 5 p.m. on October 23, 2007.
Proposed Rule On Ambulatory Surgery Center Conditions Of Coverage
On August 31, 2007, CMS issued a proposed rule regarding Ambulatory Surgery Center (ASC) Medicare conditions for coverage (CfC). ASCs must comply with the CfCs to participate in the Medicare program. Among other changes, the ASC proposed rule:
- Modifies the "quality assessment and performance improvement" (QAPI) measures
- Requires ASCs to have disaster-preparedness plans
- Adds requirements for ASCs to furnish covered radiological services
- Adds patients’ rights requirements
- Expands infection control requirements
- Requires ASCs to perform a "comprehensive patient assessment" prior to surgery
Comments on the proposed rule are due to CMS by 5 p.m. on October 23, 2007.
Medicaid State Plan Option For Non-Emergency Medical Transportation
On August 24, 2007, CMS issued a proposed rule that would allow State Medicaid programs to cover non-emergency medical transportation using a "non-emergency medical transportation brokerage program" by awarding competitively-bid contracts to provide medically-necessary transportation to Medicaid enrollees. Additionally, the rule proposes to apply to transportation brokers restrictions similar to the Stark (Section 1877 of the Social Security Act) and fraud and abuse restrictions applicable to Medicare and other federally-funded healthcare programs. Comments are due to CMS by 5 p.m. on September 24, 2007.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.