CMS Releases Final Wage Index Changes for Medicare Hospices

Hospices serving people with Medicare will see a 2.5 percent increase in their Medicare payments for fiscal year (FY) 2012, according to a final regulation released by the Centers for Medicare & Medicaid Services (CMS). Hospices are also called upon to begin reporting on the quality of care received by Medicare patients, as a result of this final regulation.

The estimated hospice payments are the net result of a 3.0 percent increase in the “hospital market basket,” an indicator of industry-related price increases, offset by an estimated 0.5 percent decrease in payments to hospices due to updated wage index data and the third year of CMS’ seven-year phase-out of a wage index budget neutrality adjustment factor (BNAF).

The final rule also implements Affordable Care Act requirements, including a hospice quality reporting program, and clarifies previously adopted policies on hospice face-to-face certifications, said Jonathan Blum, deputy administrator and director of CMS’ Center for Medicare.“These payment and policy changes and additional attention to quality will work to encourage better coordination of hospice benefits and fair payments to Medicare hospice providers.”

The final rule continues the BNAF phase-out, now in its third year. The BNAF was implemented in 1997, when the former Health Care Financing Administration (HCFA), now CMS, moved from an outdated wage index to a more current and accurate method for determining hospice payments. To minimize disruption to services during the transition, a special budget neutrality adjustment was applied. In FY 2010 rulemaking, CMS adopted a schedule to phase out the BNAF over seven years, reducing it by 10 percent in FY 2010, 15 percent in FY 2011, and successive 15 percent reductions from FY 2012 through FY 2016.

The final rule revises how CMS calculates each hospice’s yearly aggregate cap. Federal law requires that CMS impose a limit on the aggregate Medicare payments a hospice provider receives annually. CMS calculates each hospice’s aggregate cap by multiplying the number of patients served by the hospice in a cap year by a cap amount. Medicare payments made to a hospice during the cap year that exceed the hospice’s aggregate cap must be refunded to Medicare.

In this final rule, CMS will:

- Change the way it counts hospice patients for the 2012 cap accounting year and beyond. The final policy for counting the number of Medicare hospice beneficiaries in care for a given cap year calculates the cap based on the number of days of care the patient received in that cap year for each hospice. This rule also finalized that the new counting method be applied to past cap years in certain instances.

- Allow hospice providers who do not want a change in their patient counting method to elect to continue using the current method.

- Allow any hospice physician to perform the face-to-face encounter regardless of whether that same physician recertifies the patient’s terminal illness and composes the recertification narrative.

- Implement a hospice quality reporting program, which includes a timeframe for reporting, as required by section 3004 of the Affordable Care Act. The measures that are being adopted in this final rule for the FY 2014 program are one measure endorsed by the National Quality Forum related to pain management and one structural measure that assesses whether a hospice administers a Quality Assessment and Performance Improvement (QAPI) program that contains at least three indicators related to patient care.

As finalized, hospices will be required to begin collecting quality data in October 2012, and will submit the data in 2013; hospices may also voluntarily begin collecting data on the QAPI measure in October 2011 for submission in 2012. Hospices failing to report quality data in 2013 will have their market basket update reduced by two (2) percentage points in FY 2014.

Information on the final hospice wage index payment and policy changes and other healthcare news can also be found on a new web portal, www.healthcare.gov, made available by the U.S. Department of Health and Human Services. A link to the final rule, which will be published in the Federal Register on August 4, 2011, along with accompanying documents will be available at: http://www.ofr.gov/OFRUpload/OFRData/2011-19488_PI.pdf or http://www.federalregister.gov/inspection.aspx.


Source: CMS News Release

New APRs on Focused Standards Assessment Released

The Joint Commission released new Accreditation Participation Requirements (APR) on the Focused Standards Assessment (FSA) for the ambulatory care, behavioral health care, home care, hospital, laboratory services, and long term care programs. The APRs become effective on January 1. 2012.

For more information, click here.

Source: The Joint Commission Online

New App Gets "Meaningful Use" Certification

A new iPad application called "drchrono" has received ONC-ATCB "meaningful use" certification from the Centers for Medicare and Medicaid's (CMS) Electronic Health Record (EHR) Incentive Programs.

The new application allows speech-to-text, so physicians can forgo transcription of their notes and also has paperless billing and prescription writing functions.

Source: The Washington Post Ideas@Innovations Blog

Updates to Long Term Care Credentialing Requirements Released

The Joint Commission has released updates to the credentialing requirements for Long Term Care & Medicare/Medicaid Long Term Care Accreditation Programs.

Please click here for more information.

Source: The Joint Commission release

CMS Announces "Train the Trainers" Workshops

The Centers for Medicare & Medicaid Services (CMS) announced an upcoming series of "Train the Trainers Workshops." The 2011 National Medicare Train-the-Trainer Workshop schedule is designed for CMS to share consistent, accurate, current information with partners who help Medicare beneficiaries make the best choices for their healthcare coverage at these national events.

The 2011 National Medicare Training Program workshops will include:
- Refresher on Medicare program
- Basic information and detailed casework-tailored to your needs
- Medicare training information and materials that are current, accurate, and consistent
- Opportunity to network with CMS staff and other partners who share your commitment
- Subject matter experts to answer your questions
- 2011 CD Suite—with the training modules, videos, resource guide, toolkits, and more

For more information about the workshops, please click here.

Source: CMS Announcement

Study: Medicaid Increases Use of Health Care, Decreases Financial Strain, and Improves Health for Recipients

A recent study by researchers from Harvard School of Public Health (HSPH), Massachusetts Institute of Technology (MIT), the National Bureau of Economic Research (NBER), and Providence Health & Services has found that expanding low income adults’ access to Medicaid substantially increases health care use, reduces financial strain on covered individuals, and improves their self-reported health and well-being. This is the first study to evaluate the impact of insuring the uninsured in the U.S. using a randomized controlled trial, the gold standard in medical and scientific studies.

The study was released as working paper 17190 on the website of the National Bureau of Economic Research (NBER) on July 7, 2011.

“This study shows that Medicaid substantially expands access to and use of care for low-income adults relative to being uninsured,” said Katherine Baicker, professor of health economics at HSPH and co-principal investigator of the study.

Medicaid, which is jointly funded by the federal and state governments, covers the health care costs of eligible low-income individuals and families. The 2010 Affordable Care Act expands Medicaid to cover additional low income adults in all states in 2014.

Source: Fiercehealthcare.com article Health Reform Working: Medicaid Access Fixes Financial Strain, Improves Health

HHS OIG: New Technology Helps Cut Waste, Prevent Fraud

Lewis Morris, Chief Counsel to the Inspector General of the U.S. Department of Health & Human Services recently testified before the U.S. Senate Committee on Homeland Security & Governmental Affairs, Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security about the role new technologies can play in cutting waste and fraud in the Federal health care programs.

"OIG is using information technologies and analytics, including data mining, trend evaluation, and modeling, to better identify fraud vulnerabilities and target our oversight efforts," reported Morris. "OIG is leveraging an analytical foundation that provides an enterprise view of questionable activities, suspected fraud trends, and prevention opportunities. When united with the expertise of our agents, auditors, and program evaluators, OIG brings a formidable combination of cutting edge techniques and traditional investigative skills to the fight against fraud, waste, and abuse."

Source: HHS OIG News Release