';
RCPA’s Human Resources Committee met this week, and there was discussion regarding provider responsibilities for trainings for their employees and resources available to provide the needed training. We want to clarify that these requirements apply to providers of Medicare services, not Medicaid.
CMS offers an online resource – Medicare Learning Network (MLN) as a free resource to the public. One area covered in the MLN is Medicare Parts C and D Compliance and Fraud, Waste, and Abuse (FWA) Trainings. Prior to January 1, 2019, CMS required providers of Medicare services to utilize their training to meet this requirement. Beginning January 1, 2019, CMS no longer requires health care providers participating in Medicare Advantage and Part D plans to complete CMS issued training, in order to allow the training to be offered in a manner that is tailored to each organization’s operations and risks.
Providers of Medicaid Services (Waiver services are funded through Medicaid) are not mandated to provide FWA training to their employees. Although this is not a mandated training, providers may offer this training as a part of your compliance training for all staff.
For more information regarding these training requirements, please refer to the CMS website and the Compliance Program Frequently Asked Questions document. If you have any further questions, please contact Carol Ferenz.
On August 9, 2019, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2020 outpatient prospective payment system (OPPS) proposed rule. In addition to the proposed changes to the amounts used to determine the Medicare payment rates, this proposed rule updates and refines the requirements for the hospital outpatient quality reporting program. Included in this proposed rule is a provision that would require inpatient rehabilitation facilities (IRFs) and other hospitals to post certain payment information, which seeks to increase price transparency by requiring all hospitals in the United States to make hospital standard charges available to the public. It would also publish patients’ out-of-pocket costs for scheduled health care services. The rule also proposes to implement site-neutral payment rates for outpatient hospital physician visits that would align the payment amount for non-hospital physician visits. Comments on this proposed rule will be accepted through September 27, 2019. Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.
The Centers for Medicare and Medicaid Services (CMS) released proposed updates and policy changes under the Medicare outpatient prospective payment system (OPPS) and Ambulatory Surgical Center (ASC) payment systems, including price and quality transparency that lay the foundation for a patient-driven health care system. The proposed rule is scheduled to be published in the August 9, 2019 Federal Register.
CMS will be conducting a listening session on Wednesday, August 14, 2019 from 2:30 pm – 4:00 pm to briefly cover provisions from the proposed rule and address clarifying questions to assist providers with formulating written comments for formal submission. Registration for the listening session is required.
Topics will include:
Providers are encouraged to review, in addition to the proposed rule, the press release and the fact sheet prior to the call.
CMS has noted that feedback received from providers during this listening session is not a substitute for formal comments on the rule, which are due by September 27, 2019. Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.
The Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) proposed rule on July 29, 2019, scheduled to be published in the August 14, 2019 Federal Register. Proposed changes to the CY 2020 Physician Fee Schedule are aimed at reducing burden, recognizing clinicians for the time they spend taking care of patients, removing unnecessary measures, and making it easier for clinicians to be on the path towards value-based care.
CMS will be conducting a listening session on Monday, August 12, 2019 from 1:00 pm – 2:30 pm to briefly cover three provisions from the proposed rule and address clarifying questions, to assist providers with formulating written comments for formal submission. Registration for the listening session is required. The three provisions include:
Providers are encouraged to review the following materials prior to the call:
CMS has noted that feedback received from providers during this listening session is not a substitute for formal comments on the rule. Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.
On July 31, 2019, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2020 inpatient rehabilitation facility prospective payment system (IRF PPS) final rule. This final rule is scheduled to be published in the Federal Register on August 8, 2019.
Key provisions contained in the final rule include:
(SPADEs). These SPADEs assess key domain areas including functional status, cognitive function and mental status, special services, treatments and interventions, medical conditions and comorbidities, impairments, and social determinants of health (SDOH). The addition of these SPADEs to the IRF-Patient Assessment Instrument (IRF-PAI) will improve coordination of care and enable communication between PAC providers and other members of the health care community, aligning with CMS’ strategic initiative to improve interoperability. CMS is also updating the specifications for the Discharge to Community PAC IRF QRP measure to exclude baseline nursing home residents. CMS is also finalizing their policy to no longer publish a list of compliant IRFs on the IRF QRP website. CMS proposed to collect standardized patient assessment data and other data required to calculate quality measures using the IRF PAI on all patients, regardless of the patient’s payer; however, in response to stakeholder feedback, they have decided not to finalize this proposal.
The payment provisions contained in the final rule become effective for discharges on or after October 1, 2019 and the new quality reporting requirements go into effect on October 1, 2020. Contact RCPA Director of Rehabilitation Services Melissa Dehoff with questions.
The Centers for Medicare and Medicaid Services (CMS) filed the unpublished and proposed Medicare Physician Fee Schedule (MPFS) rule for calendar year 2020 on July 29, 2019. The proposed rule is scheduled to be published in the Federal Register on August 14, 2019. Payment is made under the PFS for services furnished by physicians and other practitioners in all sites of service, including nurse practitioners, physician assistants, physical therapists, etc.
Some of the key provisions in this proposed rule include:
Contact RCPA Director of Rehabilitation Services Melissa Dehoff with questions.
The Centers for Medicare and Medicaid Services (CMS) hospital open door forum, scheduled for today at 2:00 pm, includes the topic of inpatient rehabilitation facilities (IRF) appeals settlement initiative.
To participate in this open door forum, please dial: 800-837-1935 and reference conference ID: 2818049. If you are unable to participate in the call today, an encore audio recording will be available beginning four hours after the original call has ended. To listen to the recording, dial: 855-859-2056 and reference conference ID: 2818049. This recording will expire after two business days.
Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.
President Trump recently signed the Executive Order on Advancing American Kidney Health. The purpose of this Executive Order (EO) is to improve kidney health and promoting increased treatment options for Americans suffering from kidney disease. The kidney health initiative seeks to prevent kidney failure through better diagnosis, treatment, and preventative care; increase affordable alternative treatment options, educate patients on treatment alternatives, and encourage the development of artificial kidneys; and increase access to kidney transplants by modernizing the transplant system and updating counterproductive regulations. Under the executive order, Medicare will test adjusting payment incentives to encourage preventative kidney care and the use of home dialysis and kidney transplants.
Following the issuance of this EO, the Centers for Medicare and Medicaid Services (CMS) announced in a press release five new CMS Center for Medicare and Medicaid Innovation (CMMI) payment models that aim to transform kidney care in order for patients with chronic kidney disease to have access to high quality, coordinated care. One of the models, the proposed End-Stage Renal Disease Treatment Choices (ETC) Model, would encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with end-stage renal disease (ESRD) in order to enhance their quality of care while reducing Medicare expenditures. Under the proposed ETC Model, CMS would make certain payment adjustments that would encourage participating ESRD facilities and Managing Clinicians to ensure that ESRD beneficiaries have access to, and receive education about, their kidney disease treatment options. CMS would positively adjust certain Medicare payments to participating ESRD facilities and Managing Clinicians for the first three years of the model for home dialysis and dialysis-related services. The payment adjustments under the proposed ETC model would begin January 1, 2020, and end June 30, 2026.
The other optional models announced by CMS are the Kidney Care First (KCF) Model and the Comprehensive Kidney Care Contracting (CKCC), which includes the Graduated, CKCC Professional, and Global models that are designed to help health care providers reduce the cost and improve the quality of care for patients with late-stage chronic kidney disease and ESRD. These models also aim to delay the need for dialysis and encourage kidney transplantation. The final model announced by CMS is the Radiation Oncology (RO) model aimed at improving the quality of care for cancer patients receiving radiotherapy treatment. This model, which would involve required participation, would test whether prospective site neutral, episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPD), and freestanding radiation therapy centers for radiotherapy (RT) episodes of care would reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries.
Contact RCPA Director of Rehabilitation Services, Melissa Dehoff, with questions.
The Centers for Medicare and Medicaid Services (CMS) recently announced an upcoming in person inpatient rehabilitation facility quality reporting program (IRF QRP) training. This two-day “train-the-trainer” event for providers is scheduled for August 15–16, 2019 at the Four Seasons Hotel, 200 International Drive, Baltimore, MD 21202.
The primary focus of this training, which is open to all IRF providers, associations, and organizations, will be to provide those responsible for training staff at IRFs with information about IRF QRP changes and updates to the IRF Patient Assessment Instrument (PAI) v.3.0, which will become effective on October 1, 2019. Topics will include, but are not limited to:
A full agenda is available for both days of the training. Registration is limited to 100 people on a first-come, first-served basis. Questions or additional information requests should be sent to the PAC Training mailbox.