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Tags Posts tagged with "centers for medicare and medicaid services"

centers for medicare and medicaid services

0 1819

The Office of Developmental Programs (ODP) had previously issued Announcement 017-18, indicating that pending approval by the Centers for Medicare and Medicaid Services (CMS), waiver Transportation (Trip) services would be paid on a fee schedule effective July 1, 2018. ODP does not anticipate receiving this approval by July 1, 2018. Therefore, ODP is requesting that providers who deliver discrete Transportation (Trip) services as Provider Type 26 to individuals enrolled in the Consolidated, Person/Family-Directed Support (P/FDS), or Community Living (CL) Waiver programs complete this cost report in order for ODP to develop rates based on the provider’s historical expense data.

If the provider does not complete the cost report by June 17, 2018, ODP will pay the Transportation (Trip) provider the Fiscal Year (FY) 2017/2018 assigned rates. The data in the approved cost reports will be used by ODP in the development of cost-based Transportation (Trip) rates during FY 2018/2019 until ODP receives approval from CMS for the Transportation (Trip) fee schedule.

Completed cost reports should be submitted via email by 11:59 pm on Sunday, June 17, 2018. The posted materials described above can be accessed via this link. Direct all questions to the Rate Setting Mailbox.

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The Centers for Medicare and Medicaid Services (CMS) has posted a number of various inpatient rehabilitation facility patient assessment instrument (IRF PAI) resources to their website, including the RTI International Report on patient assessment data elements.

Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Proposed Rule for FY 2019: Reminder: Comments are due by June 26, 2018. See May 4, 2018 RCPA Info for additional information on the proposed provisions.

PROPOSED IRF-PAI Version 3.0: The proposed assessment tool indicates an effective date of October 1, 2019. However, the fiscal year (FY) 2019 IRF prospective payment system (PPS) proposed rule indicates it will be effective in FY 2020.

Change Table: Proposed IRF-PAI Version 3.0 – Effective October 1, 2019 (FY 2020) – Changes from Version 2.0 to 3.0: This table highlights the differences between the IRF PAI Version 3.0 and IRF PAI Version 2.0.

RTI International Report: Analyses to Inform the Potential Use of Standardized Patient Assessment Data Elements in the Inpatient Rehabilitation Facility Prospective Payment System: This report includes a summary by RTI on the use of  assessment data in the current IRF PPS and describes the process used to substitute data from the quality indicators sections of the IRF PA into the IRF PPS. The report also presents the case-mix groups (CMGs) and payment weights based on those elements that CMS proposes for FY 2020.

Contact Melissa Dehoff with questions.

0 2018

Today, The Centers for Medicare and Medicaid Services (CMS) released an informational bulletin that discusses the importance of state Medicaid and CHIP programs properly implementing their pediatric dental periodicity schedules in order to ensure children’s access to critical dental coverage. In particular, two dimensions are discussed. First, states should ensure that fee schedules and payment policies are aligned with periodicity schedules. Second, the periodicity schedule should be treated as a “floor” for coverage of dental services, not a “ceiling.” The informational bulletin can also be accessed on this Medicaid.gov web page.

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The Centers for Medicare and Medicaid Services (CMS) released the display copy of the fiscal year (FY) 2019 inpatient rehabilitation facility prospective payment system (IRF PPS) proposed rule.

Key highlights from the proposed rule:

  • Proposed Removal of FIM: Being the most significant proposal, CMS proposes to remove the Functional Independence Measure (FIM) instrument, as well as the associated Functional Modifiers, from the IRF Patient Assessment Instrument (PAI).
  • Changes to the IRF Coverage Requirements: There are several proposed changes to the coverage requirements:
    • Post-Admission Physician Evaluation: CMS is proposing allowing the post-admission physician evaluation to count towards one of the required three weekly face-to-face physician visits.
    • Physician Attendance at Interdisciplinary Team Meeting: CMS is proposing to amend the regulations to allow the rehabilitation physician leading the required interdisciplinary team meeting to attend the meeting remotely (via video conference or teleconference).
    • Admission Order Documentation Requirement: CMS is proposing to remove the requirement that there be a physician order for inpatient care when the patient is admitted since this requirement is included under the Medicare Conditions of Participation (CoPs) regulations.
    • Requests for Information on Physician Requirements: CMS is seeking information on specific areas where they can alleviate burden through changes to requirements pertaining to physician supervision in an IRF. CMS is also seeking information on the use of non-physician practitioners (NPPs) in IRFs.
  • Proposed Changes to IRF QRP – CMS is proposing to remove two measures from the IRF Quality Reporting Program (QRP):
    • National Healthcare Safety Network (NHSN) Facility-wide Inpatient Hospital-onset Methicillin-resistant Staphylococcus Aureus (MRSA) Bacteremia Outcome Measure (NQF #1716); and
    • Percent of Residents or Patients Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Short Stay) (NQF #0680).
  • Display of Functional Outcomes Measures Data on IRF Compare: CMS proposes to begin publicly displaying data on the following assessment-based measures in calendar year (CY) 2020 on IRF Compare:
    • Change in Self-Care (NQF: #2633);
    • Change in Mobility Score (NQF: #2634);
    • Discharge Self-Care Score (NQF: #2635); and
    • Discharge Mobility Score (NQF: #2636)

CMS has published a fact sheet that provides additional information on the proposed rule. The proposed rule will be published in the May 8, 2018 Federal Register, with comments being due by June 26, 2018.

0 1950

The Centers for Medicare and Medicaid Services (CMS) issued revised Change Request (CR) 10531 (MLN Matters Number: 10531). The article, “Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018,” was revised and provides direction to Medicare Administrative Contractors (MACs) to reprocess claims related to several provisions of the Bipartisan Budget Act of 2018. The initial MLN article was released on March 26, 2018.

On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018, which contains a number of provisions that extend certain Medicare Fee For Service (FFS) policies, including Ambulance add-on payment provisions and a three percent home health Rural Add-on Payment. In addition, the Act permanently repeals the outpatient therapy caps beginning on January 1, 2018, while retaining the requirement to submit the KX modifier for services in excess of the prior cap amounts. Due to the retroactive effective dates of these provisions, various Medicare FFS claims shall be reprocessed. This CR provides guidance to MACs regarding Medicare FFS claims reprocessing requirements and time frames.

0 2106

Registration is now open for providers interested in attending a free two-day, in person training session on the inpatient rehabilitation facility quality reporting program (IRF QRP). The session, scheduled for Wednesday, May 9 –  Thursday, May 10, 2018 in Baltimore, MD will be hosted by the Centers for Medicare and Medicaid Services (CMS).

The primary focus of this “Train-the-Trainer” event will be to provide those responsible for training staff at IRFs with information about IRF QRP changes and updates to the Inpatient Rehabilitation Facility–Patient Assessment Instrument (IRF-PAI) v. 2.00, effective October 1, 2018. Topics will include information on new items, including those associated with the drug regimen review quality measure. Presenters will also discuss resources available on the CMS website, support available through the IRF help desks, public reporting, and use of reports to aid providers in better understanding the IRF QRP.

Additional information, including the registration page and agenda, is posted on the CMS website. Interested providers are encouraged to register as soon as possible as the in-person training is limited to the first 200 people on a first-come, first-served basis.

The training will not be available via webcast, but will be available via a link from the IRF QRP training web page after the training has completed.

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Today, the Centers for Medicare and Medicaid Services (CMS) released the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) transfer of health measures for public review and comment. CMS contracted with the RTI International and Abt Associates to develop cross-setting post-acute care transfer of health information and care preferences quality measures in alignment with the IMPACT Act.

As part of its measure development process, CMS is requesting comments on two draft measure specifications, including:

  1. Medication Profile Transferred to Provider
  2. Medication Profile Transferred to Patient

Additional information is provided on the public comment page on the CMS website. The public comment period closes on May 3, 2018.

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On January 9, 2018, the Centers for Medicare and Medicaid Services (CMS) announced their launch of a new voluntary bundled payment model called the Bundled Payments for Care Improvement (BPCI) Advanced. BPCI Advanced will test a new iteration of bundled payments for 32 clinical episodes initially (29 Inpatient Clinical Episodes and 3 Outpatient Clinical Episodes) and will qualify as an advanced alternative payment model (APM) under the quality payment program (QPP). Participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality.

The Model Performance Period for BPCI Advanced begins on October 1, 2018, and runs through December 31, 2023. For additional information about the model, including the Request for Applications document, application template, etc., visit the BPCI Advanced web page. Applications must be submitted via the application portal. The application portal will close on March 12, 2018.

An open door forum, BPCI Advanced – Model Overview and Application Process, has been scheduled for Tuesday, January 30, 2018, from 12:00 pm – 1:00 pm EST. Registration is now open.

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On December 11, 2017, the Centers for Medicare and Medicaid Services (CMS) issued Medicare Learning Network (MLN) Matters Article, SE17036, which provides information about new instructions recently issued to Medicare medical review contractors. The guidance also provides the standards to use when reviewing claims for compliance with the intensity of therapy requirements for inpatient rehabilitation facility (IRF) claims.

If you have any questions, please contact your MAC at their toll-free number, available online.

0 2562

The Centers for Medicare and Medicaid Services (CMS) published a final rule and interim final rule with comment period that cancels the Episode Payment Models (EPM) and Cardiac Rehabilitation (CR) Incentive Payment Model and rescinds the regulations governing these models in the December 1, 2017 Federal Register. It also implements certain revisions to the Comprehensive Care for Joint Replacement (CJR) model. Some of these revisions include:

  • Allowing certain hospitals selected for participation in the CJR model a one-time option to choose whether to continue their participation in the model;
  • Technical refinements and clarifications for certain payment, reconciliation, and quality provisions; and
  • Change to increase the pool of eligible clinicians that qualify as affiliated practitioners under the Advanced Alternative Payment Model (APM) track.

An interim final rule with comment period is also being issued in conjunction with the final rule in order to address the need for a policy to provide some flexibility in the determination of episode costs for providers located in areas impacted by extreme and uncontrollable circumstances.

Comments will be accepted on the interim final rule with comment period until January 30, 2018. The final and interim final regulations become effective on January 1, 2018.

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