A variety of regulations and issues affect Medicare-certified providers. This section includes information on issues such as hospital Conditions of Participation as well as information on NAPHS advocacy positions.
Medicare: "Extension of Timeline for Publication of Final Rule on Reporting and Returning of Overpayments"
Notice of CMS ruling (CMS-4176-R): "Implementing United States v. Windsor for Purposes of Entitlement and Enrollment in Medicare Hospital Insurance and Supplementary Medical Insurance" (implementing Supreme Court ruling on Defense of Marriage Act)
CMS final rule: "Medicare Program; Contract Year 2016 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs"
CMS proposed rule: "Medicare and Medicaid Program;Revisions to Certain Patient’s Rights Conditions of Participation and Conditions for Coverage" (to ensure that same-sex spouses in legally-valid marriages are recognized and afforded equal rights)
CMS proposed rule: "Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations"
CMS final rule: "Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment"
NAPHS comment letter to OIG on proposed rule on "Medicare and State Health Care Programs: Fraud and Abuse; Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements and Gainsharing" (recommending transportation safe harbors)
CMS final rule: "Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid Innovation Models & Other Revisions to Part B for CY2015." Also see 12.31.14 corrections.
OIG proposed rule: "Medicare and State Health Care Programs: Fraud and Abuse; Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements and Gainsharing"
OIG proposed rule: "Medicare and State Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Civil Monetary Penalty Rules"
CMS final rule: "Medicare and Medicaid Programs;Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction; Part II" (includes medical staff revisions).
CMS proposed rule: "Medicare and Medicaid Programs: Fire Safety Requirements for Certain Health Care Facilities"
CMS MedLearn Matters: "Termination of the Common Working File ELGA, ELGH, HIQA, HIQH, and HUQA Part A Provider Queries (Revised MM 8248)"
“Doc Fix” Passed Into Law Includes Excellence in Mental Health Act, Delay of ICD-10, and More. On April 1, 2014, President Obama signed into law (P.L.113-93) a temporary, 12-month “doc fix.” The action avoids a 24% reduction in payments to physicians who treat Medicare beneficiaries that had been set to take effect March 31. The law also includes four additional provisions of note. 1) The law includes a $900 million demonstration of the Excellence in Mental Health Act – a bill NAPHS has supported – in eight states for two years to establish federally qualified community behavioral health clinics that would be eligible to participate in the Medicaid program. 2) The law includes an Assisted Outpatient Treatment Demonstration program that will provide $15 million per year from 2015 through 2018. 3) Congress is delaying enforcement of Medicare’s “two-midnight rule” for an additional six months (through March 31, 2015) and prohibiting recovery audit contractors from auditing inpatient claims spanning less than two midnights for the six-month period. 4) The law also approved a one-year delay in implementation of ICD-10 (until October 1, 2015).
NAPHS comment letter on "Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs"
CMS/CDC/OCR final rule: "CLIA Program and HIPAA Privacy Rule; Patients’ Access to Test Reports"
CMS proposed rule: "Medicare Program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs"
Updated FAQs on "Medicare 2013 Claim Denials Due to Beneficiary Incarceration Status"
CMS final rule: "Medicare Program: Conditions of Participation (CoPs) for Community Mental Health Centers"
Revised Medicare Learning Network publication on "Mental Health Services" (ICN 903195) [View]
OIG report: "Hospitals' Use of Observation Stays and Short Inpatient Stays for Medicare Beneficiaries"
NAPHS comment letter on proposed rule on "Medicare/Medicaid Programs: Survey, Certification and Enforcement Procedures”
CMCS-MMCO-CM Informational Bulletin: "Payment of Medicare Cost Sharing for Qualified Medicare Beneficiaries (QMBs)." Tells states that they “have a legal obligation to reimburse providers for any Medicare cost sharing due for QMBs according to the state’s CMS-approved Medicare cost-sharing payment methodology.”
NAPHS comment letter to OIG on "Solicitation of New Safe Harbors and Special Fraud Alerts"
CMS final rule on quality reporting requirements for inpatient psychiatric facilities (see pages 53644-53680). [View]
CMS final rule: "Medicare and Medicaid Programs: Reform of Hospital and Critical Access Hospital Conditions of Participation" [View]
CMS final rule: "Medicare and Medicaid Programs: Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction" [View]
CMS final rule: "Medicare & Medicaid: Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements" (including use of NPI) [View]
HHS proposed rule: "Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to Compliance Date for ICD-10-CM and ICD-10-PCS Medical Data Code Sets" [View]
NAPHS comment letter to HHS OIG on "Solicition of New Safe Harbors and Special Fraud Alerts" with recommendations on complimentary transportation [View]
CMS proposed rule: "Medicare Program: Reporting and Returning of Overpayments." Also see 2/14/12 CMS release: "Affordable Care Act Gives CMS New Authority To Recover Overpayments From Providers and Suppliers More Quickly"
CMS request for comments: "Medicare Program; EMTALA Applicability to Hospital Inpatients and Hospitals with Specialized Capabilities" [View]
HHS interim final rule: "Administrative Simplification: Adoption of Standards for Health Care Electronic Funds Transfer (EFTs) and Remittance Advice" [View]
NAPHS comment letter to CMS on proposed rule on "Reform of Hospital and Critical Access Hospital Conditions of Participation" [View]
CMS final rule: "Medicare Program; Availability of Medicare data for performance measurement" [View]
Medicare Learning Network Fact Sheet: "Substance (other than tobacco) abuse structured assessment and brief intervention (SBIRT) services" [View]
OIG Report (OEI-01-08-00590): "Adverse Events in Hospitals: Medicare's Responses to Alleged Serious Events" [View]
NAPHS comments on CMS proposed inpatient psychiatric facilities performance measures required by the Affordable Care Act [View]
NAPHS comments on CMS proposal to add alcohol screening/behavioral counseling and screening for depression to Medicare preventive services
NAPHS comment letter on Medicare proposed rule retracting physician signature requirement on clinical laboratory requisitions
NAPHS comment letter to CMS on proposed rule on Conditions of Participation for community mental health centers (CMHCs)
Final rule: "Medicare Program: Inpatient Rehab Facility PPS for Federal FY12; Changes in Size and Square Footage of Inpatient Rehabilitation Units and Inpatient Psychiatric Units" [View]
Final rule: Medicare & Medicaid: Changes Affecting Hospital and Critical Access Hospital Conditions of Participation: Telemedicine Credentialing and Privileging [View]
Federal Register: Final rule: "Medicare and Medicaid Programs: Changes to the Hospital and Critical Access Hospital Conditions of Participation to Ensure Visitation Rights for All Patients" [View]
CMS on "Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC)" [View]
CMS email on 8 "Frequently Asked Questions" (FAQs) on Medicare billing/payment policy on psychological and neuropsychological tests billed under the CPT code range 96101-96125 when performed by technicians, computers, physicians, clinical psychologists, independently practicing psychologists, and other eligible qualified nonphysician practitioners. The FAQs also address situations where more than one of these testing codes can be billed for services furnished to the same patient. [View]
OIG Open Letter to Health Care Providers refining the requirements of the OIG Provider Self-Disclosure Protocol under which healthcare providers can voluntarily report fraudulent conduct affecting Medicare, Medicaid, and other Federal healthcare programs.
NAPHS letter to CMS regarding initial surveys for new Medicare providers [View]
CMS final rule on "Medicare and Medicaid: Hospital participation conditions; patients' rights" [CMS-3018-F] published in the Federal Register. Includes revised regulatory language on the "one-hour rule."
"Hospital Conditions of Participation: Requirements for History and Physical Examinations; Authentication of Verbal Orders; Securing Medications; and Postanesthesia Evalutions (CMS-3122-F)."