GreisGuide to LTACHs » cms

CMS Rule Expands Long-Term Care Facility Administrators’ Responsibility to Report Facility Closures

Jason Greis — Thu, 03 Mar 2011 04:11:37 +0000

On February 18, 2011, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule (Interim Rule) implementing Section 6113 of the Patient Protection and Affordable Care Act (PPACA). The Interim Rule, which becomes effective March 23, 2011, requires administrators of long-term care facilities (LTCF), including skilled nursing facilities (SNF) eligible for reimbursement under Medicare and nursing facilities (NF) eligible for reimbursement under Medicaid, to submit prior written notification of an impending LTCF closure to the Secretary of the U.S. Department of Health and Human Services (Secretary), the state’s long-term care ombudsman and residents of the facility and their legal representatives or other responsible parties. LTCF administrators that do not comply with the new notice requirements may face sanctions, including civil monetary penalties of up to $100,000 and exclusion from participation in Federal health care programs. In addition, LTCFs must have related policies in place to avoid being cited for survey deficiencies. Read More...

NCQA Releases Draft Criteria for Accountable Care Organizations (ACOs)

Jason Greis — Wed, 10 Nov 2010 02:02:05 +0000

The National Committee for Quality Assurance (NCQA), a private, not-for-profit organization that accredits and certifies health plans and other healthcare related organizations published on Oct. 19, 2010, its 2011 Draft Accountable Care Organizations Criteria. The draft criteria describe the standards NCQA believes ACOs should meet in order to ensure that an ACO has the infrastructure necessary to function as an accountable entity and achieve improvements in quality and reductions in costs. The draft criteria were developed with the guidance of a multistakeholder Accountable Care Organization Task Force assembled by NCQA. Read More...

CMS Issues Stark Act Voluntary Self-Referral Disclosure Protocol – 9 Key Concepts

Jason Greis — Sun, 17 Oct 2010 18:56:43 +0000

PPACA requires the OIG to establish a protocol for healthcare providers and suppliers to disclose actual or potential violations of the Stark Act. Under the Stark Act, healthcare providers and suppliers may not refer patients to any entity for certain services if the physician has a financial relationship with that entity, unless an exception for such referral applies. On Sept. 23, 2010, CMS released its self-referral disclosure protocol (SRDP). The SRDP provides guidance for healthcare providers and suppliers to self-report actual or potential violations of the Stark Act in exchange for potentially (although not guaranteed) informal and more lenient settlement proceedings. Providers and suppliers should be cautious in self-disclosing through the SRDP. This article highlights nine key concepts and considerations regarding the SRDP.

ACOs and the Shared Savings Program: Some Common Misconceptions

Jason Greis — Sat, 02 Oct 2010 17:37:41 +0000

Section 3022 of the Patient Protection and Accountable Care Act (the Act) creates the Shared Savings Program for Medicare. Under the Shared Savings Program, which is to take effect no later than Jan. 1, 2012, Accountable Care Organizations (ACOs) that meet certain requirements established by the Secretary of Health and Human Services will be eligible to receive additional payments from Medicare where certain performance guidelines are met and cost-savings targets are achieved. The amount of the additional payment will be a percentage of the difference between the estimated per capita Medicare expenditures for patients assigned to the ACO and the cost-savings per capita Medicare expenditures threshold. Read More...

2011 Medicare Payment Update for Post-Acute Care Providers

Jason Greis — Wed, 04 Aug 2010 03:44:05 +0000

The Centers for Medicare & Medicaid Services (“CMS”) has recently released various notices and final rules updating 2011 Medicare payment rates for post-acute care providers, including long-term acute care hospitals (“LTACHs”), inpatient rehabilitation facilities (“IRFs”), skilled nursing facilities (“SNFs”), home health agencies (“HHAs”) and hospices. These Medicare rate updates generally implement negative payment adjustments mandated by the Patient Protection and Affordable Care Act (Pub. L. No. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111-152) (together, “PPACA”). Yet in spite of these adjustments, SNFs, hospices, IRFs and LTACH have fared relatively well with collective Medicare payment increases totaling $919 million, with HHAs offsetting these reimbursement gains by suffering a proposed $900 million Medicare reimbursement cut for calendar year 2011. Read More...

CMS Proposes Rule to Cross-Privilege Physicians Practicing Telemedicine

Jason Greis — Thu, 24 Jun 2010 00:50:56 +0000

Telemedicine consultations are often provided by physicians at large hospitals, often called “distant-site” hospitals (See § 1834(1)(m)(4)(A) of the Social Security Act), to patients at smaller ones, such as those in rural areas. Physicians providing these consultations are privileged and credentialed at their home institutions, but often not, at the outset, at the hospitals to which they provide their advice electronically, which for purposes of this discussion, we refer to as local hospitals. Read More...

Patient Protection and Affordable Care Act – Provisions Impacting Institutional Providers

Jason Greis — Fri, 30 Apr 2010 18:43:30 +0000

The below CMS e-mail alert was distributed via grouplist on Thursday, April 22, 2010 and impacts LTACHs, among other institutional providers. Read More...

When MedPAC Speaks Congress Listens: What the Inclusion of MedPAC Health Care Delivery Reform Proposals in Health Care Reform Legislation Means for Physicians

Jason Greis — Sun, 28 Mar 2010 22:08:50 +0000

On March 1, 2010, the Medicare Payment Advisory Commission (“MedPAC” or the “Commission”) released its 2010 Report to the Congress: Medicare Payment Policy (the “Final Report”) recommending annual Medicare payment updates for Medicare fee-for-service (“FFS”) payment systems, including among others, hospitals (including both general acute care and long term care hospitals) and physicians. MedPAC is an independent congressional agency established by the Balanced Budget Act of 1997 to formulate recommendations to Congress to address quality and cost-containment issues affecting the Medicare program and its beneficiaries. Two reports, issued in March and June each year, are the primary outlets for MedPAC’s policy and payment system updates, which change base rates paid by Medicare for a unit of service provided by a FFS provider—for example, a hospital admission or a physician visit or procedure. Recommended payment system updates are based on an assessment of payment adequacy that takes into account beneficiaries’ access to care, supply of providers, quality of care, providers’ access to capital and Medicare margins. Read More...

RTI Report to be Posted to CMS Website by End of July 2009

Jason Greis — Wed, 15 Jul 2009 00:20:28 +0000

Section 114(b) of the Medicare, Medicaid and SCHIP Extension Act of 2007 (“MMSEA”) required the Secretary of Health and Human Services to conduct a study on the feasibility of establishing national LTACH facility and patient criteria for purposes of determining medical necessity, appropriateness of admission, and continued stay at, and discharge from, LTACHs. The Centers for Medicare and Medicaid Services (“CMS”) awarded a contract for this study to Research Triangle Institute International (“RTI”), which was previously awarded a contract in 2005 to evaluate the feasibility of developing patient and facility level characteristics for LTACHs that could distinguish LTACH patients from those treated in other acute care settings. RTI was scheduled to submit its most recent report required under the MMSEA to Congress by June 2009. According to an anonymous source within CMS, the agency is presently reviewing the report’s recommendations for legislation and administrative actions and CMS hopes to post the report on its website by the end of July 2009. Read More...

Senate Finance Committee Health Reform Option Paper Proposals Would Impact Post-Acute Care Providers

Jason Greis — Sun, 17 May 2009 22:42:45 +0000

On April 29, 2009 the Senate Finance Committee (“Committee”) released the first of three health reform option papers exploring proposals for reducing costs and improving quality and efficiency in the country’s health care delivery system. The second option paper addressing potential solutions for reforming health coverage decisions was released on May 14, and the final option paper discussing solutions for financing health care reform is scheduled to be released on May 20. The policy options contained in the first option paper would shift Medicare payments to post-acute care providers from volume‐based to value‐based purchasing by providing new payment incentives for care that contributes to positive patient outcomes. The first option paper contains a number of proposals that, if enacted, would significantly affect Medicare payments to long-term acute care hospitals (“LTACH”). Read More...