The Center for Medicare and Medicaid Services (“CMS”) recently published its 2010 Outpatient Prospective Payment System Final Rule (“Final Rule”). As part of its Final Rule, CMS changed and clarified the direct supervision requirements for hospital outpatient therapeutic services and procedures. The result of these changes is a relaxation of the direct supervision requirements for outpatient therapeutic services and procedures and added flexibility. Nevertheless, the Final Rule still presents challenges for hospitals in meeting the supervision standard. Read more…
von Briesen Health Law Blog
November 16, 2009
October 30, 2009
Government’s Fight Against Fraud Continues to Heat Up
The Health Care Fraud Enforcement Act of 2009 has been introduced in Congress. This proposed legislation makes straightforward but critical improvements to the federal sentencing guidelines, to health care fraud statutes, and to forfeiture, money laundering, and obstruction statutes, all of which would strengthen prosecutors’ ability to combat this particularly destructive form of fraud. More information on the bill can be found here.
CMS Issues Memo Addressing H1N1 Influenza Emergency
The Centers for Medicare and Medicaid Services (”CMS”) has released a memorandum to its fiscal intermediaries. The memorandum notifies providers and suppliers that the Secretary of Health and Human Services has invoked her waiver authority to provide some flexibility with regard to Medicare, Medicaid and CHIP requirements for HINI influenza emergency purposes. A Survey & Certification (S&C) memo for providers is being developed and will be released within the next few days.
October 29, 2009
DQA Issues Guidance On Palliative Care Programs
On October 26, 2009, the Division of Quality Assurance issued DQA 09-042 (Palliative Care). This memorandum acknowledges the recent increase in health care entities that provide palliative and supportive care and sets out the current standards of practice for these programs. DQA also cautions that surveyors may include palliative and supportive care programs during the course of their review.
New Development in Prescription Drug Pricing
Wisconsin Assembly Bill 482 has passed the Assembly Committee on Health and Healthcare Reform, moving one step closer to ending the state’s drug-price markup rule. Representative Jon Richards (D-Milwaukee) proposed Bill 482 in an effort to allow pharmacies to sell prescription drugs below cost. Although many big chain pharmacies already sell prescription drugs at steeply discounted rates, they currently are constrained under the state’s Unfair Sales Act from being “loss leaders” and selling drugs at a price below cost. Bill 482 proposes to exempt prescription drugs from the Unfair Sales Act, thereby allowing national retailers the opportunity to offer $4.00 month prescription drug plans in Wisconsin.
October 19, 2009
von Briesen & Roper Law Bulletin Medical Staff Update: October 2009
As health care regulations and accreditation standards continuously evolve, so do medical staff requirements. This Update covers the following topics: The Joint Commission’s Telemedicine Standard; Board Certification Requirements; History & Physical Requirements for Medical Staff Documents; The Joint Commission’s Statement of Duties and Privileges Standard; and, Recent Development in Economic Credentialing. Read more…
October 12, 2009
von Briesen & Roper Law Bulletin: OIG Publishes FY 2010 Work Plan
The Office of Inspector General (the “OIG”) has released its Fiscal Year 2010 Work Plan (the “2010 Plan”). The 2010 Plan describes the OIG’s new and ongoing projects for the 2010 Fiscal Year to carry out its mission of, in part, ensuring the integrity of the Medicare and Medicaid programs. Many of the projects include audits and evaluations of the Center for Medicare and Medicaid Services (“CMS”) and provider claims. The 2010 Plan generally addresses areas the OIG believes are prone to abuse or other error. Providers can review the 2010 Plan to develop compliance activities for the upcoming year. Read more…
July 8, 2009
von Briesen & Roper Health Law Update: Who’s Supervising Who?: CMS’s Newest Take On Supervision Of Incident To Outpatient Therapeutic Services
Quality concerns, patient demands and physician staffing all contribute to providers’ focus on supervision of mid-level providers (MLPs). Regarding services provided as incident to outpatient therapeutic services, the Center for Medicare and Medicaid Services (CMS) added to the confusion by issuing a “clarification” in the CY 2009 Outpatient Prospective Payment System (OPPS) Rule that tightened supervision requirements for on-campus and in-hospital outpatient departments. Since then, however, CMS has attempted to make this “clarification” more clear with the issuance of its proposed CY 2010 OPPS Rule. This article discusses CMS’s proposed rule, with a specific focus on the proposed revisions to the supervision requirements for incident to outpatient therapeutic services. Read more…