von Briesen Health Law Blog

CMS released its CY 2011 proposed rules for hospital outpatient departments and ambulatory surgery centers on July 2, 2010.  The proposed rules update payment policies and rates for hospital outpatient departments and ambulatory surgery centers.  Some of the proposed provisions implement portions of the health reform legislation signed into law in March.  As described by CMS, notable provisions of the proposed rule include:

Hospital Outpatient Departments

• Waiver of the deductible and copayment for certain preventive services.
• Additional quality measures to report in CY 2011 (six additional measures, including a health information technology measure), CY 2012 (seven additional measures) and CY 2013 (six additional measures).
• Validation of quality reporting, including review of randomly selected cases from each hospital.
• Changes to the supervision requirements for certain non-surgical extended duration services to require direct supervision for the initiation period of such services, followed by general supervision.
• Payment for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals at an amount equal to the average sales price plus six percent.
• Removal of CPT codes 21193, 21395 and 25909 from the inpatient-only list.

Ambulatory Surgical Centers

• Waiver of the deductible and coinsurance for certain preventive services.
• The addition of five surgical procedures to the list of Medicare-covered ASC procedures.

Other Proposed Rules

• Reduced availability of the physician self-referral exceptions for ownership or investment interests in a “whole hospital” or “rural provider” for new physician-owned hospitals and those looking to expand capacity.
• Changes relating to graduate medical education payment.

You can review a summary of most of these provisions on CMS’s website here.  A display copy of the proposed rule is available here.  CMS will accept comment until August 31, 2010.

CMS recently released its CY 2011 Medicare Physician Fee Schedule Proposed Rule.  Among updated payment policies and rates for services paid under the Medicare Physician Fee Schedule, the proposed rule includes provisions to implement portions of the health reform legislation signed into law in March.  As described by CMS, the proposed rule includes provisions, among others, relating to the following:

• Elimination of the deductible and coinsurance that would otherwise apply for most preventive services.
• Coverage of annual wellness visits in which the beneficiary receives personalized prevention plan services.
• Quarterly incentive payments for primary care services furnished by primary care practitioners.
• Quarterly incentive payments for major surgical procedures provided by general surgeons in health professional shortage areas.
• Permission for physician assistants to order post-hospital extended care services.
• An increase in the Medicare payment for certified nurse-midwife services so that it equals 100% of the MPFS.
• Extension of Medicare reasonable cost payments for certain clinical diagnostic laboratory tests performed by hospitals with fewer than 50 beds that are located in certain rural areas as part of their outpatient services.
• An amendment to the in-office ancillary services exception for self-referrals.
• Adjustments to the DMEPOS competitive bidding program (to add 21 metropolitan statistical areas to round 2).
• Modification to the equipment utilization rate assumption for expensive diagnostic imaging equipment used in diagnostic computed tomography and magnetic resonance imaging services.
• Payment revisions for power-driven wheelchairs.
• Reduction of the maximum period for submission of Medicare fee-for-service claims to not more than 12 months.

You can review a summary of each of these provisions on CMS’s website here.  A display copy of the proposed rule is available here.  CMS will accept comments until August 24, 2010.