On July 8, the Department of Health and Human Services (HHS) released a proposed rule to modify the HIPAA privacy, security, and enforcement rules, extending HIPAA compliance requirements to subcontractors of business associates (BA) and strengthening patient rights to health information privacy.
According to the Office for Civil Rights (OCR), which enforces the HIPAA privacy and security rules for HHS, the proposed ‘significant’ modifications include:
- A requirement that BAs of HIPAA-covered entities be under most of the same rules as the covered entities
- New limitations on the use and disclosure of protected health information (PHI) for marketing and fundraising purposes
- Prohibition of the sale of PHI without an authorization
- Expansion of individuals’ rights to access their information and to restrict certain types of disclosures of PHI to health plans
- Provisions that strengthen and expand HIPAA’s enforcement rule
HHS will receive comments for up to 60 days after the proposed rule’s July 14 publication in the Federal Register, after which it will release an interim final rule. According to HHS, it will give covered entities and BAs 180 days after the final rule becomes effective to comply with most of the provisions.
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.
Effective July 6, 2010, physicians who have not enrolled in PECOS or opted out of Medicare will not be able to order or refer Medicare patients for home health services or DME. PECOS is the electronic database of Medicare providers and suppliers. If a physician did not file an 855I enrollment form since November 2003, it is likely that the physician is not enrolled in PECOS. Having an NPI does not mean that the physician is enrolled in PECOS.
The National Association for Home Care and Hospice recently issued a reminder of this new restriction, and noted that physicians should be receiving a letter from his/her Medicare contractor regarding this new requirement in a few weeks. However, the enrollment process is not quick, so physicians who are not now enrolled in PECOS should submit the relevant enrollment applications as soon as possible.
- To determine if a physician is enrolled in PECOS or as an opt-out physician, check the Medicare Ordering/Referring database. If the physician filed an 855I after November 2003, but is not in this database, follow-up with the physician’s Medicare enrollment contractor. Click here for a list of contacts.
- If you need to submit an enrollment application, follow the directions on the CMS website. If you want to enroll electronically, follow the directions for Internet-based PECOS. You will need to register before you use the electronic enrollment.
- If a physician wants to reassign his or her right to bill Medicare and receive payments, he or she must enroll first on the 855I, and then file an 855R for the reassignment.
Background: This new Medicare requirement implements a provision in Health Reform, and is contained in a Medicare Interim Final Rule at http://frwebgate4.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=014643292835+0+2+0&WAISaction=retrieve The comment period is open until July 6, 2010, if you want to comment on the proposed rule.
The Centers for Medicare & Medicaid Services (CMS) has revised the interpretive guidelines for anesthesia delivered in hospitals. The changes focus on the differences between anesthesia and analgesia services, where the patient does not lose consciousness.
The memo released by CMS provides hospitals with information on what practitioners may provide anesthesia services, what hospital policies should include regarding who is allowed to administer these services, guidelines on the supervision of anesthesiology assistants, and a list of information that must be included in a patient’s anesthesia record.
CMS released a supplemental proposed rule on May 21, 2010 to implement changes in payments for inpatient services in general acute care hospitals and long term care hospitals (“LTCHS”). The changes are required by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively, “PPACA”). The proposed rule supplements the 2011 IPPS Proposed Rule described in a blog on April 22. CMS did not have time to address provisions relating to PPACA in the earlier proposed rule. The provisions in the supplemental proposed rule generally take effect for discharges occuring on or after October 1, 2010. As described by CMS, the supplemental proposed rule includes provisions relating to:
- Protection for hospitals in frontier states;
- Additional payments for hospitals with low per enrollee Medicare spending;
- Temporary improvements to the low-volume hospital adjustment;
- Revisions of certain market basket updates;
- Wage index improvement related to geographic reclassification;
- National budget neutrality in the calculation of the rural floor for the hospital wage index;
- Extension of Medicare-dependent hospitals;
- Technical correction related to critical access hospital services;
- Extension of certain payment rules for long term care services and of a moratorium on the establishment of certain hospitals and facilities; and
- Extension of the rural community hospital demonstration program.
You can review a summary of each of these provisions on CMS’S website here. A display copy of the supplemental proposed rule is available here. CMS will accept comments until June 21, 2010.
The May 25 issue of the Federal Register includes a notice of proposed changes to the Medicare and Medicaid Conditions of Participation (CoPs) regarding the credentialing and privileging of telemedicine providers.
The proposed rule would permit the governing body at a hospital where a patient is receiving telemedicine services to rely on information from a hospital where the provider is currently privileged (distant-site) when making its own privileging decisions. In order to rely on information from the distant-site, the hospital where services are being received must ensure that
- “the distant-site hospital providing the telemedicine services is a Medicare-participating hospital;
- the individual distant-site physician or practitioner is privileged at the distant-site hospital providing telemedicine services, and that this distant-site hospital provides a current list of the physician’s or practitioner’s privileges;
- the individual distant-site physician or practitioner holds a license issued or recognized by the State in which the hospital, whose patients are receiving the telemedicine services, is located; and
- with respect to a distant-site physician or practitioner granted privileges by the hospital, the hospital has evidence of an internal review of the distant-site physician’s or practitioner’s performance of these privileges and sends the distant-site hospital this information for use in its periodic appraisal of the individual distant-site physician or practitioner.”
The proposed rule would also require that the periodic review information submitted to the distant-site include adverse events and complaints received about the physician or practitioner.
The proposed rule was created to address the redundant collection of information at both the distant-site and the site where services are received.
CMS is collecting comments through July 26.
For more information, click here:
http://edocket.access.gpo.gov/2010/pdf/2010-12647.pdf
CMS has issued a display copy of its 2011 Inpatient Prospective Payment System Proposed Rule. CMS proposes to update payment rates to general acute care hospital by 2.4% to adjust for inflation, but apply a -2.9% Documentation and Coding Adjustment (DCA). The DCA would continue CMS’s efforts to adjust payments to account for changes in documentation and coding practices after the adoption of the MS-DRG system. Such changes in coding practices resulted in higher aggregate payments that did not reflect an actual increase in patient severity of illness. CMS is phasing in the DCA adjustments over time. Overall, CMS estimates that after these proposed changes to the payment rates and other factors, the Proposed Rule would cause a 0.1% drop in total payments made to general acute care hospitals for operating expenses. A few other highlights from the Proposed Rule include:
- Proposed additional quality measures for hospitals to report under the Reporting Hospital Quality Data for Annual Payment Update program.
- Proposed changes to Medicare’s hospital conditions of participation regarding the types of practitioners who may provide rehabilitation services and respiratory care services.
- Proposed changes concerning effective dates for provider agreements and supplier approvals.
- Proposed clarifications concerning whether certain taxes are considered allowable costs.
CMS also proposes to update long-term care hospital (LTCH) rates by 2.4% for inflation, but apply a -2.5% DCA. Overall, CMS expects that after these proposed changes and others, total payments to LTCHs to increase by 0.8%.
CMS notes that it did not have time to address provisions in the Patient Protection and Affordable Care Act enacted on March 23, 2010. CMS, however, will issue separate proposed rules relating to provisions of the Act. Comments to the Proposed Rule are due by June 18, 2010. You can review CMS’s display copy here and summaries from CMS here and here.
The Department of Health Services’ Division of Quality Assurance released guidance today for health care providers. Specifically, the DQA issued a Quarterly Information Update which, among other things, noted that the Division is not considered a business associate of any health care provider licensed, surveyed or otherwise regulated by DQA. Click here to access this update. The DQA also released frequently asked questions for health care providers. These FAQ’s include helpful interpretation of rules and regulations governing orders, H&Ps, mid-level supervision, etc. These FAQ’s can be found here.
CMS has announced that it will delay enforcement or evaluation of the physician supervision requirements for therapeutic services provided to outpatients of Critical Access Hospitals for the duration of the 2010 calendar year. These requirements, initially set forth in its 2010 OPPS Final Rule, involve “direct supervision” over therapeutic services furnished in hospital outpatient departments and are difficult for many CAHs to meet. CMS plans to revisit the issue of supervision of therapeutic services provided to hospital outpatients in CAHs through the annual rulemaking cycle for CY 2011.
