National Health Care Affairs Office

Related documents

•   CMS Issues Final FY 2011 Medicare IPPS Update with Market Basket Increase of 2.35 Percent and A Negative Coding Adjustment of 2.9 Percent

  The Centers for Medicare and Medicaid Services (CMS) have issued an interim final rule to update both the Hospital Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year (FY) 2011. The market basket update for FY 2011 for hospitals paid under the IPPS is 2.6 percent. As required by the Deficit Reduction Act of 2005 (DRA), hospitals that do not participate successfully in the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program will receive the market basket update less 2.0 percentage points, or 0.6 percent. The update amounts will be further reduced by 0.25 percentage points, as required by the Affordable Care Act (ACA). Therefore, the applicable percentage increase to the standardized amount for FY 2011 is 2.35 percent for hospitals that submit quality data in accordance with the RHQDAPU requirements and 0.35 percent for hospitals that do not submit quality data.

•   CMS Releases Final 2011 ESRD PPS Bundled Payment System; Rates to be Budget Neutral at 98 Percent

  The Centers for Medicare and Medicaid Services (CMS) have issued a final rule that implements a case-mix adjusted bundled prospective payment system for Medicare outpatient end-stage renal disease (ESRD) dialysis facilities beginning January 1, 2011 (ESRD PPS). The ESRD PPS is mandated by the Medicare Improvements for Patients and Providers Act (MIPPA). CMS has also issued a proposed rule regarding an ESRD Quality Incentive Program (QIP), which would reduce ESRD payments by up to 2.0 percent for dialysis providers and facilities that fail to meet or exceed a total performance score for performance standards established with respect to certain specified measures, effective January 1, 2012.

•   CMS and ONC Issue Final Rules Regarding Standards, Implementation Specifications and “Meaningful Use” for EHR Incentive Program

  The Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology have issued two inter-related final regulations to implement the electronic health records incentive program under the Health Information Technology for Economic and Clinical Health Act. The regulations are mandated by the American Recovery and Reinvestment Act of 2009.

•   CMS Issues SNF PPS Update for FY 2011; Rates would Increase 2.3 Percent; Offset by Market Basket Adjustment of -0.6 Percent to Yield 1.7 Percent Update

  The Centers for Medicare and Medicaid Services have issued a final notice with comment that will update the Skilled Nursing Facility Prospective Payment System for fiscal year 2011.

•   CMS Releases Final Hospice FY 2011 Wage Index Rule

  The Centers for Medicare and Medicaid Services have issued a final notice with comment period to update the Medicare hospice wage index for fiscal year 2011.

•   CMS Issues FY 2011 IRF PPS Update; Includes Changes to FY 2010

  The Centers for Medicare and Medicaid Services have released a final notice updating the fiscal year 2011 inpatient rehabilitation facilities prospective payment system.

•   CMS Issues Proposed CY 2011 Home Health Update with Overall Negative 4.75 Percent Increase

  The Centers for Medicare & Medicaid Services have released a proposed calendar year 2011 update to the home health prospective payment system (HH PPS). The proposal would increase the HH PPS market basket by 2.4 percent, reduce that amount by 1.0 percent as mandated by the Affordable Care Act, and reduce payments by a 3.79 percent factor to account for increases unrelated to changes in “real” case-mix.

•   CMS Releases Proposed Hospital Outpatient PPS Update and ASC Payment Changes for CY 2011

  On July 2, the Centers for Medicare and Medicaid Services issued a proposed rule updating the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center payment system for Calendar Year 2011. The proposal provides for a 60-day comment period ending August 31. The rule would provide for a market-basket (MB) update of 2.15 percent, for hospitals providing quality data elements and 0.15 percent for those that do not. The updates are reduced by 0.25 percent as mandated by the Affordable Health Care Act.

•   CMS Issues CY 2010 Changes to the Hospital OPPS and ASC Payment System Rates

  The Centers for Medicare and Medicare Services have issued two rules regarding the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System for Calendar Year 2010 services. One rule – officially cited as a notice – addresses the final wage indices, hospital reclassifications, payment rates, and addenda for payments made under the Medicare hospital OPPS, and the payment rates and addenda for payments made under the Medicare ASC payment system. In the other rule – cited as a correction – CMS notes that ASC payment system uses the Practice Expense RVUs and the conversion factor (CF) from the Medicare Physician Fee Schedule (MPFS) as part of the office-based and ancillary radiology payment methodology.

•   CMS Proposes Changes for Physician and Other Part B Services for CY 2011

  The Centers for Medicare and Medicaid Services have issued a proposed rule regarding revisions to payment policies under the Medicare Physician Fee Schedule for Calendar Year 2011. The proposal addresses, implements or discusses certain provisions of both the Affordable Care Act and the Medicare Improvements for Patients and Providers Act of 2008. In addition, the proposal discusses payments under the Ambulance Fee Schedule, Clinical Laboratory Fee Schedule, payments to ESRD facilities, and payments for Part B drugs. The proposed rule includes a discussion regarding the Chiropractic Services Demonstration program, the Competitive Bidding Program for Durable Medical Equipment and Provider and Supplier Enrollment Issues associated with air ambulances.

•   President Signs the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010

  President Obama has signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010. This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare & Medicaid Services has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems.

•   CMS Issues a Notice and a Proposed Rule Modifying FY 2010 and FY 2011 IPPS and LTCH PPS Rates to Account for Changes Mandated by the Health Care Reform Bills

  CMS has issued a notice modifying both the Hospital Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year 2010. CMS has also issued a proposed rule with a 30-day comment period modifying the May 4th proposed FY 2011 IPPS/LTCH PPS rule. CMS says the changes are mandated by the Patient Protection and Affordable Health Care Act and the Heath Care Education Reconciliation Act of 2010, which CMS is collectively referring to as the Affordable Care Act (ACA). The ACA mandates several changes for hospital inpatient and long-term care PPS hospitals, including the market basket rates of increase for FY 2010 be reduced by 0.25 percent, but only for discharges occurring on and after April 1, 2010.

•   CMS Issues Inpatient Psychiatric PPS Notice for RY 2011

  The Centers for Medicare and Medicaid Services (CMS) have issued a notice updating the prospective payment system (PPS) for Medicare Inpatient Psychiatric Facilities (IPFs). The changes are applicable to IPF discharges occurring during rate year (RY) 2011 beginning July 1, 2010 through June 30, 2011. CMS is largely continuing its methodologies and assumptions in making updates from the RY 2010 to the RY 2011 values based on newer data. Section 1886(s)(3)(A) of the Social Security Act, as added by the recent health care reform legislation, requires the application of an “Other Adjustment” that reduces the update to the IPF PPS base rate for the rate year beginning in CY 2010 (effective April 1, 2010). CMS says it is reducing the update to the IPF PPS base rate by 0.25 percent for RY 2011. The market basket increase Is 2.4 percent.

•   CMS Proposes FY 2011 Medicare IPPS Update with Market Basket Increase of 2.4 Percent and A Negative Coding Adjustment of 2.9 Percent

  The Centers for Medicare and Medicaid Services have issued a proposed rule to update both the Hospital Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System for fiscal year 2011. The proposed rule does not address or reflect provisions of the recently enacted Patient Protection and Affordable Care Act as amended by the Health Care and Education Affordability Reconciliation Act – the health care reform bills. Changes mandated by these laws impact both FY 2010 and 2011 IPPS payments beginning April 1, 2010.

•   Congress passes massive health care reform using two bills

  Congress has passed the most sweeping health care reform measures since the enactment of Medicare in 1965 using two separate bills – the Senate’s Patient Protection and Affordable Care Act (H.R. 3590) from December 2009, and the House’s recent Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872) H.R. 4872 modifies a number of provisions in H.R. 3590. The president signed H.R. 3590 into law on March 23 and it is now Public Law 111-148. Together, the bills will extend health coverage to 32 million people. The Congressional Budget Office (CBO) estimates that the legislation will cost approximately $940 billion over 10 years, while reducing the federal deficit.

•   ONCHIT Issues Proposed Rule Establishing Certification Programs for Testing and Certifying Health IT

  The Office of the National Coordinator for Health Information Technology has issued a Notice of Proposed Rulemaking proposing the establishment of two certification programs for the purposes of testing and certifying health IT. The first proposal would establish a temporary certification program to authorize, test and certify complete electronic health records (EHRs) or EHR modules, thereby assuring the availability of certified EHR technology prior to the date on which health care providers seeking incentive payments may begin demonstrating meaningful use of certified EHR technology. The second proposal would establish a permanent certification program to replace the temporary certification program.

•   CMS Releases Advance Notice of Methodological Changes for CY 2011 and 2011 Call Letter

  The Centers for Medicare & Medicaid Services recently issued the Advance Notice of changes to methods used to calculate health care capitation rates for payments to Medicare Advantage organizations for CY 2011. The Advance Notice is mandated to be issued annually 45 days before the final rates are announced, and also to address policy and technical changes to payment methodologies for Medicare Advantage, Part C, and Medicare prescription drug, Part D, plans. This year, CMS combined the Advance Notice with the annual Call Letter to health plans, which outlines non-payment policy changes for the upcoming calendar year.

•   President sends FY 2011 budget to Congress; HHS releases Medicare and Medicaid details

  President Obama has delivered his FY 2011 budget to Congress, totaling $911 billion in outlays, an increase of $51 billion over FY 2010. The Department of Health and Human Services has released the details of the budget affecting the various agencies and organizations within the department. The HHS budget proposes $81 billion in discretionary budget authority, an increase of $2.3 billion over FY 2010 on a comparable basis. The FY 2011 budget request for the Centers for Medicare and Medicaid Services is $784.3 billion in mandatory and discretionary outlays, a net increase of $48.3 billion over FY 2010.

•   CBO releases budget outlook report that projects Medicare and Medicaid spending through 2020

  The Congressional Budget Office recently issued a report projecting that if current laws and policies remain unchanged, the federal budget will show a deficit of about $1.3 trillion for fiscal year 2010. At 9.2 percent of gross domestic product (GDP), that deficit would be slightly smaller than the shortfall of 9.9 percent of GDP ($1.4 trillion) posted in 2009. Last year’s deficit was the largest as a share of GDP since the end of World War II, and the deficit expected for 2010 would be the second largest. Moreover, if legislation is enacted in the next several months that either boosts spending or reduces revenues, the 2010 deficit could equal or exceed last year’s shortfall.

•   CMS and ONC issue “meaningful use” rules for the EHR incentive program

  The Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology have issued two inter-related regulations regarding the “meaningful use” of certified electronic health record technology. The American Recovery and Reinvestment Act of 2009 required the agencies to provide a meaningful use definition for EHR by the end of 2009, so these rules have been awaited. Both rules are scheduled to be published in the Federal Register on January 13th and both provide a 60-day comment period. The ONC rule is effective 30 days after publication.