IN THIS WEEK’S ISSUE:
- CMS Keeps Specialty Hospitals on Hold Despite End of Moratorium
- Swing-Bed MDS Manual Revised
- 2006 Long-Term Care PPS Instructions Published
- Governors Take Medicaid Recommendations to Congress
- HHS Approves First Medicaid Long-Term Home Care Waiver
- DOJ Ruling Limits Prosecution of Covered Entity Employees
- NPI Transition Plans Announced
- Quick Links
- New in the Resource Center
1. CMS KEEPS SPECIALTY HOSPITALS ON HOLD DESPITE END OF MORATORIUM
Although the specialty hospital moratorium of the Medicare Modernization Act of 2003 ended June 8, CMS says no new specialty hospital enrollment applications will be processed while the agency decides how to proceed on the issue. The GAO reported on potential new facilities to the Senate Finance Committee May 19 and advised that at the end of April, CMS had 39 applications seeking determination that they were under development before the MMA and therefore could open. Another 52 were recently opened or were in some stage of development. According to the GAO, 100 specialty hospitals were in existence in June 2003, but the number could very nearly double by the end of 2006, depending on interpretation of the hospitals’ status.
CMS administrator Mark McClellan told the House Energy & Commerce Committee in May that an extension of the moratorium was not needed; rather, he would put a hold on the enrollment process until changes, including DRG modifications, could level the playing field between specialty and community hospitals. He said CMS also would look at whether some of the current specialty hospitals were meeting Medicare’s definition of “hospital.”
On June 9, CMS directed its regional offices “not to issue any new provider agreements or authorize an initial survey in any specialty hospital after June 8, 2005.” The CMS instruction noted that it does not apply to specialty hospitals that have provider agreements or that requested a CMS Advisory Opinion prior to June 8, 2005.
2. SWING-BED MDS MANUAL REVISED
CMS has revised the October 2003 Swing-Bed Minimum Data Sets (MDS) Manual with changes that include clarification of several items and numerous additions and deletions of instructions for other MDS items. For example, admission status code 04, Another Nursing Facility, would include admissions from hospital swing beds. The list of changes also notes that the clarification of certain items changes the instruction content for others.
The changes became effective upon publication. A close reading of and detailed staff training on these changes should be conducted as soon as possible.
3. 2006 LONG-TERM CARE PPS INSTRUCTIONS PUBLISHED
CMS has published the implementing transmittal for the update of the long-term care hospital (LTCH) PPS rates for the payment year beginning July 2006. This revision to the CMS claims manual focuses on the financial aspects of the LTCH PPS and implements the transition from the current metropolitan statistical areas designation to the core-based statistical area designation for LTCHs, meaning that for discharges beginning July 1, 2005, the core-based statistical area designation will be used for assigning a wage index value for LTCHs.
Under the 2006 update, published on May 6, the full 3.4 percent market basket update will produce a standard federal rate of $38,086; in addition, the fixed loss outlier amount will be $10,501.The budget neutrality adjustment will be 0 percent.
4. GOVERNORS TAKE MEDICAID RECOMMENDATIONS TO CONGRESS
The National Governors Association’s (NGA’s) bipartisan report is the beginning of the process of Medicaid reform, not the end, NGA Chairman Mark Warner (D-VA) stressed, as he and NGA Vice Chairman Mike Huckabee (R-AR) met with the Senate Finance and House Energy and Commerce Committees June 15. The NGA paper, Medicaid Reform: A Preliminary Report, makes recommendations that include incentives and penalties related to how much responsibility individuals take for their care, more flexibility for states with regard to benefits, leveraging public programs for better coverage rates for small purchasers, greater use of technology to reduce costs, and policies for reducing reliance on Medicaid.
Democratic committee members in both hearings expressed concern about proposed measures that might reduce access to health care for the poor. Republicans were more receptive to the NGA’s report, but the prospect of increasing copays drew the concerns of both parties.
5. HHS APPROVES FIRST MEDICAID LONG-TERM HOME CARE WAIVER
HHS has announced its first Medicaid waiver for long-term home care services. Under the waiver, the Vermont Long Term Care Plan will establish a triage system to determine the kind of services the Medicaid program would provide to beneficiaries at risk of institutionalization.
According to CMS, beneficiaries in the highest tier of need would be offered a traditional nursing facility or expanded services needed to keep them in their homes, while beneficiaries in the second tier who need less intensive services would continue to receive nursing home or home-based care, but would be served in the order of greatest need. The program is said to expand community-based services to 950 older and disabled individuals at risk of institutionalization but who would not qualify without the demonstration. Altogether, the five-year project will include 4,500 Medicaid beneficiaries who are 65 or older and adults with physical disability. The project is expected to be budget neutral.
6. DOJ RULING LIMITS PROSECUTION OF COVERED ENTITY EMPLOYEES
A new Justice Department opinion sharply limits the government’s ability to prosecute employees of a covered entity for violating the law that protects the privacy of health information in medical records. According to a New York Times article, the ruling states “criminal penalties apply to covered entities including insurers, doctors, hospitals and other providers—but not necessarily to their employees or outsiders who steal personal health data.” Therefore, employees who work for covered entities may not be subject to criminal penalties that include a $250,000 fine and 10 years in prison for the most serious violations.
7. NPI TRANSITION PLANS ANNOUNCED
CMS has announced the following plans for transitioning to the National Provider Identifier (NPI) in the fee-for-service Medicare program:
- From May 23, 2005, to October 1, 2006, CMS’s claims processing systems will accept either an existing legacy Medicare number and or an NPI that is accompanied by an existing legacy Medicare number.
- From October 2, 2006, through May 22, 2007, CMS systems will accept an existing legacy Medicare number and/or an NPI. This will allow for six to seven months of provider testing before only an NPI will be accepted by the Medicare program.
- Beginning May 23, 2007, CMS systems will only accept an NPI.
To answer questions about this process and other NPI issues, CMS will host a nationwide HIPAA NPI Roundtable conference call on June 22, 2005 at 2:00 p.m. ET. The call in number is (877) 203-0044 and the identification number is 5580682. There is no cost and no registration is required.
8. QUICK LINKS
FORM CMS-2552-96 INSTRUCTIONS. CMS has updated the Provider Reimbursement Manual, clarifying instructions to the provider cost reporting Form CMS 2552-96 and implementing provisions of the Medicare Modernization Act and the Balanced Budget Refinement Act of 1999.
REVISED 1500 FORM COMMENT PERIOD. The National Uniform Claim Committee has announced a 45-day public comment period, ending July 25, 2005, for the changes to the 1500 Professional Claim Form to accommodate the National Provider Identifier.
UNINSURED COSTS INCREASE PREMIUMS. A Families USA study, Paying a Premium: The Added Cost of Care for the Uninsured, asserts that as the costs of care for the uninsured are added to health insurance premiums, more employers can be expected to drop coverage, leaving even more people without insurance.
COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM. The Commonwealth Fund has established an 18-member Commission on a High Performance Health System that will identify healthcare delivery and financing policies and practices that would lead to improved system performance, better access, and improved quality for high-risk populations.
9. NEW IN THE RESOURCE CENTER
FY06 SKILLED NURSING FACILITY PPS PROPOSED UPDATES FACT SHEET. Use this fact sheet as a quick reference on the key provisions of the FY06 SNF PPS proposed rule.
Copyright 2005 Healthcare Financial Management Association, all rights reserved. HFMA Express News ISSN: 1540-0689. Volume XII, Number 24. Editor: Rob Fromberg rfromberg@hfma.org, (800) 252-HFMA, ext. 385.
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