Earlier this week, the Centers for Medicare and Medicaid Services (CMS) proposed to change the way it pays Medicare reimbursements to hospitals. CMS seeks to encourage higher quality of care in hospitals by rewarding those that meet a certain threshold. To fund the “incentive payment pool,” CMS will cut payments by a flat rate of 2 percent to 5 percent.
The American Hospital Association (AHA) has responded to CMS’s proposal. Noting that the changes could create financial problems, AHA senior vice president Tom Nickels told CQ Health Beat: “Two to five percent reduction in hospital payments [is] a significant cut, and there’s a lot of uncertainty in how that money is returned to the system or if that money is returned to the system. Ultimately, we would prefer a pool of new money, additional resources being provided…”
In a three-page letter, the Department of Aging and Disability Services (DADS) informed Nursing Facilities, Community Services, ICF/MR, and Therapy Providers that the National Provider Identifier (NPI) contingency period ends on March 1, 2008. NPI will replace legacy provider identifiers.
Providers’ claims can’t be paid if they are submitted without NPI data. For more information, download the letter here.
Yesterday, the Centers for Medicare and Medicaid Services (CMS) proposed to change the way it pays Medicare reimbursements to hospitals. (Kaiser Network)
CMS seeks to reduce payments by a flat rate (2 percent to 5 percent) to create an “incentive payment pool” for hospitals that meet quality of care thresholds. According to CQ HealthBeat, the plan would create a “Value-Based Purchasing Program.” Under this program, a hospital’s diagnosis-related group reimbursements would be based on quality performance.
Kerry Weems, acting administrator for CMS, said: “Value-based purchasing would benefit Medicare beneficiaries and other health care consumers by encouraging higher quality hospital care. Under the plan, additional information would be collected and publicly disseminated to patients and health care providers so that they can make better health care decisions.” (Source)
Weems added: “Getting hospitals to report their quality measures was an important first step. Now, building on that experience, we are taking the next step of actually rewarding hospitals for the quality of care they provide Medicare beneficiaries.”
The following information was obtained from the November 16 edition of the Texas Register:
Proposed Rules
The Texas Board of Nursing (BON) proposes to amend 22 TAC §§216.1 - 216.7, relating to Continuing Education, pursuant to Senate Bill 993 (SB 993), which deleted the portion of the Nursing Practice Act that required the Board to allow Type II CE. Currently, the BON has discretion to accept only Type I CE courses for license renewal.
BON also proposes to amend Title 22, Texas Administrative Code (TAC), §§219.1 - 219.13 relating to Advanced Nurse Practitioner Program, pursuant to recommendations made by the Sunset Advisory Commission and subsequent changes to the Nursing Practice Act during the 2007 legislative session.
BON will continue to approve pre-licensure programs but will not approve nationally accredited post-licensure programs. For more information about these proposals and where to send written comments, see the relevant section of the Texas Register.
The following information was obtained from the November 9 edition of the Texas Register:
Open Meeting
The Texas Health and Human Services Commission (HHSC) will hold a public hearing on November 28, 2007, at 9:00 a.m. to receive public comment on the proposed rate for Support Consultation Services. The hearing will be held in the Lone Star Conference Room of the Health and Human Services Commission, Braker Center, Building H, located at 11209 Metric Blvd, Austin, Texas. See the relevant section of the Texas Register for where to send written comments.
Proposed Rules
HHSC proposes to amend Title 1, Part 15, Chapter 355, Subchapter C, by adding new §355.313, relating to the reimbursement methodologies for rehabilitative and specialized services provided to Medicaid-eligible residents of a nursing facility. This amendment would set out the reimbursement methodology for rehabilitative and specialized services delivered to Medicaid-eligible clients in nursing facilities.
For more information about the amendment and where to send written comments, see the relevant section of the Texas Register.
HHSC also proposes to amend §355.503, concerning Reimbursement Methodology for the Community-Based Alternatives Waiver Program and the Integrated Care Management-Home and Community Support Services and Assisted Living/Residential Care Programs; §355.505, concerning Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program; and §355.5902, concerning Reimbursement Methodology for Primary Home Care Services.
The amendment would add subparagraph (D) to §355.503(d)(2), which sets out a reimbursement methodology for Personal Care III. For more information about the amendment and where to send written comments, see the relevant section of the Texas Register.
The Texas Department of Aging and Disability Services (DADS) informed Community Living Assistance and Support Services (CLASS), Case Management Agencies, and Direct Services Agencies that before CLASS enrollment can be finalized, an applicant’s enrollment in other community service programs, including Personal Care Services, must end.
For more information, download the letter here.
In a provider letter to Home and Community Support Services Agencies (HCSSA), DADS clarified the Informal Review of Deficiencies (IRoD) process (formerly known as the Informal Review of Violations).
The IRoD, an informal, administrative process, applies to all licensed and Medicare-certified HCSSA. For more information, download the four-page letter here.
The Texas Department of Aging and Disability Services (DADS) issued a provider letter to Nursing Facilities and Hospitals Seeking Medicare Certification for a Skilled Nursing Care Unit to inform them about new policy documents issued by the Centers for Medicare and Medicaid Services (CMS) regarding workload prioritization on initial certification surveys.
Attached to the two-page letter is a two-page Q&A memo. Download the letter and attachment here for more information.
CMS published the final Calendar Year 2008 Medicare Home Health Prospective Payment System (PPS) rule on August 29, 2007. This final rule requires changes to Outcome and Assessment Information Set (OASIS-B1) data set, and DADS notified Medicare-certified Home Health Agencies of these changes. See the OASIS-B1 page for more information. You may download the provider letter here.
The Texas Department of Aging and Disability Services (DADS) notified all Long Term Services and Supports Providers about tentative plans for late-January Health and Human Services Commission system changes that will affect all claim payments. Because of a system upgrade, claims will not be paid between January 24 and February 6, 2008. For more information, download the letter here.
DADS notified Home and Community-based Services (HCS), Texas Home Living (TxHmL) Service Providers, and Mental Retardation Authorities about training on the Consumer Directed Services (CDS) option. CDS is scheduled to be implemented in early 2008. For a list of training dates and locations, download the letter here.
DADS informed HCS and TxHmL providers that there will be no claims payment processing on December 21, 2007, because of state holiday closures on December 24, 25, and 26, 2007. The processing schedule will resume on December 28, 2007. Download the letter for more information.
Open enrollment in the Medicare Part D prescription drug plan for 2008 begins November 15 and runs through December 31. Those who miss the deadline will have to wait until the next enrollment period.
Medicare Part D, which began on January 1, 2006, was designed to give Medicare-eligible individuals more coverage options for prescription drugs.
Providers looking for more information about Part D can find resources at the Centers for Medicare and Medicaid Service’s Medicare Learning Network drug coverage page.
Proposed Rules
The Texas Health and Human Services Commission (HHSC) has proposed to amend §§352.1 - 352.9, concerning the quality assurance fee for the Intermediate Care Facilities Mental Retardation (ICF/MR) program. The amendments would establish the quality assurance fee for facilities in the ICF/MR program. See the relevant section of the November 2 Texas Register for more information.
The Texas Board of Nursing (BON) has proposed to repeal §217.13 (Peer Assistance Programs), §217.19 (Incident-Based Nursing Peer Review), and §217.20 (Safe Harbor Peer Review for Nurses) after it determined that further changes are no longer needed. See the relevant section of the November 2 Texas Register for more information.
Open Meetings
HHSC will hold a public hearing on proposed Medicaid payment rates for seven specific laboratory services procedure codes on November 20, 2007, at 1:30 p.m., to receive public comment. The hearing will be held in the Lone Star Conference Room of the Texas Health and Human Services Commission, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas. See the relevant section of the November 2 Texas Register for more information on the hearing and where to send written comments.