Your Government at Work

CMS Listening Session on Physician Fee Schedule Proposed Rule

The Centers for Medicare & Medicaid Services (“CMS”) will conduct a listening session on its physician fee schedule proposed rule.  Proposed changes to the 2019 physician fee schedule would increase the amount of time doctors and other clinicians spend with their patients by reducing the burden of Medicare paperwork.  CMS will cover three topics from the proposed rule:  streamlining evaluation and management payment and reducing clinical burden, advancing virtual care, and continuing to improve the Quality Payment Program to reduce clinician burden, focus on outcomes, and promote interoperability.  Register here for the listening session to be held on August 22, 2018 from 1:30-3:00 p.m.

CMS Issues Final Payment Rules

The Centers for Medicare & Medicaid Services (“CMS”) issued a final rule that updates Medicare payment policies and rates under the Inpatient Prospective Payment System (“IPPS”) and the Long-Term Care Hospital Prospective Payment System.  Among other changes, the rule will increase operating payment rates for general acute care hospitals that are paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are meaningful electronic health record (“EHR”) users by approximately 1.85 percent.  The changes apply to discharges occurring on or after October 1, 2018.

CMS also issued final rules increasing payment for skilled nursing facilities, inpatient rehabilitation facilities (“IRFs”), inpatient psychiatric facilities (“IPFs”) and hospices for 2019.

The IRF Final Rule will increase IRFs’ Medicare payments for 2019 by 1.3% when compared with 2018.  The rule will also impose changes such as allowing post-admission physician evaluations to qualify as a face-to-face physician visit, allowing rehabilitation physicians to lead disciplinary teams remotely without requiring any additional documentation, and removing the admission order documentation requirement.

The IPF Final Rule will increase Medicare payments to IPF facilities by 1.1% in 2019.  Under this rule, CMS will remove quality measures for assessment of patient experience of care, alcohol use screening, influenza vaccination coverage among health care personnel, tobacco use screening, and use of an EHR.

HHS Issues Final Rule on Short-Term, Limited Duration Insurance

The Department of Health and Human Services (“HHS”) issued a final rule amending the definition of short-term limited duration insurance for purposes of its exclusion from the definition of individual health insurance coverage.  This will lengthen the maximum duration of short-term, limited duration insurance, which will provide more affordable consumer choices for health coverage.  Under the final rule, short-term, limited duration insurance will have an expiration date specified in the contract that is less than 12 months after the original effective date, but the duration of such will be no longer than 36 months in total.  The final rule will be effective on October 2, 2018.

OIG Advisory Opinion No. 18-07

The Office of Inspector General (“OIG”) issued Advisory Opinion No. 18-07 regarding a proposal from a group purchasing organization (“GPO”) to serve as a purchasing agent on behalf of certain GPO-affiliated health care facilities on the same terms and conditions that apply to its unaffiliated members.  In its opinion, the OIG found that under the proposed arrangement, the requestor would fail to continue meeting the safe harbor’s definition of a GPO.  However, the OIG determined that the arrangement would not materially increase the risk of fraud and abuse under the anti-kickback statute.