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Policy Updates

Getting a joke
There are many changes happening in health care every day at the state and federal level. To help you navigate this information, we have implemented this Policy Update page as a place to post the most recent changes and proposed changes that may affect you and your facility.

For archived policy, please visit the Policy Archive.

Federal

H1N1 Waivers
We have received many communications in the last few days about the H1N1 Emergency. We apologize for adding to the email overload about H1N1, but we want to make sure you all have the latest information available to you. ORH is working closely with OAHHS, CMS, ORHP, and NRHA to receive the latest information on the outbreak and waiver process. We appreciate all the questions we have received and have forwarded them on to ORHP and CMS. Below are messages from ORHP, CMS, DHS, and NRHA regarding the bed limit waiver.

We are currently in the process of posting the latest information on the ORH website. We will continue to update this page with all communications that we receive on this topic, so please bookmark this page as a resource. If you have an immediate question, please contact Linda Lang with OAHHS directly at llang@oahhs.org or 503.467.9910 Cell or 503.636.2204 Main. OAHHS is working closely with DHS, CMS and others to determine the steps necessary to get a waiver. We heard from CMS that CAHs will have to be at their bed 25-bed limit before granted a waiver. Please stay tuned for more information later today from both DHS and OAHHS on this matter.

In the meantime, a quick message from OAHHS -
  • Stay in communication with your local public health and emergency management system.
  • Think about what regulations you need waived and justification (waivers are site-specific and decided case-by-case).
  • Continue to make daily reports to the state on H1N1 incidence.
TRICARE CAH Reimbursement Final Rule
The U.S. Department of Defense published a final payment rule on August 31, 2009, for critical access hospitals under TRICARE, which covers uniformed service members and their families. The rule is effective on December 1, 2009 and pays 101% of reasonable costs for inpatient and outpatient care. According to the rule, “ this rule implements the statutory provisions that TRICARE payment methods for institutional care be determined to the extent practicable in accordance with the same reimbursement rules as those that apply to payments to providers of services of the same type under Medicare. This final rule implements a reimbursement methodology similar to that furnished to Medicare beneficiaries for services provided by critical access hospitals (CAHs).” See this for the final rule.
Medicare CY 2010 OPPS/ASC rule currently on display (CMS-1414-P)
Medicare CY 2010 OPPS/ASC rule currently on display (CMS-1414-P) includes some proposed changes to current physician supervision requirements for outpatient services in hospitals and CAHs. Here follows an extract of the some relevant language included in the Fact Sheet for the proposed rule (also see information and links included further below):

Proposed Payment Provisions:
  • Physician supervision requirements – CMS is proposing to revise or further define several current policies for the physician supervision of outpatient services. First, CMS is proposing that nonphysician practitioners, specifically physician assistants, nurse practitioners, certified nurse specialists, and certified nurse-midwives, may directly supervise all hospital outpatient therapeutic services that they are able to personally perform within their state scope of practice and hospital-granted privileges. Under current policy, only physicians may provide the direct supervision of these services.

In addition, CMS is proposing to define “direct supervision” for on-campus hospital outpatient services to mean that the physician or nonphysician practitioner must be present in the hospital or on-campus provider-based department of the hospital and immediately available to furnish assistance and direction throughout the performance of the procedure, in contrast to the current definition which requires the physician to be present in the on-campus provider-based department. For services furnished in an off-campus provider-based department, “direct supervision” would continue to mean that the physician or nonphysician practitioner must be present in the off-campus provider-based department and immediately available to furnish assistance and direction throughout the performance of the procedure. CMS is also proposing to require that all hospital outpatient diagnostic services furnished directly or under arrangement, whether provided in the hospital, in a provider-based department, or at a nonhospital location, follow the MPFS physician supervision requirements for individual tests."
Proposed Medicare CY 2010 Medicare Physician Fee Schedule Rule (CMS-1413-P)
On July 1, 2009, CMS announced a Medicare proposed rule, Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B (CY 2010) (CMS-1413-P). On July 9, 2009, CMS announced a correction to the proposed rule (CMS-1413-CN).

This proposed CY 2010 rule for the Medicare physician fee schedule (MPFS) remains on display at the Office of the Federal Register (FR) and is expected to be published in the FR on July 13, 2009. Pubic comments will be accepted until 5 PM Eastern time on August 31, 2009. To view or download information on the current rule on display, click on any of the following links:
Proposed Medicare CY 2010 OPPS/ASC Rule (CMS-1414-P)
On July 1, 2009, CMS announced a Medicare proposed rule, Proposed Changes to the Hospital Outpatient Prospective Payment System (OPPS) and CY 2010 Payment Rates; Proposed Changes to the Ambulatory Surgical Center (ASC) Payment System and CY 2010 Payment Rates (CMS-1414-P).

This proposed CY 2010 OPPS/ASC rule remains on display at the Office of the FR and is expected to be published in the FR on July 20, 2009. Public comments will be accepted until 5 PM Eastern time on August 31, 2009. To view or download information on the current rule on display, click on any of the following links:
CMS Website on Recovery Act and Health Information Technology Now Available
A new website from CMS now is available concerning Health Information Technology as provided for in the American Recovery and Reinvestment Act of 2009. On this website, you can find information pertaining to the Medicare and Medicaid incentives for electronic health records adoption and important links to related websites at the Department of Health and Human Services.

Posted now are:
  • A CMS fact sheet and questions/answers pertaining to the incentive programs

  • Link to press release pertaining to the process of defining meaningful use.

  • Resources on Health IT and privacy & security (HIPAA)

Bookmark this linked page to find the latest on Health Information Technology.
Proposed DMEPOS Regulatory Updates
CMS has announced limited proposed regulatory provisions for the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program. These proposals include a proposed administrative process for contract suppliers whose contracts were terminated by the Medicare Improvements for Patients and Providers Act of 2008 to submit claims for any applicable damages and proposed grandfathering provision updates. These proposed provisions are found in Section O of the Physician Fee Schedule and Other Revisions to Part B regulation (CMS-1413-P), which is now on display at the Office of the Federal Register.

 

Visit the CMS website to obtain additional information and view the rule.


You also may view or download the proposed rule on display at the Office of the FR here.
Healthcare Common Procedure Coding System (HCPCS) Quarterly Update
CMS is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set. These changes have been posted to the HCPCS website. Changes are effective on the date indicated on the update.
Revised National Correct Coding Initiative (NCCI) Edits for Physicians from July 1st
Important Notice: If you downloaded the National Correct Coding Initiative (NCCI) Edits for Physicians (version number 15.2, effective 07/01/09 – 09/30/09) on July 6 or 7, 2009, please download the files again. Incorrect files were posted for the NCCI Edits for Physicians. The files have been corrected, and can be found on the CMS website.
Updated CAH Conditions of Participation
The Conditions of Participation (CoP) for Critical Access Hospitals (State Operations Manual Appendix W) was updated on June 12, 2009. The addition includes § 485.610(e) Standard: Off-campus and Co-Location Requirements for CAHs.

The new version of Appendix W can be viewed here. Please note that Appendix W that was included in the Flex Coordinator Manual distributed April 2009 is now outdated.

 

This document was referenced in the July 21, 2009 Flex Webinar on CAH Surveys.
Upper Midwest Rural Health Research Center Policy Brief, June 2009
Health Information Technology Policy and Rural Hospitals
American Recovery and Reinvestment Act of 2009 (ARRA)
The Recovery Act appropriated $7.2 billion and directed the Department of Agriculture's Rural Utilities Service (RUS) and The Department of Commerce's National Telecommunications Information Administration (NTIA) to expand broadband access to unserved and underserved communities across the U.S., increase jobs, spur investments in technology and infrastructure, and provide long-term economic benefits.

The result is the RUS Broadband Initiatives Program (BIP) and the NTIA Broadband Technology Opportunities Program (BTOP).

National Rural HIT Coalition meeting summary
AHA ARRA and Critical Access Hospitals
Meaningful Use Proposed Matrix
Meaningful Use: A Definition
Meaningful Use Summary 6/20/2009
HIT Policy Committee Meeting 6/16/2009
CSRHA Launches ARRA Rural Resources Webpage, Rural Health Funding Matrix

For a related webinar, please see visit the Flex WebEx Archive from 6/23/20009 titled EMR Incentives in the Stimulus Bill (right column on linked page).
Federal Funding Opportunities From ARRA