Tags Posts tagged with "CMS"


Unprecedented additions to regulations that interpret Stark Law open avenues for health care providers to ensure that patients receive the highest quality of care.

Today the Centers for Medicare and Medicaid Services (CMS) finalized changes to outdated federal regulations that have burdened health care providers with added administrative costs and impeded the health care system’s move toward value-based reimbursement. The Physician Self-Referral Law, also known as the Stark Law, generally prohibits a physician from sending a patient, who needs many types of services, to a provider who the physician owns, is employed by, or otherwise receives payment from—regardless of what that payment is for. The old federal regulations that interpret and implement this law were designed for a health care system that reimburses providers on a fee-for-service basis, where the financial incentives are to deliver more services. However, the twenty-first century American health care system is increasingly moving toward financial arrangements that reward providers who are successful at keeping patients healthy and out of the hospital. This is an arrangement where payment is tied to value rather than volume.

Read more here.

Please contact your RCPA policy staff for more information.

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The Centers for Medicare and Medicaid Services (CMS) has released a video tutorial for providers in Inpatient Rehabilitation Facilities (IRFs) with standardized data assessment guidance and assessment strategies for the cognitive assessment—known as the Brief Interview for Mental Status (BIMS). The video is approximately 22 minutes in length and is designed to provide targeted guidance for accurate coding by using live action patient scenarios.

National and State advocacy organizations have appealed to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma to extend flexibilities that have been vital to state systems during the COVID-19 pandemic. Our national organizations, ANCOR and ACCSES, signed this letter dated October 23, 2020. It is an Appendix K waiver that has been invaluable to maintaining the capacity of states and providers in continuing to support individuals in need of long-term supports and services throughout this pandemic.

CMS originally developed a timeline for Appendix K expiration of one year from the initial start date in recognition of the fact that it may take a year to reestablish the pre-public health emergency. However, given that the COVID-19 pandemic has continued for several months, the advocates have suggested that the one-year timeframe should actually begin when the public health emergency has ended.

The second very important issue for many states and providers of service is the continued availability of retainer payments. These payments are crucial to keeping provider networks in place during a period of time when they are unable to provide services due to the pandemic. The three 30-day periods of retainer payments were crucial to keeping providers in business; however, we are now entering a new phase of the pandemic. It is still not safe for typical services to resume. Without retainer payments, the stability of the provider network is at risk. The request to CMS is to extend to states the ability to provide retainer payments beyond the three 30-day periods.


January 13, 2020

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

CMS Reduces Psychiatric Hospital Burden with New Survey Process
Streamlined process will improve quality of care for patients

Today, the Centers for Medicare & Medicaid Services (CMS) announced a streamlined survey and certification process for psychiatric hospitals, delivering on the Agency’s “Patients Over Paperwork” initiative. The full benefits of this initiative can be explored here. This new process will ensure safety and quality through more holistic and efficient hospital inspections that protect patients, while reducing burden for providers.

Currently, psychiatric hospitals surveyed by State Survey Agencies are subject to two separate onsite compliance surveys, one by the State Survey Agency (SSA) for compliance with the hospital requirements and one by an outside contractor selected by the SSA for compliance with two additional psychiatric hospital standards.

Beginning in March 2020, CMS will implement a streamlined process in which psychiatric hospitals will receive one comprehensive hospital survey performed by the SSA to review compliance with both hospital and psychiatric hospital participation requirements, allowing inspectors to take a broader view of a psychiatric hospital’s operations and better identify systemic quality issues.

“The policy of multiple inspections for psychiatric hospitals is emblematic of the absurd status quo in healthcare. For too long, fragmented and misaligned processes have increased burden and administrative costs,” said CMS Administrator Seema Verma. “Under President Trump’s leadership, CMS is upending the status quo and forging ahead with practical, commonsense changes to streamline our processes to reduce burden and improve oversight and patient safety, and reducing unnecessary administrative costs.”

To participate in Medicare, a psychiatric hospital is required to meet both general hospital Conditions of Participation (CoPs) and separate CoPs for psychiatric hospitals. CoPs are federal requirements that promote the health, safety and well-being of the patients being treated in these facilities. CMS is not making any changes to these safety and quality requirements.

Moving to a single survey process will benefit patients by ensuring psychiatric hospital services are evaluated in the context of the overall hospital survey program, making it easier for surveyors and the provider to identify and correct systemic quality issues that impact patient care. It also benefits providers by reducing the regulatory burden currently imposed on psychiatric hospitals because a single survey team conducting the survey will conduct, and only one report would be issued documenting any survey findings, instead of two.

CMS is notifying hospitals, SSAs and psychiatric hospital stakeholders of this upcoming change through a memorandum released today. This change does not affect accreditation organizations’ current methodologies for approving hospitals or psychiatric hospitals, or CMS’s criteria for approving accreditation organizations to survey such facilities. To ensure states are appropriately prepared to begin conducting these surveys in March 2020, CMS is developing an online training that will be released soon.

For more information about the change in the psychiatric hospital survey process and to see the memorandum, visit: https://www.cms.gov/httpswwwcmsgovmedicareprovider-enrollment-and-certificationsurveycertificationgeninfoadministrative/informational-notice-forthcoming-integration-psychiatric-hospital-program-hospital-program-and-state


Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.

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The Centers for Medicare and Medicaid Services (CMS) recently announced the availability of the inpatient rehabilitation facility (IRF) provider preview reports. These reports have been updated and contain information based on quality data submitted by IRFs between Quarter 3 of 2018 and Quarter 2 of 2019. The data will reflect what will be published on IRF Compare during the March 2020 update of the website.

Providers have 30 days (December 9, 2019 – January 9, 2020) to review their performance data. While corrections to the underlying data will not be permitted during this time, providers can request CMS to review their data during the preview period if they believe the quality measure scores that are displayed are inaccurate.

Additionally, providers are reminded that the data for the quality measure Percent of Residents or Patients that have new or worsened Pressure Ulcers (short stay), will continue to reflect data collected between Quarter 3 2017 – Quarter 2 2018, and will continue to be publicly displayed until the new Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury, is publicly displayed in fall 2020, as finalized in the fiscal year (FY) 2018 IRF PPS Final Rule.

As of the March 2020 refresh, CMS will no longer publicly display the measure Percent of Residents or Patients who were assessed and appropriately given the seasonal influenza vaccine (short stay), as finalized in the FY 2019 IRF PPS Final Rule. This change is reflected in preview reports. Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.

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The Centers for Medicare and Medicaid Services (CMS) recently notified the Office of Long-Term Living (OLTL) of the approval of the OBRA Waiver amendment. The amendment is effective on January 1, 2020.

The changes in the approved amendment include:

  • Revise the Residential Habilitation service definition by modifying the number of hours that are defined as a day unit from a minimum of 12 hours to 8 hours.
  • Revise the service definitions of Job Finding, Job Coaching, Employment Skills Development, Career Assessment, and Benefits Counseling to address when employment services can be provided through the OBRA waiver, should the Office of Vocational Rehabilitation (OVR) have a waiting list (closed order of selection) or when OVR has not made an eligibility determination within 120 days.
  • Update the Abuse Registry Screening information to reflect that the Department of Human Services (DHS) utilizes IDEMIA as the data system to process fingerprint-based FBI criminal record checks, as well as other minor changes.
  • Revise cost neutrality estimates to reflect rate changes to the Personal Assistance Services (PAS) and Residential Habilitation waiver services.

If you have any questions, please contact the OLTL Bureau of Policy Development and Communications Management at 717-857-3280.

ODP Announcement 19-102 provides information regarding the amendments submitted to the Centers for Medicare and Medicaid Services (CMS) regarding the Consolidated, Community Living, and P/FDS waivers. It is anticipated that the amendments will become effective October 1, 2019.

CMS has 90 days to review the amendments and changes may occur to the content based upon discussion with CMS during the approval process. Each full waiver application, as well as a side-by-side of substantive changes made as a result of public comment is available online here.

The amendments align with 55 Pa. Code Chapter 6100 regulations when effective, ensure compliance with the Home and Community-Based Settings regulations, and align with the Office of Developmental Programs’ Everyday Lives recommendations.

The amendments include a plan to serve medically complex children in a community home when transitioning from an extended hospital stay if they are unable to return to their family home. Also, the scope of professionals who can diagnose intellectual disability has been expanded.

ODP is adding the expectation that all providers of Community Participation Support services must offer individuals opportunities to participate in community activities that are consistent with the individual’s preferences, choices, and interests. On-call and remote support is proposed in order to support the fading of service and dependence on paid staff. The number of procedure codes and staffing levels has been decreased to more accurately reflect service delivery.

Starting January 1, 2022, CPS services may not be provided in any facility required to hold a 2380 or 2390 license that serves more than 150 individuals at any one time, including individuals funded through any source. All participants receiving prevocational services must have a competitive integrated employment outcome included in their service plan. There must be documentation in the service plan regarding how and when the provision of prevocational services is expected to lead to competitive integrated employment. CPS may not be provided in newly funded (on or after January 1, 2020) licensed 2380 or 2390 locations which serve more than 25 individuals in the facility at any one time.

Residential Habilitation, Life Sharing, and Supported Living Services will be required to utilize the recommendations provided in the Health Risk Screening Tool. SCs will be expected to monitor the implementation of the recommendations and incorporate them into the Individual’s Plan. Also, clarification is provided regarding the location parameters for newly funded sites.

ODP is proposing that respite can be provided by nurses for children with medical needs to assure the appropriate level of care is available.

Qualifications required for Support Service Professionals, Individuals, and Agency Providers have been clarified, including timelines for completion of certification requirements. Additionally, supported employment can be provided to individuals until OVR services are available, particularly when OVR has established a waiting list.

For a side-by-side comparison of substantive changes made as a result of public comment, see this online document. Questions about this communication should be directed to the appropriate ODP Regional Office.

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The Centers for Medicare and Medicaid Services (CMS) recently announced an upcoming in person inpatient rehabilitation facility quality reporting program (IRF QRP) training. This two-day “train-the-trainer” event for providers is scheduled for August 15–16, 2019 at the Four Seasons Hotel, 200 International Drive, Baltimore, MD 21202.

The primary focus of this training, which is open to all IRF providers, associations, and organizations,  will be to provide those responsible for training staff at IRFs with information about IRF QRP changes and updates to the IRF Patient Assessment Instrument (PAI) v.3.0, which will become effective on October 1, 2019. Topics will include, but are not limited to:

  • An overview of the changes between the IRF-PAI v.2.0 and v.3.0;
  • Updated training materials for Section GG, which will include videos of patient scenarios; and
  • An interactive session on the use of reports to identify opportunities for process improvement and utilize information contained in reports available via the Certification and Survey Provider Enhanced Reports (CASPER) system, which will be used to develop quality improvement plans.

A full agenda is available for both days of the training. Registration is limited to 100 people on a first-come, first-served basis. Questions or additional information requests should be sent to the PAC Training mailbox.

Final Rule will strengthen popular Medicare private health insurance plans, expand telehealth access for patients, and improve coordination for dual-eligible individuals

Today, the Centers for Medicare & Medicaid Services (CMS) finalized policies that will increase plan choices and benefits, including allowing Medicare Advantage plans to include additional telehealth benefits. These policies continue the agency’s efforts to modernize the Medicare Advantage and Part D programs, unleash innovation and drive competition to improve quality among private Medicare health and drug plans.

“Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” said CMS Administrator Seema Verma. “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”

The final policies announced today leverage new authorities provided to CMS in the Bipartisan Budget Act of 2018, which President Trump signed into law last year. CMS is finalizing changes that would allow Medicare Advantage beneficiaries to access additional telehealth benefits, starting in plan year 2020. These additional telehealth benefits offer patients the option to receive health care services from places like their homes, rather than requiring them to go to a healthcare facility.

Before this year, seniors in Original Medicare could only receive certain telehealth services if they live in rural areas. Starting this year, Original Medicare began paying for virtual check-ins across the country, meaning patients can connect with their doctors by phone or video chat. Historically, Medicare Advantage plans have been able to offer more telehealth services, compared to Original Medicare, as part of their supplemental benefits. But with the final rule, it will be more likely that plans will offer the additional telehealth benefits outside of supplemental benefits, expanding patients’ access to telehealth services from more providers and in more parts of the country than before, whether they live in rural or urban areas.

CMS is also finalizing changes that will make improvements to Medicare Advantage and Part D Star Ratings so that consumers can identify high-value plans. The final rule updates the methodology for calculating Star Ratings, which provide information to consumers on plan quality. The new Star Ratings methodology will improve the stability and predictability for plans and will adjust how the ratings are set in the event of extreme and uncontrollable events such as hurricanes.

The final rule will improve the quality of care for beneficiaries dually eligible for Medicare and Medicaid who participate in Dual Eligible Special Needs Plans (D-SNPs). These beneficiaries usually have complex health needs; if they have a complaint about their healthcare or about access to items and services, they have to work with multiple organizations, one responsible for Medicare benefits and another responsible for Medicaid benefits, in order to file an appeal. The final rule will create one appeals process across Medicare and Medicaid, which will make it easier for enrollees in certain D-SNPs to navigate the healthcare system and have access to high quality services. The final rule will also require plans to more seamlessly integrate Medicare and Medicaid benefits across the two programs, such as notifying the state Medicaid agency (or its designee) of hospital and skilled nursing facility admissions for certain high-risk beneficiaries, to promote coordination of care for these patients.

Today’s announcement builds on the 2020 Rate Announcement and Final Call Letter released earlier this week that gives Medicare Advantage plans flexibility to offer chronically ill patients a broader range of supplemental benefits that are not necessarily health related and can address social determinants of health. With these new telehealth and supplemental benefits, Medicare Advantage plans will have the flexibility to provide a historic set of offerings to beneficiaries. Medicare Advantage plans will be able to compete for patients based on their new offerings and overall cost. CMS is working to update the Medicare Plan Finder with these new choices, so that beneficiaries will be able to see their new choices and benefits and can pick the plans that work best for them.

The fact sheet on the CY 2020 Medicare Advantage and Part D Flexibility Final Rule (CMS-4185-F) can be found here. The final rule can be downloaded from the Federal Register.