Thursday, April 30, 2015
MLN Connects Provider eNews for April 30th, 2015
Click here to view this week's MLN Connects Provider eNews from the Centers for Medicare and Medicaid Services.
CMS National Training Program Partner Update Webinar
Join us for the monthly CMS National Training Program Partner Update Webinar
May 5, 2015, 2:30 – 3:30 pm EST
This month we'll feature:
Audio Conference Details
Toll-free dial in number: 1-800-603-1774
Conference ID: 43244841
Webinar Link: https://webinar.cms.hhs.gov/ntpupdatewebinar050515/
May 5, 2015, 2:30 – 3:30 pm EST
This month we'll feature:
- Revisions to the Nursing Home Compare 5-Star Quality Rating System–Recent changes to the system
- Plan Finder–An overview of the April Release
- Social Security Initiatives and Campaigns
Toll-free dial in number: 1-800-603-1774
Conference ID: 43244841
Webinar Link: https://webinar.cms.hhs.gov/ntpupdatewebinar050515/
NRHA applauds change in Veterans Choice Program
As of today, the Veterans Choice Program will begin using driving distance to determine the distance between a veteran’s residence and the nearest VA medical facility for the purpose of determining a veteran’s eligibility for the Veterans Choice Program based on a distance of greater than 40 miles from a VA facility. The Department of Veterans Affairs released an interim final rule making this important change.
Free Webinar 5.8.2015 Agricultural Safety and Health in Argentina
Current Situation of Agricultural Health and Safety in Argentina:
Preventive education and training from the cooperative model
Date: Friday, May 8, 2015
Time: 12:00pm - 1:00pm CST
Objectives:
- Describe the main features of agricultural production in Argentina
- Identify the health and safety situation of rural actors in Argentina
- Share the main aspects and characteristics of agricultural accidents and occupational illnesses (statistics)
- To share the health and safety training activities and preventive actions taken by the cooperative of farmers AFA scl (Federated Farmers Argentinos).
Presenter:
Marcos Grigioni: Coordinator of Agricultural Health and Safety Programme, Argentinian Federated Farmers Cooperative (AFA SCL)
Proposed FY 2016 Medicare Payment And Policy Changes For Inpatient Psychiatric Facilities
FACT SHEET
April 24, 2015
Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
Proposed FY 2016 Medicare Payment And Policy Changes For Inpatient Psychiatric Facilities
OVERVIEW: On April 24, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed fiscal year (FY) 2016 Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS).
The proposed rule also updates the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program, which requires participating facilities to report on quality measures or incur a reduction in their annual payment update. This proposed rule would expand the measure sets in future fiscal years and change certain data reporting requirements for these measures.
The FY 2016 proposals are summarized below. SUMMARY OF PAYMENT UPDATES AND PROPOSED CHANGES TO THE IPF PPS Federal Per Diem Base Rate Update: CMS is proposing to update the estimated payments to IPFs in FY 2016 relative to estimated payments in FY 2015 by 1.6 percent (or $80 million). This amount reflects 2.7 percent IPF-specific market basket estimate less the productivity adjustment of 0.6 percentage point and less the 0.2 percentage point reduction required by law, for a net update of 1.9 percent. Estimated payments to IPFs are reduced by 0.3 percent due to updating the outlier fixed-dollar loss threshold amount.
Stand-alone IPF Market Basket and Labor Related Share for FY 2016: CMS is proposing an IPF-specific market basket to replace the Rehabilitation, Psychiatric and Long-Term Care (RPL) market basket. The proposed IPF market basket would be based on 2012 Medicare cost report data (the RPL market basket is based on 2008 data) for both freestanding and hospital-based IPFs. The proposed FY 2016 Labor Related Share (LRS) of the IPF-specific market basket is 74.9 percent, which is an increase from the FY 2015 LRS of 69.294 percent.
Wage Index: CMS is proposing to update the Core Based Statistical Areas (CBSAs) with the Office of Management and Budget (OMB) Bulletin No. 13-01 and 2010 US Census Data. To implement this update, CMS is proposing to adopt the newest OMB delineations for the FY 2016 IPF PPS wage index using a 1-year transition with a 50/50 blended wage index for all providers. The FY 2016 wage index for each provider would consist of a blend of fifty percent of the FY 2016 wage index using the current OMB delineations and fifty percent of the FY 2016 wage index using the revised OMB delineations.
As a result of the proposed adoption of the new OMB delineations for the FY 2016 IPF PPS wage index, 37 IPF providers would have their status changed from rural to urban, and therefore would lose their 17 percent rural adjustment. CMS is proposing a gradual phase-out of their rural adjustment, so that these 37 providers would receive two-thirds of the rural adjustment in FY 2016, one-third of the rural adjustment in FY 2017, and no rural adjustment for FY 2018 and subsequent years.
QUALITY MEASURE UPDATES AND OTHER IPFQR PROGRAM CHANGES
Background on the IPFQR Program. The IPFQR Program is a pay-for-reporting program established by the Affordable Care Act (ACA) and added to the Social Security Act. IPFs are subject to a reduction of two percentage points in their annual payment update for failure to meet administrative and data reporting requirements on certain quality measures. Our current IPFQR Program measure set includes 14 measures. CMS proposes to increase the IPFQR Program measure set to 16 measures by proposing the addition of five measures and the removal of three measures. The proposed rule also proposes several policies that would lessen the burden on reporting entities.
Measures Proposed for Adoption for FY 2018 Payment Determination and Subsequent Years
· One Tobacco Treatment Measure. TOB-3 - Tobacco Use Treatment Provided or Offered at Discharge and a subset measure TOB-3a Tobacco Use Treatment at Discharge (NQF #1656) measures patients 18 and older who have used tobacco products and who were referred to counseling and received or refused a prescription for cessation medication upon discharge, and the subset measure includes only those patients who received counseling and cessation medication at discharge.
· One Substance Use Measure. SUB-2 - Alcohol Use Brief Intervention Provided or Offered and a subset measure SUB-2a Alcohol Use Brief Intervention (NQF #1663) measures patients 18 and older to whom a brief substance-abuse intervention was provided, or offered and refused, and the subset measure includes only those patients who received a brief intervention.
· Two Transition Record Measures.
· Transition Record with Specified Elements Received by Discharged Patients (Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care) (NQF #0647) measures the percentage of patients discharged from an inpatient facility, or their caregivers, who received a transition record with specified elements at the time of discharge.
· Timely Transmission of Transition Record (Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care) (NQF #0648) measures the percentage of patients discharged from an inpatient facility for whom a transition record was transmitted to the health care setting designated for follow-up care within 24 hours of discharge.
· One Screening for Metabolic Disorders Measure. Screening for Metabolic Disorders measures the percentage of discharges with an antipsychotic prescription for which a structured metabolic screening for (1) BMI; (2) blood pressure; (3) glucose or HbA1c; and (4) a lipid panel elements was completed in the past year.
Measures Proposed for Removal
Beginning with FY 2017 Payment Determination. HBIPS 4 (Patients Discharged on Multiple Antipsychotic Medications) is proposed for removal due to the loss of NQF endorsement, and because CMS believes that HBIPS-5 Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification sufficiently includes the data that HBIPS-4 was intended to collect.
Beginning with FY 2018 Payment Determination. HBIPS 6 (Post-Discharge Continuing Care Plan Created) and HBIPS 7 (Post-Discharge Continuing Care Plan Transmitted to Next Level of Care Provider Upon Discharge) because these measures would be duplicative of two measures CMS is proposing for FY 2018 and the measures proposed for removal are not as robust as the proposed new measures.
Other Changes CMS is also proposing changes to the data reporting requirements for IPFQR Program measures. Specifically, CMS is proposing to require IPFs to report measure data as a single, yearly count rather than by quarter and age because obtaining data for each quarter and by age is burdensome to providers and the resultant number of cases is often too small to allow public reporting. In addition, CMS is proposing to require IPFs to report aggregate population counts for discharges as a single, yearly count rather than by quarter. CMS is also proposing to change sampling requirements to give providers the option of obtaining one global sample for most measures, rather than having different sampling requirements for different measures. CMS believes that uniform sampling will decrease provider burden and allow streamlined procedures.
CMS will accept comments on the proposed rule until June 23, 2015. The proposed IPF PPS rule can be downloaded from the Federal Register at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-09880.pdf or www.federalregister.gov/public-inspection
It will publish at the Federal Register on May 1, 2015 will be available online at: https://federalregister.gov/a/2015-09880
Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
Proposed FY 2016 Medicare Payment And Policy Changes For Inpatient Psychiatric Facilities
OVERVIEW: On April 24, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed fiscal year (FY) 2016 Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS).
The proposed rule also updates the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program, which requires participating facilities to report on quality measures or incur a reduction in their annual payment update. This proposed rule would expand the measure sets in future fiscal years and change certain data reporting requirements for these measures.
The FY 2016 proposals are summarized below. SUMMARY OF PAYMENT UPDATES AND PROPOSED CHANGES TO THE IPF PPS Federal Per Diem Base Rate Update: CMS is proposing to update the estimated payments to IPFs in FY 2016 relative to estimated payments in FY 2015 by 1.6 percent (or $80 million). This amount reflects 2.7 percent IPF-specific market basket estimate less the productivity adjustment of 0.6 percentage point and less the 0.2 percentage point reduction required by law, for a net update of 1.9 percent. Estimated payments to IPFs are reduced by 0.3 percent due to updating the outlier fixed-dollar loss threshold amount.
Stand-alone IPF Market Basket and Labor Related Share for FY 2016: CMS is proposing an IPF-specific market basket to replace the Rehabilitation, Psychiatric and Long-Term Care (RPL) market basket. The proposed IPF market basket would be based on 2012 Medicare cost report data (the RPL market basket is based on 2008 data) for both freestanding and hospital-based IPFs. The proposed FY 2016 Labor Related Share (LRS) of the IPF-specific market basket is 74.9 percent, which is an increase from the FY 2015 LRS of 69.294 percent.
Wage Index: CMS is proposing to update the Core Based Statistical Areas (CBSAs) with the Office of Management and Budget (OMB) Bulletin No. 13-01 and 2010 US Census Data. To implement this update, CMS is proposing to adopt the newest OMB delineations for the FY 2016 IPF PPS wage index using a 1-year transition with a 50/50 blended wage index for all providers. The FY 2016 wage index for each provider would consist of a blend of fifty percent of the FY 2016 wage index using the current OMB delineations and fifty percent of the FY 2016 wage index using the revised OMB delineations.
As a result of the proposed adoption of the new OMB delineations for the FY 2016 IPF PPS wage index, 37 IPF providers would have their status changed from rural to urban, and therefore would lose their 17 percent rural adjustment. CMS is proposing a gradual phase-out of their rural adjustment, so that these 37 providers would receive two-thirds of the rural adjustment in FY 2016, one-third of the rural adjustment in FY 2017, and no rural adjustment for FY 2018 and subsequent years.
QUALITY MEASURE UPDATES AND OTHER IPFQR PROGRAM CHANGES
Background on the IPFQR Program. The IPFQR Program is a pay-for-reporting program established by the Affordable Care Act (ACA) and added to the Social Security Act. IPFs are subject to a reduction of two percentage points in their annual payment update for failure to meet administrative and data reporting requirements on certain quality measures. Our current IPFQR Program measure set includes 14 measures. CMS proposes to increase the IPFQR Program measure set to 16 measures by proposing the addition of five measures and the removal of three measures. The proposed rule also proposes several policies that would lessen the burden on reporting entities.
Measures Proposed for Adoption for FY 2018 Payment Determination and Subsequent Years
· One Tobacco Treatment Measure. TOB-3 - Tobacco Use Treatment Provided or Offered at Discharge and a subset measure TOB-3a Tobacco Use Treatment at Discharge (NQF #1656) measures patients 18 and older who have used tobacco products and who were referred to counseling and received or refused a prescription for cessation medication upon discharge, and the subset measure includes only those patients who received counseling and cessation medication at discharge.
· One Substance Use Measure. SUB-2 - Alcohol Use Brief Intervention Provided or Offered and a subset measure SUB-2a Alcohol Use Brief Intervention (NQF #1663) measures patients 18 and older to whom a brief substance-abuse intervention was provided, or offered and refused, and the subset measure includes only those patients who received a brief intervention.
· Two Transition Record Measures.
· Transition Record with Specified Elements Received by Discharged Patients (Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care) (NQF #0647) measures the percentage of patients discharged from an inpatient facility, or their caregivers, who received a transition record with specified elements at the time of discharge.
· Timely Transmission of Transition Record (Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care) (NQF #0648) measures the percentage of patients discharged from an inpatient facility for whom a transition record was transmitted to the health care setting designated for follow-up care within 24 hours of discharge.
· One Screening for Metabolic Disorders Measure. Screening for Metabolic Disorders measures the percentage of discharges with an antipsychotic prescription for which a structured metabolic screening for (1) BMI; (2) blood pressure; (3) glucose or HbA1c; and (4) a lipid panel elements was completed in the past year.
Measures Proposed for Removal
Beginning with FY 2017 Payment Determination. HBIPS 4 (Patients Discharged on Multiple Antipsychotic Medications) is proposed for removal due to the loss of NQF endorsement, and because CMS believes that HBIPS-5 Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification sufficiently includes the data that HBIPS-4 was intended to collect.
Beginning with FY 2018 Payment Determination. HBIPS 6 (Post-Discharge Continuing Care Plan Created) and HBIPS 7 (Post-Discharge Continuing Care Plan Transmitted to Next Level of Care Provider Upon Discharge) because these measures would be duplicative of two measures CMS is proposing for FY 2018 and the measures proposed for removal are not as robust as the proposed new measures.
Other Changes CMS is also proposing changes to the data reporting requirements for IPFQR Program measures. Specifically, CMS is proposing to require IPFs to report measure data as a single, yearly count rather than by quarter and age because obtaining data for each quarter and by age is burdensome to providers and the resultant number of cases is often too small to allow public reporting. In addition, CMS is proposing to require IPFs to report aggregate population counts for discharges as a single, yearly count rather than by quarter. CMS is also proposing to change sampling requirements to give providers the option of obtaining one global sample for most measures, rather than having different sampling requirements for different measures. CMS believes that uniform sampling will decrease provider burden and allow streamlined procedures.
CMS will accept comments on the proposed rule until June 23, 2015. The proposed IPF PPS rule can be downloaded from the Federal Register at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-09880.pdf or www.federalregister.gov/public-inspection
It will publish at the Federal Register on May 1, 2015 will be available online at: https://federalregister.gov/a/2015-09880
HPCAR’s 'LEADING THE WAY'
HPCAR’s ‘LEADING THE WAY’ is right around the corner and we’ve had a terrific response already for the conference, which has its pre-conference session on Wednesday, May 13, and the two-day full conference Thursday and Friday, May 14 and 15.
Here's a partial line-up of hospice track sessions:
Click on the following links to access:
CONGRATULATIONS TO TIFFANY BURANOSKY OF PIKES PEAK HOSPICE & PALLIATIVE CARE FOR WINNING A FREE CONFERENCE REGISTRATION FOR HPCAR'S FALL CONFERENCE! This contest was announced in last week's email promotion.
ACT NOW! Click here to view the conference brochure. The first Hospice, Home Care and Home Health Conference & Exhibition will be a dynamic, engaging gathering of the best and brightest in Colorado, Wyoming and adjacent states. Click here to register. Information about the Pre-Conference session for administrators, directors, and managers is available here. Click here for information about Sponsoring, Exhibiting, and Program Advertising.
Here's a partial line-up of hospice track sessions:
- ICD-10 Preparation for Hospice
- Hospice Track Lunch: What Is Our Mission and How Is It Influenced?
- Medicare Hospice Benefit
- USA & UK Hospice Giving
- Nobody Ever Told Me I Would Have to Sell
- Back to the Future for Home Care & Hospice Providers
- Planning for Success: How to Engage Everyone from Your Board Chair to Middle Managers in Developing Strategic Plans that Work
- Using Hospice Skills Upstream in the Healthcare Continuum: Advice for Hospice & Palliative Care Executives
- Closing Lunch and General Sessions: National Legislative Update: Hospice & Home Care
Click on the following links to access:
- “Leading The Way” Conference Schedule on Sched,org
- Conference speakers
- Conference attendees
- Watch the Sched Attendee Video and Learn how to build your own personal schedule
CONGRATULATIONS TO TIFFANY BURANOSKY OF PIKES PEAK HOSPICE & PALLIATIVE CARE FOR WINNING A FREE CONFERENCE REGISTRATION FOR HPCAR'S FALL CONFERENCE! This contest was announced in last week's email promotion.
ACT NOW! Click here to view the conference brochure. The first Hospice, Home Care and Home Health Conference & Exhibition will be a dynamic, engaging gathering of the best and brightest in Colorado, Wyoming and adjacent states. Click here to register. Information about the Pre-Conference session for administrators, directors, and managers is available here. Click here for information about Sponsoring, Exhibiting, and Program Advertising.
Stroke Advisory Board Public Notice
This serves as public notice for the upcoming:
Stroke Advisory Board meeting
Wednesday, May 13, 1:00-4:00
Sabin-Cleere room at CDPHE main campus
Teleconference: 712-432-3148 Conference code: 914468
Adobeconnect: https://cdphe.adobeconnect.com/stemi/
The topic of discussion will focus on whether state designation is appropriate or necessary to assure access to the best quality care for Colorado residents with stroke events. The Stroke Advisory Board is seeking input from hospitals and EMS to help craft recommendations to the legislature.
For more information you may visit the Stroke Advisory Board website at:
https://www.colorado.gov/pacific/cdphe/stroke-advisory-board
Please email eileen.brown@state.co.us with questions or comments.
Stroke Advisory Board meeting
Wednesday, May 13, 1:00-4:00
Sabin-Cleere room at CDPHE main campus
Teleconference: 712-432-3148 Conference code: 914468
Adobeconnect: https://cdphe.adobeconnect.com/stemi/
The topic of discussion will focus on whether state designation is appropriate or necessary to assure access to the best quality care for Colorado residents with stroke events. The Stroke Advisory Board is seeking input from hospitals and EMS to help craft recommendations to the legislature.
For more information you may visit the Stroke Advisory Board website at:
https://www.colorado.gov/pacific/cdphe/stroke-advisory-board
Please email eileen.brown@state.co.us with questions or comments.
Open Payments: Data review and dispute underway for physicians
Open Payments: Data review and dispute underway for physicians – log in today
In its second year, the Open Payments program continues to promote transparency and accountability in health care by providing consumers with information about financial relationships between drug and medical device manufacturers and physicians and teaching hospitals. The data posted has been viewed nearly 6 million times and we’re pleased with the continuing engagement of stakeholders on this important transparency initiative.
All data for payments made in 2014 has been submitted by the drug and medical device manufacturers who are reporting the information. CMS is encouraging physicians and representatives of teaching hospitals to register in Open Payments now. Instructions and quick tips for registration are available here. While companies that are submitting payment records to CMS attest to the accuracy of the data, the continued success of the program relies on voluntary participation by physicians and teaching hospitals. This is the only opportunity for doctors and teaching hospitals to review the data submitted by manufacturers and group purchasing organizations (GPOs) before it is included in the public database on June 30, 2015.
CMS acknowledges the benefits of collaboration among physicians, teaching hospitals and drug and device manufacturers in the design and delivery of many life-saving drugs and devices. Open Payments has given patients a tool to become more involved and informed health care consumers by discussing these relationships with their physicians.
Last year, 26,000 physicians registered in the system and lodged over 12,500 disputes. In contrast, we published information about 4.45 million payments made to at least 366,000 physicians or teaching hospitals that were valued at $3.7 billion. I expect that the data reported this year will be on scale with the number and value of payments reported last year. For physicians, the only way for each of you to confirm that the data reported about you is correct is to register and review your payments before the review period ends.
To learn more about the program, visit cms.gov/openpayments today.
In its second year, the Open Payments program continues to promote transparency and accountability in health care by providing consumers with information about financial relationships between drug and medical device manufacturers and physicians and teaching hospitals. The data posted has been viewed nearly 6 million times and we’re pleased with the continuing engagement of stakeholders on this important transparency initiative.
All data for payments made in 2014 has been submitted by the drug and medical device manufacturers who are reporting the information. CMS is encouraging physicians and representatives of teaching hospitals to register in Open Payments now. Instructions and quick tips for registration are available here. While companies that are submitting payment records to CMS attest to the accuracy of the data, the continued success of the program relies on voluntary participation by physicians and teaching hospitals. This is the only opportunity for doctors and teaching hospitals to review the data submitted by manufacturers and group purchasing organizations (GPOs) before it is included in the public database on June 30, 2015.
CMS acknowledges the benefits of collaboration among physicians, teaching hospitals and drug and device manufacturers in the design and delivery of many life-saving drugs and devices. Open Payments has given patients a tool to become more involved and informed health care consumers by discussing these relationships with their physicians.
Last year, 26,000 physicians registered in the system and lodged over 12,500 disputes. In contrast, we published information about 4.45 million payments made to at least 366,000 physicians or teaching hospitals that were valued at $3.7 billion. I expect that the data reported this year will be on scale with the number and value of payments reported last year. For physicians, the only way for each of you to confirm that the data reported about you is correct is to register and review your payments before the review period ends.
To learn more about the program, visit cms.gov/openpayments today.
Weekly CREATE Bulletin
Don’t Be a Copy Cat!
No one likes a copycat – especially when applying for more than one course or conference in one grant application. Writing one master service need and cost effective project budget narrative then cutting and pasting it into all other course section narratives is a recipe for failure. Having key messages, stats and objectives is fine, but the tone and focus of each course narrative should reflect each individual course requested. It may take longer than cutting and pasting, but you’ll get a much higher success rate this way.
Develop your key facts and figures
These are the things that don’t change (or don’t change much) from one application to the next. They could include your organization’s background, what makes you unique, monitoring & evaluation, budget, etc.
Don’t assume what the ERC will assume
Just because the Expert Review Committee (ERC) members are all experts in EMTS, does not mean you should assume they understand the justification for your request. Write in clear and accessible language. Reading it out loud will help you express your need in the most effective way possible.
Thank you for all you do for our Colorado communities!
If you have any questions about the CREATE Grant process, please contact Megan Lyda at ml@coruralhealth.org or 720.248.2742.
No one likes a copycat – especially when applying for more than one course or conference in one grant application. Writing one master service need and cost effective project budget narrative then cutting and pasting it into all other course section narratives is a recipe for failure. Having key messages, stats and objectives is fine, but the tone and focus of each course narrative should reflect each individual course requested. It may take longer than cutting and pasting, but you’ll get a much higher success rate this way.
Develop your key facts and figures
These are the things that don’t change (or don’t change much) from one application to the next. They could include your organization’s background, what makes you unique, monitoring & evaluation, budget, etc.
Don’t assume what the ERC will assume
Just because the Expert Review Committee (ERC) members are all experts in EMTS, does not mean you should assume they understand the justification for your request. Write in clear and accessible language. Reading it out loud will help you express your need in the most effective way possible.
Thank you for all you do for our Colorado communities!
If you have any questions about the CREATE Grant process, please contact Megan Lyda at ml@coruralhealth.org or 720.248.2742.
Thursday, April 23, 2015
Funding Opportunity- National Rural ACO
Rural providers have until May 1 to apply for a share of $114 million in one-time federal grants to help the transition to accountable care organizations. Letters of Inquiry can be submitted through the website of the National Rural ACO. For more information, please reference this press release and determine if this opportunity is right for your organization.
MLN Connects Provider eNews for April 23rd, 2015
MLN Connects® Provider eNews for April 23, 2015
View this edition as a PDF
In This Edition:
MLN Connects® National Provider Calls
CMS Events
Claims, Pricers, and Codes
Medicare Learning Network® Educational Products
View this edition as a PDF
In This Edition:
MLN Connects® National Provider Calls
- Medicare Acute Care Quality and Reporting Programs — Registration Now Open
- New MLN Connects® National Provider Call Audio Recording and Transcript
CMS Events
- Special Open Door Forum: Home Health Electronic and Paper Clinical Templates
- Proposed FY 2016 Skilled Nursing Facility Payment and Policy Changes
- Proposed FY 2016 Inpatient and Long-Term Care Hospital Payment and Policy Changes
- DMEPOS Competitive Bidding Round 1 2017 Announced
- National Minority Health Month
- CMS Releases Hospital Compare Star Ratings
- New Hospice Reports Available in CASPER
- CMS to Release Transthoracic Echocardiography Comparative Billing Report in May
- CMS to Award Special Innovation Projects for Partnership-Driven Quality Improvement Projects
- CMS is Accepting Suggestions for Potential PQRS Measures
Claims, Pricers, and Codes
- Coordination of Benefits Issue Impacting Outpatient Hospital Claims
- Updated: Correcting the Display Issue for OPPS Claims Where Value Code “FD” Is Present
Medicare Learning Network® Educational Products
- “Independent Diagnostic Testing Facilities” Podcast — Released
- “Vaccine and Vaccine Administration Payments under Medicare Part D” Fact Sheet — Revised
- “Home Health Prospective Payment System” Fact Sheet — Revised
- “Medicare Fraud and Abuse: Prevention, Detection, and Reporting” Web-Based Training Course — Revised
- New Medicare Learning Network® Educational Web Guides Fast Fact
Medicare Part A News-Jurisdiction H for April 17th, 2015
The following information is provided by Novitas Solutions.
Medicare News
New Release of PEPPER for CAHs, IPFs, and Hospital-Based IRFs, PHPs and SNFs
The Q4FY14 release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER), with statistics through September 2014, has been made available the QualityNet secure portal for:
About PEPPER
PEPPER summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. Visit PEPPERresources.org to access updated resources for using PEPPER, including recorded web-based training sessions, sample PEPPERs and PEPPER User's Guides, which are available on the applicable "Training and Resources" pages.
**Coming Soon** - PEPPER will be available for Home Health Agencies in July, 2015. Visit the Home Health Agency Training and Resources page at PEPPERresources.org for more information. Join our email list to receive information about the new Home Health Agency PEPPER.
PEPPER is distributed by TMF® Health Quality Institute under contract with the Centers for Medicare & Medicaid Services.
New Release of PEPPER for SNFs
The Q4FY14 release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for Skilled Nursing Facilities (SNFs), with statistics through September 2014, is now available for download. To obtain the PEPPER, the Chief Executive Officer, President or Administrator of the organization should:
1. Review the Secure PEPPER Access Guide.
2. Review the instructions and obtain the information required to authenticate access. A new validation code will be required (medical record number or patient control number from a claim for services from September 1, 2014 through September 30, 2014).
3. Visit the PEPPER Resources Portal.
4. Complete all the fields.
5. Download the PEPPER.
The PEPPERs will be available to download for approximately two years. Note: SNF/swing bed units of short-term acute care hospitals received their PEPPER via the QualityNet secure portal.
Spring has sprung and so have our 2015 Medicare Symposiums!
Join us, live and in-person, as we discuss what is new and exciting with Medicare. Topics this year include Medicare Secondary Payer (MSP), provider enrollment, and modifiers. Don’t miss your chance to interact with the Novitas Solutions Provider Outreach and Education team!
Register today to attend our upcoming symposium in Albuquerque, NM on Wednesday, April 22! This event will be held at the DoubleTree by Hilton Albuquerque.
Registration is available for other symposium events and more locations are still to come!
Registration closes two business days prior to the event, so register early to reserve your seat!
We look forward to seeing you at an upcoming symposium event!
Important Credit Balance News
Any Credit Balance 838-Certifications that are not accurate and complete will be deemed invalid. Effective for the 03/31/15 reporting quarter, the immediate return of invalid or incomplete CMS-838 Certification Pages will result for the following reasons and please note that invalid Certification Pages will invalidate your entire submission:
How to Complete the CMS-838 Credit Balance Reports
Medicare News
New Release of PEPPER for CAHs, IPFs, and Hospital-Based IRFs, PHPs and SNFs
The Q4FY14 release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER), with statistics through September 2014, has been made available the QualityNet secure portal for:
- Critical Access Hospitals (CAHs),
- Inpatient Psychiatric Facilities (IPFs),
- Inpatient Rehabilitation Facility (IRF) distinct part units of short-term acute care and critical access hospitals,
- Partial Hospitalization Programs (PHPs) administered by short-term acute care hospitals or IPFs, and
- Skilled Nursing Facility swing-bed units that are administered by short-term acute care hospitals.
About PEPPER
PEPPER summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. Visit PEPPERresources.org to access updated resources for using PEPPER, including recorded web-based training sessions, sample PEPPERs and PEPPER User's Guides, which are available on the applicable "Training and Resources" pages.
**Coming Soon** - PEPPER will be available for Home Health Agencies in July, 2015. Visit the Home Health Agency Training and Resources page at PEPPERresources.org for more information. Join our email list to receive information about the new Home Health Agency PEPPER.
PEPPER is distributed by TMF® Health Quality Institute under contract with the Centers for Medicare & Medicaid Services.
New Release of PEPPER for SNFs
The Q4FY14 release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for Skilled Nursing Facilities (SNFs), with statistics through September 2014, is now available for download. To obtain the PEPPER, the Chief Executive Officer, President or Administrator of the organization should:
1. Review the Secure PEPPER Access Guide.
2. Review the instructions and obtain the information required to authenticate access. A new validation code will be required (medical record number or patient control number from a claim for services from September 1, 2014 through September 30, 2014).
3. Visit the PEPPER Resources Portal.
4. Complete all the fields.
5. Download the PEPPER.
The PEPPERs will be available to download for approximately two years. Note: SNF/swing bed units of short-term acute care hospitals received their PEPPER via the QualityNet secure portal.
Spring has sprung and so have our 2015 Medicare Symposiums!
Join us, live and in-person, as we discuss what is new and exciting with Medicare. Topics this year include Medicare Secondary Payer (MSP), provider enrollment, and modifiers. Don’t miss your chance to interact with the Novitas Solutions Provider Outreach and Education team!
Register today to attend our upcoming symposium in Albuquerque, NM on Wednesday, April 22! This event will be held at the DoubleTree by Hilton Albuquerque.
Registration is available for other symposium events and more locations are still to come!
Registration closes two business days prior to the event, so register early to reserve your seat!
We look forward to seeing you at an upcoming symposium event!
Important Credit Balance News
Any Credit Balance 838-Certifications that are not accurate and complete will be deemed invalid. Effective for the 03/31/15 reporting quarter, the immediate return of invalid or incomplete CMS-838 Certification Pages will result for the following reasons and please note that invalid Certification Pages will invalidate your entire submission:
- The incorrect version of the CMS-838 Certification Page/Detail Page is received. Please use the correct version of the CMS-838 Credit Balance Report. You can type directly into this version which is strongly encouraged to ensure your report is legible. Once completed in full, the report should be printed for signatures.
- Proper 6-digit Provider Transaction Access Number (PTAN) is missing, invalid, or a National Provider Identifier (NPI) is listed.
- The name of the facility is missing.
- Multiple PTANS are present. Only one PTAN per Certification Page is acceptable
- Incomplete or inaccurate Quarter Ending date. Quarters should be reported as 03/31/XX, 06/30/XX, 09/30/XX or 12/31/XX. Four digit years will also be acceptable.
- Signature and date of Administrator is missing
- Correct “Check One” block is blank or does not match the contents.
How to Complete the CMS-838 Credit Balance Reports
Information Regarding the Medicare Access and CHIP Reauthorization Act of 2015
Attention Health Professionals: Information Regarding the Medicare Access and CHIP Reauthorization Act of 2015
On April 14 , 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; the President is expected to sign it shortly. This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015, for the Medicare Physician Fee Schedule. In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1 have been extended. CMS will immediately begin work to implement these provisions.
In an effort to minimize financial effects on providers, CMS previously instituted a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later. While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount. The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate.
No action is necessary from providers who have already submitted claims for the impacted dates of service.
SAMHSA's Topics in the News
SAMHSA Funding Opportunity: Statewide Peer Networks for Recovery and Resiliency
SAMHSA is accepting applications for fiscal year 2015 Statewide Peer Networks for Recovery and Resiliency grants. The purpose of this grant program is to create and/or enhance statewide networks that represent mental health and addictions recovery communities to improve access to and the quality of behavioral health systems, services, treatment, and recovery supports statewide.
Learn more and apply…
As PTSD Cases Surge, Army Overhauling Mental Health Services
The Army is overhauling mental health services after years of war in Iraq and Afghanistan, aiming to end an era of experimentation in which nearly 200 programs were tried on different bases. At Joint Base Lewis-McChord and elsewhere, the Army has pushed counseling teams out of hospitals to embed with troops. It’s also cutting back the use of private psychiatric hospitals while expanding intensive mental health programs at military facilities like Madigan Army Medical Center.
Read more…
Thousands of Michigan Veterans Miss Out on Benefits
Hundreds of thousands of Michiganians who qualify for veteran benefits aren't using them, and many veterans don't know they're eligible. As a result, Michigan ranks among the bottom five states for federal spending per veteran. Veterans' benefits can include healthcare, monthly disability checks, life insurance, home loans, and education through the GI bill. Benefits at the state and local levels include vocational training and the Michigan Veterans Trust Fund.
Read more…
Let Your Brain Relax: Mindfulness Meditation Can Reduce Some TBI Symptoms
Staying in the moment can be hard for anyone, but it’s a particular challenge for people recovering from brain trauma. Mental distractions, such as too much excitement, anxiety, and other mental stress, are hallmarks of traumatic brain injury and can affect the healing process. According to experts and research, a simple and effective way to help the brain repair itself is to give it a little R&R (military slang for rest and recuperation).
Read more…
VA Extends Program for Veterans with Traumatic Brain Injury
The Department of Veterans Affairs announced the award of 20 contracts for the Assisted Living Pilot Program for Veterans with Traumatic Brain Injury. Originally slated to end in 2014, the Veterans Access, Choice, and Accountability Act of 2014 extended this program through October 2017.
Read more…
PTSD Research Quarterly: Biomarkers for Treatment and Diagnosis
Read the full newsletter…
SAMHSA is accepting applications for fiscal year 2015 Statewide Peer Networks for Recovery and Resiliency grants. The purpose of this grant program is to create and/or enhance statewide networks that represent mental health and addictions recovery communities to improve access to and the quality of behavioral health systems, services, treatment, and recovery supports statewide.
Learn more and apply…
As PTSD Cases Surge, Army Overhauling Mental Health Services
The Army is overhauling mental health services after years of war in Iraq and Afghanistan, aiming to end an era of experimentation in which nearly 200 programs were tried on different bases. At Joint Base Lewis-McChord and elsewhere, the Army has pushed counseling teams out of hospitals to embed with troops. It’s also cutting back the use of private psychiatric hospitals while expanding intensive mental health programs at military facilities like Madigan Army Medical Center.
Read more…
Thousands of Michigan Veterans Miss Out on Benefits
Hundreds of thousands of Michiganians who qualify for veteran benefits aren't using them, and many veterans don't know they're eligible. As a result, Michigan ranks among the bottom five states for federal spending per veteran. Veterans' benefits can include healthcare, monthly disability checks, life insurance, home loans, and education through the GI bill. Benefits at the state and local levels include vocational training and the Michigan Veterans Trust Fund.
Read more…
Let Your Brain Relax: Mindfulness Meditation Can Reduce Some TBI Symptoms
Staying in the moment can be hard for anyone, but it’s a particular challenge for people recovering from brain trauma. Mental distractions, such as too much excitement, anxiety, and other mental stress, are hallmarks of traumatic brain injury and can affect the healing process. According to experts and research, a simple and effective way to help the brain repair itself is to give it a little R&R (military slang for rest and recuperation).
Read more…
VA Extends Program for Veterans with Traumatic Brain Injury
The Department of Veterans Affairs announced the award of 20 contracts for the Assisted Living Pilot Program for Veterans with Traumatic Brain Injury. Originally slated to end in 2014, the Veterans Access, Choice, and Accountability Act of 2014 extended this program through October 2017.
Read more…
PTSD Research Quarterly: Biomarkers for Treatment and Diagnosis
Read the full newsletter…
The New Colorado MOST Effective Today
The New Colorado MOST:
Officially Launched Today, April 16, 2015
Over the past year, the Colorado Advance Directives Consortium ("CADC") has made significant updates and changes to the Colorado Medical Orders for Scope of Treatment form, in line with feedback from the field and emerging national standards. The updated MOST form "goes live" today, National Healthcare Decisions Day, April 16, 2015. Providers, first responders, and healthcare facility staff across Colorado will need training and updated information on the form and refinements to the utilization process.
Please take advantage of the following resources to implement the new MOST in your organization:
Download the new standardized MOST form
Download the updated MOST instruction booklet
Read frequently asked questions about the MOST
Please take a few minutes to watch this brief and important video by CADC Co-chair, David Koets, MD, outlining the changes to the Colorado MOST.
Officially Launched Today, April 16, 2015
Over the past year, the Colorado Advance Directives Consortium ("CADC") has made significant updates and changes to the Colorado Medical Orders for Scope of Treatment form, in line with feedback from the field and emerging national standards. The updated MOST form "goes live" today, National Healthcare Decisions Day, April 16, 2015. Providers, first responders, and healthcare facility staff across Colorado will need training and updated information on the form and refinements to the utilization process.
Please take advantage of the following resources to implement the new MOST in your organization:
Download the new standardized MOST form
Download the updated MOST instruction booklet
Read frequently asked questions about the MOST
Please take a few minutes to watch this brief and important video by CADC Co-chair, David Koets, MD, outlining the changes to the Colorado MOST.
Wouldn’t it be Great to Reduce Paperwork?
The following information is provided by Novitas Solutions.
So much time each day is spent completing paperwork. Wouldn’t it be great if we could reduce the amount of time spent on paperwork? We think so, and have some information that can help do just that! Under the Health Insurance Portability and Accountability Act (HIPAA), claims, even claims with attachments, must be submitted electronically, except where waived, for reimbursement by the Medicare Program. However, providers should only send medical documentation when necessary for the adjudication of procedures/services that are unusual or require such documentation on a pre-payment basis that cannot be adequately documented in the Claim Note Segment, also known as the NTE segment or narrative field. Recent analysis at Novitas indicates that many providers are sending unnecessary documentation via the Claim Supplemental Information Segment, also known as the PWK segment, and submitting the additional documentation incorrectly. It is important that additional documentation is only submitted when it is necessary for claim adjudication. Here is some information to help you determine when and how to submit additional documentation to Medicare:
- When additional, supporting information for a procedure code, modifier, etc. is required for claim adjudication and can be reported without sending the medical records, the additional information should be reported in the NTE segment (Loop 2300) of the electronic claim. However, it is important to only report additional information in the NTE segment when necessary for claim adjudication or it could delay claim processing.
- When additional information must be provided for claim adjudication and cannot be reported in the NTE segment, or narrative field, of the electronic claim (i.e., medical records), an indicator must be reported in the PWK segment of the electronic claim to indicate that additional documentation will be submitted via fax or mail after the electronic claim has been submitted to Medicare. The PWK segment allows providers to indicate that additional documentation will be submitted to support the services billed so that Medicare can properly identify and match the additional documentation submitted to the claim for processing upon receipt. However, additional documentation should only be sent when necessary for claim adjudication; therefore, the PWK segment should rarely be used and is NOT necessary on all electronic claims submitted.
Recently, Novitas has been receiving numerous faxes that are submitted incorrectly, precluding us from properly matching the documentation to the claim in question. For example, providers are not submitting a cover sheet to let us know why they are submitting the records or they are submitting records for multiple patients under one cover sheet. If cover sheets are not completed or are completed incorrectly, the medical records will be sent back to the submitter. Oftentimes, the submitter could be the provider’s billing service; therefore, providers may not be aware that their medical records are being returned.
If additional documentation is required for claim adjudication, please use the following guidelines:
- Maintain the appropriate medical documentation on file for electronic (and paper) claims.
- Complete one “Medicare Part A/B Fax/Mail Cover Sheet” form per beneficiary. For accurate processing of your claim(s), please complete all requested information in capital letters and avoid contact with the edge of the boxes. The cover sheet can be found on our website.
- Clearly write the Attachment Control Number (ACN), Internal Control Number (ICN), patient name, Health Insurance Claim (HIC) number, date of service, total claim billed amount, National Provider Identification (NPI) number, contact information, and state where services were provided on the cover sheet. NOTE: The ACN is the number used to identify the documents sent as attachments to an electronic claim. The ACN is entered on the Fax Cover Sheet and in the PWK segment of the electronic claim.
- Report the PWK segment on your electronic claim as follows:
- Select the appropriate Report Type Code for the medical documentation
- Use the By Fax or By Mail option for the Attachment Transmission Code
- Enter AC for the Identification Code Qualifier
- Report the Attachment Control Number
- Only the first iteration of the PWK, at either the claim level and/or line level, will be considered for adjudication.
439-5479. You may fax documentation any time after claim submission, including the same day. 5. Faxing is available 24 hours a day, 7 days a week.
6. Failure to submit all items requested will result in documentation being returned and could delay claim processing.
7.Again, it is important that additional documentation is only submitted when it is necessary for claim adjudication, which may ultimately reduce the amount of paperwork in your practice. For more information regarding when and how to submit medical documentation for Medicare Part A and Part B electronic claims, please refer to
6. Failure to submit all items requested will result in documentation being returned and could delay claim processing.
7.Again, it is important that additional documentation is only submitted when it is necessary for claim adjudication, which may ultimately reduce the amount of paperwork in your practice. For more information regarding when and how to submit medical documentation for Medicare Part A and Part B electronic claims, please refer to
See Practice Transformation In Action on June 5
Robust, comprehensive primary care must be the foundation of our healthcare system.
To make this happen, primary care practices are undergoing significant changes, shifting to the Patient Centered Medical Home (PCMH) model.
That shift provides exciting opportunities and very real challenges.
Overcoming these challenges will be one highlight of the Colorado Primary Care Collaborative's Convening Event.
When: June 5th, 8:15 a.m. - 3:30 p.m.
Where: To Be Determined
Cost: FREE
Get the full conference agenda & learn more about CPCC.
Register Now ›
To make this happen, primary care practices are undergoing significant changes, shifting to the Patient Centered Medical Home (PCMH) model.
That shift provides exciting opportunities and very real challenges.
Overcoming these challenges will be one highlight of the Colorado Primary Care Collaborative's Convening Event.
When: June 5th, 8:15 a.m. - 3:30 p.m.
Where: To Be Determined
Cost: FREE
Get the full conference agenda & learn more about CPCC.
Register Now ›
Caring Transitions: Integrated Health Homes and Jefferson Center for Mental Health
Caring Transitions: Integrated Health Homes and Jefferson Center for Mental Health
Webinar: Wednesday, April 29 12:00pm-1:00pm MT
Hosted by the Center for Improving Value in Health Care
Click Here for Free Registration
Integrated health homes for persons with serious mental illness are essential to achieving the triple aim and healthy care transitions. In this webinar, learn from the real world experience of Jefferson Center for Mental Health as we feature their Union Square Health Home and other integration initiatives.
Presented by:
Mindy Klowden, MNM
Director, Office of Healthcare Transformation Jefferson Center for Mental Health
Ms. Klowden is the Director of the Office of Healthcare Transformation at Jefferson Center for Mental Health, a position she has held since December 2011. She is responsible for providing coordination to the Center's healthcare integration programs, developing staff capacity building and training related to integration. She also serves as behavioral health integration "content expert" and provides technical assistance, training and consultation to primary care and behavioral health providers, and other key stakeholders.
Click Here for Free Registration
Webinar: Wednesday, April 29 12:00pm-1:00pm MT
Hosted by the Center for Improving Value in Health Care
Click Here for Free Registration
Integrated health homes for persons with serious mental illness are essential to achieving the triple aim and healthy care transitions. In this webinar, learn from the real world experience of Jefferson Center for Mental Health as we feature their Union Square Health Home and other integration initiatives.
Presented by:
Mindy Klowden, MNM
Director, Office of Healthcare Transformation Jefferson Center for Mental Health
Ms. Klowden is the Director of the Office of Healthcare Transformation at Jefferson Center for Mental Health, a position she has held since December 2011. She is responsible for providing coordination to the Center's healthcare integration programs, developing staff capacity building and training related to integration. She also serves as behavioral health integration "content expert" and provides technical assistance, training and consultation to primary care and behavioral health providers, and other key stakeholders.
Click Here for Free Registration
State health department wants your input on Colorado Cancer Plan
The Colorado Department of Public Health and Environment (CDPHE) invites you to complete a short questionnaire about your interest and perspective on the implementation of the 2016-2020 Colorado Cancer Plan.**
**Like all US states, Colorado has a statewide cancer plan developed by cancer community members and supported by the Center for Disease Control and Prevention (CDC). These plans set forth measurable 5-year objectives with the potential to positively impact a state's cancer burden. Colorado's comprehensive 2016 - 2020 plan goals and objectives — currently under development — are intended to be a framework for collaborative efforts across the state that can empower individuals and organizations in Colorado’s fight against cancer.
The questionnaire will take about 10 minutes to complete and the anonymous, aggregated results will be used to help CDPHE make decisions about how to move forward with implementing the plan. To complete the questionnaire, please click on the following link or cut and paste into your browser by May 5, 2015:
https://www.surveymonkey.com/s/CancerPlan
To capture feedback from as many potential stakeholders as possible, we encourage you to forward the link to anyone you know who might be interested in the 2016-2020 Colorado Cancer Plan. We are interested in opinions from individuals across all phases of the cancer continuum of care (prevention, screening, treatment, and survivorship) as well as those who are engaged in cancer-related policy and health equity issues.
If you have any questions about this questionnaire, please contact Shannon Lawrence, Lead Evaluator, at shannon.lawrence@state.co.us.
**Like all US states, Colorado has a statewide cancer plan developed by cancer community members and supported by the Center for Disease Control and Prevention (CDC). These plans set forth measurable 5-year objectives with the potential to positively impact a state's cancer burden. Colorado's comprehensive 2016 - 2020 plan goals and objectives — currently under development — are intended to be a framework for collaborative efforts across the state that can empower individuals and organizations in Colorado’s fight against cancer.
The questionnaire will take about 10 minutes to complete and the anonymous, aggregated results will be used to help CDPHE make decisions about how to move forward with implementing the plan. To complete the questionnaire, please click on the following link or cut and paste into your browser by May 5, 2015:
https://www.surveymonkey.com/s/CancerPlan
To capture feedback from as many potential stakeholders as possible, we encourage you to forward the link to anyone you know who might be interested in the 2016-2020 Colorado Cancer Plan. We are interested in opinions from individuals across all phases of the cancer continuum of care (prevention, screening, treatment, and survivorship) as well as those who are engaged in cancer-related policy and health equity issues.
If you have any questions about this questionnaire, please contact Shannon Lawrence, Lead Evaluator, at shannon.lawrence@state.co.us.
Thursday, April 16, 2015
Revisions to the State Operations Manual (SOM), Appendix W for CAHS
Please
note Revisions to the State Operations Manual (SOM), Appendix W for CriticalAccess Hospitals.
I.
SUMMARY OF CHANGES: Appendix W, Survey Protocol, Regulations and Interpretive
Guidance for Critical Access Hospitals (CAHs) and Swing Beds in CAHs, is being
revised to reflect recent regulation changes. We are also taking this
opportunity to make clarifications and updates to existing guidance.
NOTE:
The table of contents was revised to remove the reference to Standards and only
reflect the Conditions. Tag C-0299 is new and has been added to reflect the new
Interpretive Guidelines for §485.635(e). Tag C-0286 has been deleted and the
revised Interpretive Guidelines have been relocated to tag C-0287. Tag C-0290
has been deleted and the Interpretive Guidelines have been relocated to C-0287
and to Tag C-0288. Tag C-0293 has been deleted and the Interpretive Guidelines
have been relocated to tag C-0292. Tag C-0295 has been deleted and the revised
Interpretive Guidelines have been relocted to Tac C-0294.
NEW/REVISED
MATERIAL - EFFECTIVE DATE: April 7, 2015 IMPLEMENTATION DATE: April 7,
2015
The
revision date and transmittal number apply to the red italicized material only.
Any other material was previously published and remains unchanged. However, if
this revision contains a table of contents, you will receive the new/revised
information only, and not the entire table of contents.
Medicare News- April 15th, 2015
Medicare News
CMS Provider Education Message:
MLN Connects® Provider eNews for April 9, 2015
View this edition as a PDF
In This Edition:
CMS Events
Announcements
Claims, Pricers, and Codes
Medicare Learning Network® Educational Products
Medical Policy Local Coverage Determination (LCD) and Article Updates
Medical Policy Updates
The following JH MAC Local Coverage Determination (LCDs) which were posted for notice on February 20, 2015 are now effective. These LCDs have also been revised:
The following JH LCDs have been retired effective April 8, 2015 for dates of service on and after April 9, 2015:
Local Coverage Article Updates
The following JH Local Coverage Articles have been added:
Medicare Learning Network (MLN) Articles from CMS
New:
Revised:
Spring has sprung and so have our 2015 Medicare Symposiums!
Join us, live and in-person, as we discuss what is new and exciting with Medicare. Topics this year include Medicare Secondary Payer (MSP), provider enrollment, and modifiers. Don’t miss your chance to interact with the Novitas Solutions Provider Outreach and Education team!
Register today to attend our upcoming symposium in Albuquerque, NM on Wednesday, April 22! This event will be held at the DoubleTree by Hilton Albuquerque.
Registration is available for other symposium events and more locations are still to come!
Registration closes two business days prior to the event, so register early to reserve your seat!
We look forward to seeing you at an upcoming symposium event!
CMS Provider Education Message:
MLN Connects® Provider eNews for April 9, 2015
View this edition as a PDF
In This Edition:
- MLN Connects® National Provider Calls
- Open Payments (Sunshine Act) 2015: Prepare to Review Reported Data — Last Chance to Register
- How to Register for the PQRS Group Practice Reporting Option in 2015 — Last Chance to Register
- Medicare Shared Savings Program ACO: Application Process — Register Now
CMS Events
- Volunteer for ICD-10 End-to-End Testing in July — Forms Due April 17
- Webinar for Comparative Billing Report on Ophthalmology
Announcements
- Results From March 2015 ICD-10 Acknowledgement Testing Week
- Prepare for a Successful Transition to ICD-10 with Medicare Testing Resources
- 2015 PV-PQRS GPRO Registration is Now Open
- Open Payments Physician and Teaching Hospital Review and Dispute Period Began April 6
- EHR Stage 3 Proposed Rule: Comment Period Closes May 29
- Medscape Article for CME Credit: Public Reporting on Quality and Payments
Claims, Pricers, and Codes
- Mass Adjustment of OPPS Claims with APC 1448
- April 2015 Outpatient Prospective Payment System Pricer File Update
- January 2015 PPS Provider Data Available — Revised
Medicare Learning Network® Educational Products
- “Food and Drug Administration Approval of First Biosimilar Product” MLN Matters® Article —Released
- “Discontinued Coverage of Vacuum Erection Systems (VES) Prosthetic Devices in Accordance with the Achieving a Better Life Experience Act of 2014” MLN Matters® Article — Released
- “Partial Hospitalization Program (PHP) Claims Coding & CY2015 per Diem Payment Rates” MLN Matters® Article — Released
- “Medicare Information for Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants” Booklet — Revised
- “The ABCs of the Initial Preventive Physical Examination (IPPE)” Educational Tool — Revised
- “The ABCs of the Annual Wellness Visit (AWV)” Educational Tool — Revised
Medical Policy Local Coverage Determination (LCD) and Article Updates
Medical Policy Updates
- The following JH Local Coverage Determination (LCDs) which were posted for notice on February 20, 2015 are now effective:
- Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (L27475)
- Coverage of Services and Procedures in Nursing Facilities (L27485)
- Diagnostic Abdominal Aortography and Renal Angiography (L32709)
- Evaluation and Management Services Provided in a Nursing Facility (L27496)
- Hemophilia Factor Products (L33658)
- Hydration Therapy (L32738)
- Lower Extremity Major Joint Replacement (Hip and Knee) (L35594)
- Monitored Anesthesia Care (MAC) (L32628)
- Non-Coronary Vascular Stents (L32641)
- Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy (L27537)
- Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L32673)
The following JH MAC Local Coverage Determination (LCDs) which were posted for notice on February 20, 2015 are now effective. These LCDs have also been revised:
- Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L27549)
- Co-Management of Surgical Procedures (L27481)
- Speech-Language Pathology (SLP) Services: Communication Disorders (L27531)
The following JH LCDs have been retired effective April 8, 2015 for dates of service on and after April 9, 2015:
- Bioengineered Skin Substitutes (L32622)
- Hemophilia Factor Products (L32735)
Local Coverage Article Updates
The following JH Local Coverage Articles have been added:
- Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54115)
- Speech-Language Pathology (SLP) Services: Communication Disorders (A54110)
- Co-Management of Surgical Procedures (A47790)
Medicare Learning Network (MLN) Articles from CMS
New:
Revised:
Spring has sprung and so have our 2015 Medicare Symposiums!
Join us, live and in-person, as we discuss what is new and exciting with Medicare. Topics this year include Medicare Secondary Payer (MSP), provider enrollment, and modifiers. Don’t miss your chance to interact with the Novitas Solutions Provider Outreach and Education team!
Register today to attend our upcoming symposium in Albuquerque, NM on Wednesday, April 22! This event will be held at the DoubleTree by Hilton Albuquerque.
Registration is available for other symposium events and more locations are still to come!
Registration closes two business days prior to the event, so register early to reserve your seat!
We look forward to seeing you at an upcoming symposium event!
Deadline: PHASE 3 (CPOE, EDTC) MBQIP Data
CAHs – Please note the deadline to submit your PHASE 3
(CPOE, EDTC) MBQIP data is fast approaching. Please send your data to Caleb by
close of business Friday April 17th. If you have any questions
please contact Caleb at cs@coruralhealth.org.
Information Regarding the Medicare Access and CHIP
The following information is provided by Novitas Solutions.
Medicare News
Attention Health Professionals: Information Regarding the Medicare Access and CHIP Reauthorization Act of 2015
On April 14 , 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; the President is expected to sign it shortly. This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015, for the Medicare Physician Fee Schedule. In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1 have been extended. CMS will immediately begin work to implement these provisions.
In an effort to minimize financial effects on providers, CMS previously instituted a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later. While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount. The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate.
No action is necessary from providers who have already submitted claims for the impacted dates of service.
Medicare News
Attention Health Professionals: Information Regarding the Medicare Access and CHIP Reauthorization Act of 2015
On April 14 , 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; the President is expected to sign it shortly. This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015, for the Medicare Physician Fee Schedule. In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1 have been extended. CMS will immediately begin work to implement these provisions.
In an effort to minimize financial effects on providers, CMS previously instituted a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later. While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount. The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate.
No action is necessary from providers who have already submitted claims for the impacted dates of service.
Congress Approves Formula Fixing Medicare Doctors Pay
"Congress on Tuesday approved a bill to repair the formula for reimbursing Medicare physicians, marking a rare bipartisan achievement just in time to head off a 21 percent cut in the doctors' pay."
To read more, click here.
ACA Implementation News--April 16, 2015
The latest issue of the Department of Health Care Policy
and Financing’s ACA Implementation
News is now available online here. Please feel
free to forward this along to your colleagues that may find the content of
interest.
If you would like to receive ACA Implementation News or our ACA Communication Updates
please click here.
Weekly CREATE Bulletin
Webinars to Help You CREATE Your Best
Colorado Rural Health Center and the CREATE Program frequently offer webinars to help guide you through the grant writing program. Here are two opportunities you shouldn’t miss if your organization relies on grant funding:
How to Write a Successful CREATE Grant and Avoid Common Mistakes
Grant writing can be stressful. You send your hard work off and hope that the Expert Review Committee approves your request. But is the committee looking for? What makes a strong application? This webinar will go through some helpful guidance on what makes or breaks an application and the common mistakes many grantees make. Click here to register for this webinar.
Grant Writing 101 - Finding the Right Opportunities
Join us for the first of a four part series dedicated to helping you with your grant writing in 2015 and beyond. Megan Lyda. Manager of the CREATE program, and Matt Enquist, Outreach Coordinator, as we delve into the first part of our series. We’ll focus on prospecting, the art of finding grant opportunities (with a focus on free resources) and we’ll save plenty of time for questions. Click here to register for this webinar.
Thank you for all you do for all our Colorado communities! We are here to support you, so please do not hesitate to contact us with questions or concerns.
If you have any questions about the CREATE Grant process, please contact Megan Lyda at ml@coruralhealth.org.
Colorado Rural Health Center and the CREATE Program frequently offer webinars to help guide you through the grant writing program. Here are two opportunities you shouldn’t miss if your organization relies on grant funding:
How to Write a Successful CREATE Grant and Avoid Common Mistakes
Grant writing can be stressful. You send your hard work off and hope that the Expert Review Committee approves your request. But is the committee looking for? What makes a strong application? This webinar will go through some helpful guidance on what makes or breaks an application and the common mistakes many grantees make. Click here to register for this webinar.
Grant Writing 101 - Finding the Right Opportunities
Join us for the first of a four part series dedicated to helping you with your grant writing in 2015 and beyond. Megan Lyda. Manager of the CREATE program, and Matt Enquist, Outreach Coordinator, as we delve into the first part of our series. We’ll focus on prospecting, the art of finding grant opportunities (with a focus on free resources) and we’ll save plenty of time for questions. Click here to register for this webinar.
Thank you for all you do for all our Colorado communities! We are here to support you, so please do not hesitate to contact us with questions or concerns.
If you have any questions about the CREATE Grant process, please contact Megan Lyda at ml@coruralhealth.org.
Tuesday, April 7, 2015
HCPF Provider News
The following message is provided by the Colorado Department of Health Care Policy and Financing:
We would like to remind our valued providers that Colorado Medicaid contracts for many important provider-related services. We know how busy you are. While we enjoy working with you directly, our goal is to connect you to the appropriate resource as quickly as possible to resolve your questions and concerns.
Xerox State Healthcare is the Department’s contracted fiscal agent. As such, Xerox is responsible for supporting provider enrollment and claims activities and responding to provider inquiries. The Department also contracts for maintenance of the Provider Web Portal, utilization management functions, and management of the Medicaid dental benefit. Providers should initially contact these resources for questions on enrollment, claims, PARs and reimbursement.
These kinds of questions should be brought to Provider Relations or other Department staff if the appropriate contractors have been unable to resolve your issue. We will do our best to move things forward. We are also happy to help direct you to other resources, as needed, and to research policy or program questions that are not covered by our contractors.
Our Provider Help Page is available online at: https://www.colorado.gov/hcpf/provider-help. Here is a brief summary of resources available to you. It’s a good idea to note the name of the representative with whom you speak, and the ticket or issue number for your concern. This will help us to escalate your issue, if necessary.
· Xerox State Healthcare 1-800-237-0757
o Medicaid Billing and Bulletin questions
o Medicaid Claims and PAR submissions
o Correspondence, Inquiries and Adjustments
o Enrollment, Changes, Signature Authorization and Claim Requisition
· CGI 1-888-538-4275 or Helpdesk.HCG.centra.us@CGI.com
o Colorado Medicaid Web Portal technical support
o Web Portal Password resets
o Web Portal End User training
· ColoradoPAR 1-888-454-7686
o Prior authorization requests for: diagnostic imaging (non-urgent CTs, MRIs, PETs); durable medical equipment/supplies; pediatric home health; medical/surgical services; EBI bone stimulator; EPSDT; surgical 2nd opinions; PT/OT; out-of-state transportation and non-emergency surgery; organ transplants; private duty nursing, vision.
· DentaQuest 1-855-225-1731
o Dental and orthodontia PARs
o Dental billing and claims questions
We would like to remind our valued providers that Colorado Medicaid contracts for many important provider-related services. We know how busy you are. While we enjoy working with you directly, our goal is to connect you to the appropriate resource as quickly as possible to resolve your questions and concerns.
Xerox State Healthcare is the Department’s contracted fiscal agent. As such, Xerox is responsible for supporting provider enrollment and claims activities and responding to provider inquiries. The Department also contracts for maintenance of the Provider Web Portal, utilization management functions, and management of the Medicaid dental benefit. Providers should initially contact these resources for questions on enrollment, claims, PARs and reimbursement.
These kinds of questions should be brought to Provider Relations or other Department staff if the appropriate contractors have been unable to resolve your issue. We will do our best to move things forward. We are also happy to help direct you to other resources, as needed, and to research policy or program questions that are not covered by our contractors.
Our Provider Help Page is available online at: https://www.colorado.gov/hcpf/provider-help. Here is a brief summary of resources available to you. It’s a good idea to note the name of the representative with whom you speak, and the ticket or issue number for your concern. This will help us to escalate your issue, if necessary.
· Xerox State Healthcare 1-800-237-0757
o Medicaid Billing and Bulletin questions
o Medicaid Claims and PAR submissions
o Correspondence, Inquiries and Adjustments
o Enrollment, Changes, Signature Authorization and Claim Requisition
· CGI 1-888-538-4275 or Helpdesk.HCG.centra.us@CGI.com
o Colorado Medicaid Web Portal technical support
o Web Portal Password resets
o Web Portal End User training
· ColoradoPAR 1-888-454-7686
o Prior authorization requests for: diagnostic imaging (non-urgent CTs, MRIs, PETs); durable medical equipment/supplies; pediatric home health; medical/surgical services; EBI bone stimulator; EPSDT; surgical 2nd opinions; PT/OT; out-of-state transportation and non-emergency surgery; organ transplants; private duty nursing, vision.
· DentaQuest 1-855-225-1731
o Dental and orthodontia PARs
o Dental billing and claims questions
Weekly CREATE Bulletin
Deadlines…a love/hate story.
Douglas Adams said, “I love deadlines. I like the whooshing sound they make as they fly by.”
I am continually impressed by the work you do in your communities. Many of you wear multiple hats and adding a CREATE Grantee to that can be overwhelming. There are guidelines to follow, information to collect, the actual writing of the grant and making sure all of this happens in time to meet the CREATE Monthly deadlines.
As a reminder, here are the remaining deadlines for Fiscal Year 2015:
· April 13, 2015
· May 11, 2015
· June 8, 2015
We will announce the Fiscal Year 2016 Deadlines very soon.
It’s important to pay attention to deadlines, even if they are sometimes difficult. Maybe Harvey Mackay’s quote about deadlines is a better way to look at them: “Deadlines aren’t bad. They help you organize your time. They help you set priorities. They make you get going when you might not feel like it.”
Thank you for all you do for all our Colorado communities! We are here to support you, so please do not hesitate to contact us with questions or concerns.
If you have any questions about the CREATE Grant process, please contact Megan Lyda at ml@coruralhealth.org.
Douglas Adams said, “I love deadlines. I like the whooshing sound they make as they fly by.”
I am continually impressed by the work you do in your communities. Many of you wear multiple hats and adding a CREATE Grantee to that can be overwhelming. There are guidelines to follow, information to collect, the actual writing of the grant and making sure all of this happens in time to meet the CREATE Monthly deadlines.
As a reminder, here are the remaining deadlines for Fiscal Year 2015:
· April 13, 2015
· May 11, 2015
· June 8, 2015
We will announce the Fiscal Year 2016 Deadlines very soon.
It’s important to pay attention to deadlines, even if they are sometimes difficult. Maybe Harvey Mackay’s quote about deadlines is a better way to look at them: “Deadlines aren’t bad. They help you organize your time. They help you set priorities. They make you get going when you might not feel like it.”
Thank you for all you do for all our Colorado communities! We are here to support you, so please do not hesitate to contact us with questions or concerns.
If you have any questions about the CREATE Grant process, please contact Megan Lyda at ml@coruralhealth.org.
Opinion: Working to provide care in Colorado’s ‘dental deserts’
The following article is published on the Health News Colorado website:
A recent Colorado Health Institute report, highlighted on Colorado Public Radio, cited a record-increase in the number of Colorado residents who have dental coverage under Medicaid, and the lack of provider access to meet their dental needs.
With a record 1.1 million people now covered for dental care under Medicaid, it’s true that the “dental desert” has been heating up in Colorado over the last few years. While access to dental providers in rural and low-income areas of Colorado is limited today, oral health advocates in Colorado have been working hard toward solutions that continue to address oral health equity by working to create access to dental care throughout Colorado.
To read the rest of the article, click here.
A recent Colorado Health Institute report, highlighted on Colorado Public Radio, cited a record-increase in the number of Colorado residents who have dental coverage under Medicaid, and the lack of provider access to meet their dental needs.
With a record 1.1 million people now covered for dental care under Medicaid, it’s true that the “dental desert” has been heating up in Colorado over the last few years. While access to dental providers in rural and low-income areas of Colorado is limited today, oral health advocates in Colorado have been working hard toward solutions that continue to address oral health equity by working to create access to dental care throughout Colorado.
To read the rest of the article, click here.
Medicare Part A News-Jurisdiction H for April 7th, 2015
The following information is provided by Novitas Solutions.
Medicare News
Spring has sprung and so have our 2015 Medicare Symposiums!
Join us, live and in-person, as we discuss what is new and exciting with Medicare. Topics this year include Medicare Secondary Payer (MSP), provider enrollment, and modifiers. Don’t miss your chance to interact with the Novitas Solutions Provider Outreach and Education team!
Register today to attend our upcoming symposium in Albuquerque, NM on Wednesday, April 22! This event will be held at the DoubleTree by Hilton Albuquerque.
Registration is available for other symposium events and more locations are still to come!
Registration closes two business days prior to the event, so register early to reserve your seat!
We look forward to seeing you at an upcoming symposium event!
Important Credit Balance News
Any Credit Balance 838-Certifications that are not accurate and complete will be deemed invalid. Effective for the 03/31/15 reporting quarter, the immediate return of invalid or incomplete CMS-838 Certification Pages will result for the following reasons and please note that invalid Certification Pages will invalidate your entire submission:
Effective for the 06/30/14 reporting quarter, incomplete or inaccurate CMS-838 Detail Pages will be immediately returned. Please see the following for details:
How to Complete the CMS-838 Credit Balance Reports
Medicare News
Spring has sprung and so have our 2015 Medicare Symposiums!
Join us, live and in-person, as we discuss what is new and exciting with Medicare. Topics this year include Medicare Secondary Payer (MSP), provider enrollment, and modifiers. Don’t miss your chance to interact with the Novitas Solutions Provider Outreach and Education team!
Register today to attend our upcoming symposium in Albuquerque, NM on Wednesday, April 22! This event will be held at the DoubleTree by Hilton Albuquerque.
Registration is available for other symposium events and more locations are still to come!
Registration closes two business days prior to the event, so register early to reserve your seat!
We look forward to seeing you at an upcoming symposium event!
Important Credit Balance News
Any Credit Balance 838-Certifications that are not accurate and complete will be deemed invalid. Effective for the 03/31/15 reporting quarter, the immediate return of invalid or incomplete CMS-838 Certification Pages will result for the following reasons and please note that invalid Certification Pages will invalidate your entire submission:
- The incorrect version of the CMS-838 Certification Page/Detail Page is received. Please use the correct version of the CMS-838 Credit Balance Report. You can type directly into this version which is strongly encouraged to ensure your report is legible. Once completed in full, the report should be printed for signatures.
- Proper 6-digit Provider Transaction Access Number (PTAN) is missing, invalid, or a National Provider Identifier (NPI) is listed.
- The name of the facility is missing.
- Multiple PTANS are present. Only one PTAN per Certification Page is acceptable
- Incomplete or inaccurate Quarter Ending date. Quarters should be reported as 03/31/XX, 06/30/XX, 09/30/XX or 12/31/XX. Four digit years will also be acceptable.
- Signature and date of Administrator is missing
- Correct “Check One” block is blank or does not match the contents.
Effective for the 06/30/14 reporting quarter, incomplete or inaccurate CMS-838 Detail Pages will be immediately returned. Please see the following for details:
How to Complete the CMS-838 Credit Balance Reports
CMS finalizes 2016 payment and policy updates for Medicare Health and Drug Plans
CMS finalizes 2016 payment and policy updates for Medicare Health and Drug Plans
Rate Announcement Details Plan Payments and Other Program Updates for 2016
The Centers for Medicare & Medicaid Services (CMS) today released final Medicare Advantage (MA) and Part D Prescription Drug program changes for 2016 that provide fair and accurate payments to plans, and encourage the delivery of high-quality care for all populations.
“These policies strengthen Medicare Advantage for current and future consumers by encouraging higher quality care,” said Andy Slavitt, acting CMS Administrator. “As the Medicare Advantage marketplace continues to grow, consumers are getting access to better care through more choice and competition. Seniors and people with disabilities, including the dual-eligible population, will continue to have an extensive choice of plans, affordable premiums, and better and more transparent information about provider networks and pharmacies.”
The Medicare Advantage and the Part D Prescription Drug programs’ enrollments and quality continue to grow and improve since the Affordable Care Act became law. Medicare Advantage has reached record high enrollment each year since 2010, a trend continuing in 2015 with a cumulative increase of more than 40 percent since 2010. At the same time, premiums have fallen by nearly 6 percent from 2010 to 2015. And, more than 90 percent of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan.
The finalized policies fully consider the many comments received during the public comment period. Particular care is being taken to ensure that plan sponsors have the right incentives to care for dual eligible populations over the long term. The Rate Announcement finalizes changes in payments that will affect plans differently depending on the characteristics of those plans. On average, the expected revenue change is 1.25 percent without accounting for the expected growth in coding acuity that has typically added another 2 percent. The final revenue increase is larger than the February advance notice largely because the Medicare actuaries recently updated Medicare per capita spending estimates for 2014 and 2015. Medicare per capita spending in 2014, 2015 and 2016 is still expected to be below historical standards.
Today’s announcement drives important improvements to the star rating system, additional accuracy and transparency of provider networks, and continues to promote improvements in quality of care for beneficiaries. The policies in the Rate Announcement and final Call Letter reflect Secretary Burwell’s commitment to a Medicare program – including Medicare Advantage – that delivers better care, spends health care dollars more wisely and results in healthier people. In the Final Call Letter, CMS continues to update the Star Ratings measures to drive improved quality for Medicare Advantage and Part D enrollees. To enhance program integrity and payment accuracy, Medicare Advantage plans will continue to be provided stringent oversight for improper payments, just like other providers in the Medicare program.
Lastly, the final policies will provide enrollees with greater information to make informed and timely decisions about their care and their coverage. The Final Call Letter takes steps to require Medicare Advantage plans to maintain accurate provider directories in a timely manner and make those directories widely available. These steps will help enrollees better understand the providers and choices available to them. In addition, CMS will ensure that Part D sponsors provide clear and accurate access to information on preferred cost sharing pharmacies in their networks so that all beneficiaries have access to affordable coverage.
To view a fact sheet on the 2016 Rate Announcement and final Call Letter, please visit: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-04-06.html
Rate Announcement Details Plan Payments and Other Program Updates for 2016
The Centers for Medicare & Medicaid Services (CMS) today released final Medicare Advantage (MA) and Part D Prescription Drug program changes for 2016 that provide fair and accurate payments to plans, and encourage the delivery of high-quality care for all populations.
“These policies strengthen Medicare Advantage for current and future consumers by encouraging higher quality care,” said Andy Slavitt, acting CMS Administrator. “As the Medicare Advantage marketplace continues to grow, consumers are getting access to better care through more choice and competition. Seniors and people with disabilities, including the dual-eligible population, will continue to have an extensive choice of plans, affordable premiums, and better and more transparent information about provider networks and pharmacies.”
The Medicare Advantage and the Part D Prescription Drug programs’ enrollments and quality continue to grow and improve since the Affordable Care Act became law. Medicare Advantage has reached record high enrollment each year since 2010, a trend continuing in 2015 with a cumulative increase of more than 40 percent since 2010. At the same time, premiums have fallen by nearly 6 percent from 2010 to 2015. And, more than 90 percent of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan.
The finalized policies fully consider the many comments received during the public comment period. Particular care is being taken to ensure that plan sponsors have the right incentives to care for dual eligible populations over the long term. The Rate Announcement finalizes changes in payments that will affect plans differently depending on the characteristics of those plans. On average, the expected revenue change is 1.25 percent without accounting for the expected growth in coding acuity that has typically added another 2 percent. The final revenue increase is larger than the February advance notice largely because the Medicare actuaries recently updated Medicare per capita spending estimates for 2014 and 2015. Medicare per capita spending in 2014, 2015 and 2016 is still expected to be below historical standards.
Today’s announcement drives important improvements to the star rating system, additional accuracy and transparency of provider networks, and continues to promote improvements in quality of care for beneficiaries. The policies in the Rate Announcement and final Call Letter reflect Secretary Burwell’s commitment to a Medicare program – including Medicare Advantage – that delivers better care, spends health care dollars more wisely and results in healthier people. In the Final Call Letter, CMS continues to update the Star Ratings measures to drive improved quality for Medicare Advantage and Part D enrollees. To enhance program integrity and payment accuracy, Medicare Advantage plans will continue to be provided stringent oversight for improper payments, just like other providers in the Medicare program.
Lastly, the final policies will provide enrollees with greater information to make informed and timely decisions about their care and their coverage. The Final Call Letter takes steps to require Medicare Advantage plans to maintain accurate provider directories in a timely manner and make those directories widely available. These steps will help enrollees better understand the providers and choices available to them. In addition, CMS will ensure that Part D sponsors provide clear and accurate access to information on preferred cost sharing pharmacies in their networks so that all beneficiaries have access to affordable coverage.
To view a fact sheet on the 2016 Rate Announcement and final Call Letter, please visit: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-04-06.html
CMS proposes mental health parity rule for Medicaid and CHIP
CMS proposes mental health parity rule for Medicaid and CHIP
Proposed rule will strengthen access to mental health and substance use disorder benefits for low-income Americans
The Centers for Medicare & Medicaid Services (CMS) today announced a proposed rule to align mental health and substance use disorder benefits for low-income Americans with benefits required of private health plans and insurance. The proposal applies certain provisions of the Mental Health Parity and Addiction Equity Act of 2008 to Medicaid and Children's Health Insurance Program (CHIP). The Act ensures that mental health and substance use disorder benefits are no more restrictive than medical and surgical services.
“Improving quality and access to care impacts the health of our nation. Whether private insurance, Medicaid, or CHIP, all Americans deserve access to quality mental health services and substance use disorder services,” said Vikki Wachino, acting director, Center for Medicaid and CHIP Services.
The proposed rule ensures that all beneficiaries who receive services through managed care organizations or under alternative benefit plans have access to mental health and substance use disorder benefits regardless of whether services are provided through the managed care organization or another service delivery system. The full scope of the proposed rule applies to CHIP, regardless of whether care is provided through fee-for-service or managed care.
Currently, states have flexibility to provide services through a managed care delivery mechanism using entities other than Medicaid managed care organizations, such as prepaid inpatient health plans or prepaid ambulatory health plans. The proposed rule would continue this States flexibility in identifying varying delivery systems for Medicaid services provided to beneficiaries, while ensuring that enrollees of a Medicaid managed care organization receive the benefit of parity in services provided to them through these various means. States will be required to include contract provisions requiring compliance with parity requirements in all applicable contracts for these Medicaid managed care arrangements.
Under the proposed rule, plans must make available upon request to beneficiaries and contracting providers the criteria for medical necessity determinations with respect to mental health and substance use disorder benefits. The proposed rule also would require the state to make available to the enrollee the reason for any denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.
“The proposed rule is a way to advance equity in the delivery of mental health and substance use disorder services. The proposal will support federal and state efforts to promote access to mental health and substance use services as part of broader delivery system reform through the Affordable Care Act,” said Wachino.
The proposed rule is currently on display at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-08135.pdf and will be published in the Federal Register on April 10, 2015 online at http://federalregister.gov/a/2015-08135 , and on FDsys.gov. The deadline to submit comments is June 9, 2015.
For more information, go to http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/mental-health-services.html.
Proposed rule will strengthen access to mental health and substance use disorder benefits for low-income Americans
The Centers for Medicare & Medicaid Services (CMS) today announced a proposed rule to align mental health and substance use disorder benefits for low-income Americans with benefits required of private health plans and insurance. The proposal applies certain provisions of the Mental Health Parity and Addiction Equity Act of 2008 to Medicaid and Children's Health Insurance Program (CHIP). The Act ensures that mental health and substance use disorder benefits are no more restrictive than medical and surgical services.
“Improving quality and access to care impacts the health of our nation. Whether private insurance, Medicaid, or CHIP, all Americans deserve access to quality mental health services and substance use disorder services,” said Vikki Wachino, acting director, Center for Medicaid and CHIP Services.
The proposed rule ensures that all beneficiaries who receive services through managed care organizations or under alternative benefit plans have access to mental health and substance use disorder benefits regardless of whether services are provided through the managed care organization or another service delivery system. The full scope of the proposed rule applies to CHIP, regardless of whether care is provided through fee-for-service or managed care.
Currently, states have flexibility to provide services through a managed care delivery mechanism using entities other than Medicaid managed care organizations, such as prepaid inpatient health plans or prepaid ambulatory health plans. The proposed rule would continue this States flexibility in identifying varying delivery systems for Medicaid services provided to beneficiaries, while ensuring that enrollees of a Medicaid managed care organization receive the benefit of parity in services provided to them through these various means. States will be required to include contract provisions requiring compliance with parity requirements in all applicable contracts for these Medicaid managed care arrangements.
Under the proposed rule, plans must make available upon request to beneficiaries and contracting providers the criteria for medical necessity determinations with respect to mental health and substance use disorder benefits. The proposed rule also would require the state to make available to the enrollee the reason for any denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.
“The proposed rule is a way to advance equity in the delivery of mental health and substance use disorder services. The proposal will support federal and state efforts to promote access to mental health and substance use services as part of broader delivery system reform through the Affordable Care Act,” said Wachino.
The proposed rule is currently on display at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-08135.pdf and will be published in the Federal Register on April 10, 2015 online at http://federalregister.gov/a/2015-08135 , and on FDsys.gov. The deadline to submit comments is June 9, 2015.
For more information, go to http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/mental-health-services.html.
American Nurses Association National Nurses Week 2015 Free Webinar
Thursday, May 7, 2015
1:00 p.m. EDT, Noon CDT, 11:00 a.m. MDT, 10:00 a.m. PDT
Nurses face ethical dilemmas related to patient care and its practice on a daily basis. Dealing with these ethical situations requires finding the best option and acting to resolve the issue. Success is often dependent on a supportive work environment, and without it, nurses often feel a high level of moral distress and fatigue.
ANA’s National Nurses Week free webinar provides practical advice, based on extensive research, to help staff nurses and managers take the lead in ethical situations. Incorporating the provisions from the revised Code of Ethics for Nursing, experts will explore several case studies that apply to common day-to-day dilemmas, not just high-visibility issues. You will gain a better understanding of the daily stresses experienced when making ethical decisions, and recognize the importance of employing self-care and self-awareness.
Learn the tools and resources needed to effectively recognize, manage and resolve a wide range of ethically challenging scenarios.
Better understand the importance of the interprofessional team you work with and the roles the team members take in addressing ethical dilemmas.
Discover how to incorporate and employ systems thinking about ethical challenges and the measures that need to be in place to gain resolution.
Learn how to stay resilient and morally resolute in your ethical decision-making and actions.
Attend this informative webinar and earn free CE credit.
Register today!
1:00 p.m. EDT, Noon CDT, 11:00 a.m. MDT, 10:00 a.m. PDT
Nurses face ethical dilemmas related to patient care and its practice on a daily basis. Dealing with these ethical situations requires finding the best option and acting to resolve the issue. Success is often dependent on a supportive work environment, and without it, nurses often feel a high level of moral distress and fatigue.
ANA’s National Nurses Week free webinar provides practical advice, based on extensive research, to help staff nurses and managers take the lead in ethical situations. Incorporating the provisions from the revised Code of Ethics for Nursing, experts will explore several case studies that apply to common day-to-day dilemmas, not just high-visibility issues. You will gain a better understanding of the daily stresses experienced when making ethical decisions, and recognize the importance of employing self-care and self-awareness.
Learn the tools and resources needed to effectively recognize, manage and resolve a wide range of ethically challenging scenarios.
Better understand the importance of the interprofessional team you work with and the roles the team members take in addressing ethical dilemmas.
Discover how to incorporate and employ systems thinking about ethical challenges and the measures that need to be in place to gain resolution.
Learn how to stay resilient and morally resolute in your ethical decision-making and actions.
Attend this informative webinar and earn free CE credit.
Register today!
State Plan Amendment Regarding Payment to Rural Health Clinics for Contraception Devices
State Plan Amendment Regarding Payment to Rural Health Clinics for Contraception Devices
Effective April 1, 2015, the Colorado Department of Health Care Policy and Financing intends to submit a State Plan Amendment (SPA) to amend the reimbursement method for Rural Health Clinics for long-acting reversible contraceptives (LARC) which include: implantable and intraeuterine contraceptive devices. This reimbursement shall be separate from any encounter payment the RHC's may receive for the insertion procedures. Reimbursement for LARCs and for the permanent non-surgical transcervical contraceptive devices shall be at the actual acquisition cost (such as with 340b drug discount pricing) or the rate on the Department's practitioner fee schedule, whichever is applicable.
The Department is requesting authority from the Centers for Medicare and Medicaid Services (CMS) to make this change effective April 1, 2015.
General Information
A link to this notice will be posted for 60 days on the Department's web site (www.colorado.gov/hcpf) starting on March 25, 2015. Written comments may be addressed to: Director, Health Programs Office, Department of Health Care Policy and Financing, 1570 Grant Street, Denver, CO 80203)
Effective April 1, 2015, the Colorado Department of Health Care Policy and Financing intends to submit a State Plan Amendment (SPA) to amend the reimbursement method for Rural Health Clinics for long-acting reversible contraceptives (LARC) which include: implantable and intraeuterine contraceptive devices. This reimbursement shall be separate from any encounter payment the RHC's may receive for the insertion procedures. Reimbursement for LARCs and for the permanent non-surgical transcervical contraceptive devices shall be at the actual acquisition cost (such as with 340b drug discount pricing) or the rate on the Department's practitioner fee schedule, whichever is applicable.
The Department is requesting authority from the Centers for Medicare and Medicaid Services (CMS) to make this change effective April 1, 2015.
General Information
A link to this notice will be posted for 60 days on the Department's web site (www.colorado.gov/hcpf) starting on March 25, 2015. Written comments may be addressed to: Director, Health Programs Office, Department of Health Care Policy and Financing, 1570 Grant Street, Denver, CO 80203)
Thursday, April 2, 2015
Webinars: Safety Net Hospitals for Pharmaceutical Access
SNHPA SPRING EVENTS:
Webinars and Roundtable
Please join us for these educational and interactive events! Pre-registration is required.
HRSA Audits Webinar
Thursday, April 9
1:00 PM - 2:30 PM (Eastern)
Topics Overview:
Deadline to register: April 7.
Webinars and Roundtable
Please join us for these educational and interactive events! Pre-registration is required.
HRSA Audits Webinar
Thursday, April 9
1:00 PM - 2:30 PM (Eastern)
Topics Overview:
- Discuss major audit findings about patient definition, the GPO prohibition, and contract pharmacy and their impact on your 340B operations
- Review what to expect if you are selected for an audit
- Highlight how HRSA has changed the audit process
- Cover how to respond to audit findings through challenges, a corrective action plan, and the public letter
Deadline to register: April 7.
340b ESSENTIALS: A COMPLIMENTARY WEBINAR FOR PERSPECTIVE SNHPA MEMBERS
Friday, April 10
12:00 - 1:00 PM (Eastern)
Topics Overview:
Let us help you with these questions and more during this complimentary webinar for prospective members.
Click here for more information.
Deadline to register: April 8.
Special 340B workshop in Philadelphia
Tuesday, April 14
12:30 PM – Event Check In
1:00 – 4:00 PM – Educational Session
(refreshments provided)
Thomas Jefferson University Hospital
DePalma Auditorium
125 South 11th Street
Philadelphia, PA 19107
Topics overview:
Plus time for networking and Q&A!
Click here for more information.
Deadline to register: April 7. Secure your space today!
NOTE: You must present a government issued driver's license to enter the hospital.
HRSA’s Mega-Guidance webinar
Thursday, May 7
1:00 PM - 2:30 PM (Eastern)
Topics overview:
Deadline to register: May 5.
Friday, April 10
12:00 - 1:00 PM (Eastern)
Topics Overview:
- What does the intensifying scrutiny of the program by Congress, federal agencies and the drug industry mean for my hospital/health-system?
- How can our hospital prepare for the anticipated “mega-guidance” and new regulations that are coming down the pike in the coming months?
- What are innovative best practices that we can employ to use our savings to provide high-quality pharmacy care to our hospital’s underserved patients?
- How can SNHPA’s team of experts support us in effectively navigating 340B?
- How can we engage in advocacy efforts to promote the importance of, and protect, 340B?
Let us help you with these questions and more during this complimentary webinar for prospective members.
Click here for more information.
Deadline to register: April 8.
Special 340B workshop in Philadelphia
Tuesday, April 14
12:30 PM – Event Check In
1:00 – 4:00 PM – Educational Session
(refreshments provided)
Thomas Jefferson University Hospital
DePalma Auditorium
125 South 11th Street
Philadelphia, PA 19107
Topics overview:
- Congressional oversight of 340B (including the recent House hearing)
- Current and emerging 340B issues (including upcoming guidance and regulations)
- How to advocate for 340B
- C-suite's crucial oversight and advocacy roles
- Lessons learned from HRSA audits
Plus time for networking and Q&A!
Click here for more information.
Deadline to register: April 7. Secure your space today!
NOTE: You must present a government issued driver's license to enter the hospital.
HRSA’s Mega-Guidance webinar
Thursday, May 7
1:00 PM - 2:30 PM (Eastern)
Topics overview:
- Discuss what we expect the guidance will cover
- Address how to analyze the guidance's potential impact on your 340B operations
- Show you how to influence what gets left in and taken out of the final guidance
Deadline to register: May 5.
Medicare Update: Open Payments - Data Submission and Attestation Period Open until April 3, 2015
Data Submission and Attestation Period Open until April 3, 2015
Important Note to Industry: The Open Payments data submission period will remain open until midnight (Eastern Standard Time) on Friday, April 3, 2015 to accommodate all applicable manufacturers and group purchasing organizations (GPOs) that are in the final stages of data submission.
The Open Payments system is scheduled to open for review and dispute on April 6, 2015. This will be the start of the 45-day review and dispute process for physicians and teaching hospitals, which occurs after applicable manufacturers and GPOs submit their payment data to CMS and before the data becomes public. The review process is voluntary, but to participate in the process and review and correct the data, physicians and teaching hospitals will need to register in both the CMS Enterprise Identity Management System (EIDM) and the Open Payments system.
Important Note to Industry: The Open Payments data submission period will remain open until midnight (Eastern Standard Time) on Friday, April 3, 2015 to accommodate all applicable manufacturers and group purchasing organizations (GPOs) that are in the final stages of data submission.
The Open Payments system is scheduled to open for review and dispute on April 6, 2015. This will be the start of the 45-day review and dispute process for physicians and teaching hospitals, which occurs after applicable manufacturers and GPOs submit their payment data to CMS and before the data becomes public. The review process is voluntary, but to participate in the process and review and correct the data, physicians and teaching hospitals will need to register in both the CMS Enterprise Identity Management System (EIDM) and the Open Payments system.
Register for The Forum: April 8th-10th
The 16th Annual Colorado Rural Health Center Forum will once again be held at the foothills of the Rocky Mountains at the beautiful Denver Sheraton West Hotel in Lakewood. This event typically brings together over 200 rural healthcare professionals from Colorado’s 51 certified Rural Health Clinics (RHCs), non-certified rural clinics and other healthcare professionals, vendors, and leading experts in the field.
The conference planning committee is working to put together a comprehensive meeting agenda that will inspire, connect and educate rural healthcare providers and others interested in learning more about rural specific healthcare trends. We hope you will join us! Here are just a few of the top reasons to attend.
The conference planning committee is working to put together a comprehensive meeting agenda that will inspire, connect and educate rural healthcare providers and others interested in learning more about rural specific healthcare trends. We hope you will join us! Here are just a few of the top reasons to attend.
- Six fascinating general sessions presented by leading experts in the field
- Eighteen educational breakout sessions
- Four hours of in-depth workshops
- Plenty of time for networking with colleagues
- Learn about new resources from our wide array of healthcare vendors
Click here to find more information on the conference and to register today!
Second PQRS/Value Modifier Webinar Scheduled
REGISTER NOW: Additional PQRS/Value Modifier Webinar Scheduled
The Philadelphia Regional Office of CMS will be hosting an additional webinar on Tuesday, April 7, 2015 at 12:00 Noon EDT to provide an overview of the requirements of the 2015 Physician Quality Reporting System (PQRS) and the Value-based Payment Modifier (VM). The link to register for this call can be found here:
https://www.eventbrite.com/e/2015-pqrs-and-value-based-payment-modifier-programs-april-7-registration-16351613115
This will be the same presentation that will be delivered on March 31, so if you are attending that call we kindly ask that you do not register for this call so as to give as many people a chance to hear the presentation. This call is intended for eligible professionals, practice managers, office staff, and all other interested parties who deal with the PQRS and VM programs. The dial in number and link to the webinar will be given upon registration. If we maximize attendance on this call, there may be additional calls scheduled soon. Please share this meeting invitation with partners, members, and colleagues who would benefit from this information. Thank you.
The Philadelphia Regional Office of CMS will be hosting an additional webinar on Tuesday, April 7, 2015 at 12:00 Noon EDT to provide an overview of the requirements of the 2015 Physician Quality Reporting System (PQRS) and the Value-based Payment Modifier (VM). The link to register for this call can be found here:
https://www.eventbrite.com/e/2015-pqrs-and-value-based-payment-modifier-programs-april-7-registration-16351613115
This will be the same presentation that will be delivered on March 31, so if you are attending that call we kindly ask that you do not register for this call so as to give as many people a chance to hear the presentation. This call is intended for eligible professionals, practice managers, office staff, and all other interested parties who deal with the PQRS and VM programs. The dial in number and link to the webinar will be given upon registration. If we maximize attendance on this call, there may be additional calls scheduled soon. Please share this meeting invitation with partners, members, and colleagues who would benefit from this information. Thank you.
IMPT: SIM Workgroups Application Process
Colorado's State Innovation Model (SIM) would like to announce the launch of the SIM Workgroup Application Process.
You will find the links provided below to the application for the workgroups, criteria for each workgroup and the expectations for workgroup members.
The SIM Office is excited to implement the new process for workgroup members as we believe this will provide a more efficient way of tracking all of the hard work that is going on throughout Colorado in regards to the SIM Collaborative Efforts.
Applications for each Workgroup will be accepted through close of business, Friday April 10, 2015. If you are interested in continuing your current role on the Workgroup or you would like to become a new member of the SIM Workgroups, please apply through the application that has been provided below.
All applications should be submitted to gov_simgrant@state.co.us
Attachments:
Click Here to View Workgroup Expectations
HIT, Data and Quality Measures:
Criteria
Application
Workforce Development:
Criteria
Application
Population Health and Consumer Engagement:
Criteria
Application
Service Delivery and Practice Transformation:
Criteria
Application
Policy and Evaluation:
Criteria
Application
Payers, Purchasers and Payment Reform:
Criteria
Application
You will find the links provided below to the application for the workgroups, criteria for each workgroup and the expectations for workgroup members.
The SIM Office is excited to implement the new process for workgroup members as we believe this will provide a more efficient way of tracking all of the hard work that is going on throughout Colorado in regards to the SIM Collaborative Efforts.
- The workgroups will consist of the following topical areas:
- Health Information Technology, Data, and Quality Measures;
- Workforce Development;
- Population Health and Consumer Engagement;
- Service Delivery and Practice Transformation;
- Policy and Evaluation; and
- Payers, Purchasers, and Payment Reform.
Applications for each Workgroup will be accepted through close of business, Friday April 10, 2015. If you are interested in continuing your current role on the Workgroup or you would like to become a new member of the SIM Workgroups, please apply through the application that has been provided below.
All applications should be submitted to gov_simgrant@state.co.us
Attachments:
Click Here to View Workgroup Expectations
HIT, Data and Quality Measures:
Criteria
Application
Workforce Development:
Criteria
Application
Population Health and Consumer Engagement:
Criteria
Application
Service Delivery and Practice Transformation:
Criteria
Application
Policy and Evaluation:
Criteria
Application
Payers, Purchasers and Payment Reform:
Criteria
Application
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