Recent Healthcare Law Developments

Recent Healthcare Law Developments

Payment Rates or In-Patient Rehabilitation Facilities

(IRF’s for federal fiscal year 2015 are published.)

The Center for Medicare and Medicaid services, Department of Health and Human Services issued a final rule updating the prospective payment rates for in-patient rehabilitation facilities on August 6, 2014. Among other things, the final rule is consistent with the Department’s policy to collect data on the amount and mode (individual, concurrent, group and co-treatments) of therapy provided in the IRF setting according to the therapy discipline, and revises the lists of diagnosis and group codes.

The final rule also addresses the implantation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-TEN-CM), for the IRF Prospective Treatment System (PTS), which will be effected when ICD-TEN-CM becomes the required medical data record set for use on Medicare claims and IRF-PAI submissions.

The rule also delays the effective date for the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the “60% Rule” that were finalized in the fiscal year 2014 IRF-PTS final rule and adopts the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the “60% Rule” that are finalized in the Rule. The updated quality measures and recording requirements under the IRF-QRP are applicable for IRF discharges occurring on or after October 1, 2004.

ENROLLMENT OF NEW AMBULANCE SUPPLIERS AND HOME HEALTH AGENCIES STILL IN LIMBO

On Friday, August 1, 2004 The Center for Medicare and Medicaid Services, Department of Health and Human Services issued an extension of the temporary moratoria on the enrollment of new ambulance suppliers and home heath agencies in specific locations within designated metropolitan areas including New Jersey. With respect to New Jersey, the temporary moratorium affects the enrollment of new ambulance suppliers in the counties of Burlington, Camden and Gloucester.

CHANGES TO HOSPICE RATES

On August 22, 2014 The Center for Medicare and Medicaid Services, Department of Health and Human Services issued a final rule to update the Hospice Payment Rates and Wage Index for fiscal year 2015 and continues the phase-out of the wage index ????? Neutrality Adjustment Factor (BNAF). The rule provides for potential definitions of “Terminal Illness” and “Related Conditions,” and information of potential processes and appeals for Part-D payment for drugs while beneficiaries are under a hospice election. The rule specifies time frames for filing the Notice of Election and the Notice of Termination/Revocation; adds the attending physician’s name to the Hospice Election Form, and requires hospices to document changes to the attending physician and also requires hospices to complete their Hospice Aggregate Cap Determinations within five months after the cap year ends. The rules require hospices remit any overpayments, and updates the Hospice Quality Recording Program. Finally, the rule will provide guidance on determining hospice eligibility; information on the delay in the implementation of the International Classification of Diseases, and will further clarify how hospices are to report diagnosis on hospice claims.