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Other Medicare Issues
Background
News

A variety of regulations and issues affect Medicare-certified providers.  This section includes information on issues such as hospital Conditions of Participation as well as information on NAPHS advocacy positions.

2/3/2016

CMS proposed rule: "Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations -- Revised Benchmark Rebasing Methodology, Facilitating Transition to Performance-Based Risk, and Administrative Finality of Financial Calculations"

2/2/2016

CMS proposed rule: "Medicare Program: Expanding Uses of Medicare Data by Qualified Entities"

1/4/2016

NAPHS comment letter to CMS on "Medicare and Medicaid Programs; Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies”

11/16/2015

CMS final rule: "Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY2016" (see p.70919 for sections on Collaborative Care Models for common behavioral health conditions)

11/9/2015

CMS: "Recovery Audit Program Enhancements (status as of November 6, 2015)"

11/9/2015

CMS: "Medicare Fee-for-Service Recovery Audit Program Additional Documentation Limits for Medicare providers (except suppliers and physicians)." Effective 1.1.16.

11/3/2015

CMS proposed rule: "Medicare and Medicaid Programs; Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies"

10/29/2015

OIG/CMS final rule: "Medicare Program; Final Waivers in Connection With the Shared Savings Program"

9/8/2015

CMS Office of Minority Health: "CMS Equity Plan for Improving Quality in Medicare"

9/8/2015

NAPHS comment letter to CMS on "“Collaborative Care Model for Beneficiaries with Common Behavioral Health Conditions” (in proposed rule on CY16 physician fee schedule) 

7/15/2015

CMS proposed rule: "Medicare: Revisions to Payment Policies Under the Physician Fee Schedule & Other Revisions to Part B for CY16" (see p.41710 requesting comments on Collaborative Care Models for common behavioral health conditions)

6/29/2015

HRSA notice: "Publication of the Revised Guidebook for the National Practitioner Data Bank"

5/22/2015

CMS final rule: "Medicare and Medicaid Programs: Revisions to Deeming Authority Survey, Certification,and Enforcement Procedures"

3/25/2015

America's Hospitals and Health Systems letter to House in support of the Medicare Access and CHIP Reauthorization Act of 2015 (H.R.2), a bipartisan compromise to permanently resolve the Sustainable Growth Rate (SGR)

3/12/2015

Revised Medicare Learning Network publication on "Mental Health Services" (ICN 903195)

2/17/2015

Medicare: "Extension of Timeline for Publication of Final Rule on Reporting and Returning of Overpayments"

2/13/2015

Notice of CMS ruling (CMS-4176-R): "Implementing United States v. Windsor for Purposes of Entitlement and Enrollment in Medicare Hospital Insurance and Supplementary Medical Insurance" (implementing Supreme Court ruling on Defense of Marriage Act)

2/12/2015

CMS final rule: "Medicare Program; Contract Year 2016 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs"

12/12/2014

CMS proposed rule: "Medicare and Medicaid Program;Revisions to Certain Patient’s Rights Conditions of Participation and Conditions for Coverage" (to ensure that same-sex spouses in legally-valid marriages are recognized and afforded equal rights)

12/8/2014

CMS proposed rule: "Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations"

12/5/2014

CMS final rule: "Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment"

12/2/2014

NAPHS comment letter to OIG on proposed rule on "Medicare and State Health Care Programs: Fraud and Abuse; Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements and Gainsharing" (recommending transportation safe harbors)

11/13/2014

CMS final rule: "Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid Innovation Models & Other Revisions to Part B for CY2015."  Also see 12.31.14 corrections.

10/3/2014

OIG proposed rule: "Medicare and State Health Care Programs: Fraud and Abuse; Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements and Gainsharing"

5/12/2014

OIG proposed rule: "Medicare and State Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Civil Monetary Penalty Rules"

5/12/2014

CMS final rule: "Medicare and Medicaid Programs;Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction; Part II" (includes medical staff revisions).

4/16/2014

CMS proposed rule: "Medicare and Medicaid Programs: Fire Safety Requirements for Certain Health Care Facilities"

4/14/2014

CMS MedLearn Matters: "Termination of the Common Working File ELGA, ELGH, HIQA, HIQH, and HUQA Part A Provider Queries (Revised MM 8248)"

3/5/2014

NAPHS comment letter on "Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs"

2/6/2014

CMS/CDC/OCR final rule: "CLIA Program and HIPAA Privacy Rule; Patients’ Access to Test Reports"

1/10/2014

CMS proposed rule: "Medicare Program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs"

12/27/2013

CMS proposed rule: “Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers”. (Comment deadline extended to 3.31.14)

11/27/2013

Updated FAQs on "Medicare 2013 Claim Denials Due to Beneficiary Incarceration Status"

10/29/2013

CMS final rule: "Medicare Program: Conditions of Participation (CoPs) for Community Mental Health Centers"

7/29/2013

OIG report: "Hospitals' Use of Observation Stays and Short Inpatient Stays for Medicare Beneficiaries"

7/3/2013

NAPHS comment letter on proposed rule on "Medicare/Medicaid Programs: Survey, Certification and Enforcement Procedures”

6/7/2013

CMCS-MMCO-CM Informational Bulletin:  "Payment of Medicare Cost Sharing for Qualified Medicare Beneficiaries (QMBs)." Tells states that they “have a legal obligation to reimburse providers for any Medicare cost sharing due for QMBs according to the state’s CMS-approved Medicare cost-sharing payment methodology.” 

5/23/2013

CMS final rule: "Medicare: Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare Prescription Drug Benefit Programs."  Also see 7.22.13 correction.

5/13/2013

NAPHS releases first study to examine readmissions within the Medicare Inpatient Psychiatric Facility Prospective Payment System (IPF PPS). View news release and study.

5/8/2013

OIG guidance: "Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs."  Also see 5/9/13 Federal Register.

3/18/2013

Notice of CMS ruling (revising current policy on rebilling) and CMS proposed rule ("Part B Inpatient Bililng in Hospitals")

2/26/2013

NAPHS comment letter to OIG on "Solicitation of New Safe Harbors and Special Fraud Alerts"

8/31/2012

CMS final rule on quality reporting requirements for inpatient psychiatric facilities (see pages 53644-53680). [View]

5/16/2012

CMS final rule: "Medicare and Medicaid Programs: Reform of Hospital and Critical Access Hospital Conditions of Participation" [View]

5/16/2012

CMS final rule: "Medicare and Medicaid Programs: Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction" [View]

4/27/2012

CMS final rule: "Medicare & Medicaid: Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements" (including use of NPI) [View]

4/7/2012

HHS proposed rule: "Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to Compliance Date for ICD-10-CM and ICD-10-PCS Medical Data Code Sets" [View]

2/27/2012

NAPHS comment letter to HHS OIG on "Solicition of New Safe Harbors and Special Fraud Alerts" with recommendations on complimentary transportation [View]

2/16/2012

CMS proposed rule: "Medicare Program: Reporting and Returning of Overpayments." Also see 2/14/12 CMS release: "Affordable Care Act Gives CMS New Authority To Recover Overpayments From Providers and Suppliers More Quickly"

2/2/2012

CMS request for comments: "Medicare Program; EMTALA Applicability to Hospital Inpatients and Hospitals with Specialized Capabilities" [View]

1/10/2012

HHS interim final rule: "Administrative Simplification: Adoption of Standards for Health Care Electronic Funds Transfer (EFTs) and Remittance Advice" [View]

12/21/2011

NAPHS comment letter to CMS on proposed rule on "Reform of Hospital and Critical Access Hospital Conditions of Participation" [View]

12/7/2011

CMS final rule: "Medicare Program; Availability of Medicare data for performance measurement" [View]

11/1/2011

Medicare Learning Network Fact Sheet: "Substance (other than tobacco) abuse structured assessment and brief intervention (SBIRT) services" [View]

10/1/2011

OIG Report (OEI-01-08-00590): "Adverse Events in Hospitals: Medicare's Responses to Alleged Serious Events" [View]

8/25/2011

NAPHS comments on CMS proposed inpatient psychiatric facilities performance measures required by the Affordable Care Act [View]

8/18/2011

NAPHS comments on CMS proposal to add alcohol screening/behavioral counseling and screening for depression to Medicare preventive services

8/17/2011

NAPHS comment letter on Medicare proposed rule retracting physician signature requirement on clinical laboratory requisitions

8/11/2011

NAPHS comment letter to CMS on proposed rule on Conditions of Participation for community mental health centers (CMHCs)

8/5/2011

Final rule: "Medicare Program: Inpatient Rehab Facility PPS for Federal FY12; Changes in Size and Square Footage of Inpatient Rehabilitation Units and Inpatient Psychiatric Units" [View]

5/5/2011

Final rule: Medicare & Medicaid: Changes Affecting Hospital and Critical Access Hospital Conditions of Participation: Telemedicine Credentialing and Privileging [View]

11/19/2010

Federal Register: Final rule: "Medicare and Medicaid Programs: Changes to the Hospital and Critical Access Hospital Conditions of Participation to Ensure Visitation Rights for All Patients" [View]

11/1/2008

CMS on "Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC)" [View]

6/18/2008

CMS email on 8 "Frequently Asked Questions" (FAQs) on Medicare billing/payment policy on psychological and neuropsychological tests billed under the CPT code range 96101-96125 when performed by technicians, computers, physicians, clinical psychologists, independently practicing psychologists, and other eligible qualified nonphysician practitioners. The FAQs also address situations where more than one of these testing codes can be billed for services furnished to the same patient. [View]

4/15/2008

OIG Open Letter to Health Care Providers refining the requirements of the OIG Provider Self-Disclosure Protocol under which healthcare providers can voluntarily report fraudulent conduct affecting Medicare, Medicaid, and other Federal healthcare programs.

11/14/2007

NAPHS letter to CMS regarding initial surveys for new Medicare providers [View]

12/8/2006

CMS final rule on "Medicare and Medicaid: Hospital participation conditions; patients' rights" [CMS-3018-F] published in the Federal Register. Includes revised regulatory language on the "one-hour rule."

11/27/2006

"Hospital Conditions of Participation: Requirements for History and Physical Examinations; Authentication of Verbal Orders; Securing Medications; and Postanesthesia Evalutions (CMS-3122-F)."

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