On the Regulatory Radar Screen

CMS proposed rule on rural health clinic payment system changes.

Released June 26; Effective TBD.   

CMS proposed rule on physician fee schedule changes for CY 2009.

Released June 30; Effective Jan. 1, 2009.

CMS proposed rule on outpatient PPS and ASC changes for CY 2009.

Released July 3; Effective Jan. 1, 2009.

CMS final rule on inpatient PPS changes for FY 2009.

Released July 31; Effective Oct. 1.

CMS final rule on inpatient rehabilitation PPS changes for FY 2009.

Released July 31; Effective Oct. 1.

CMS final rule on skilled-nursing facility PPS changes for FY 2009.

Released July 31; Effective Oct. 1.

Implementation expected in Fall 2008.

CMS proposed revisions to hospital cost report.

Expected Fall 2008; Effective for cost reporting periods after Spring 2009.

CMS final rule to revise current rules governing Medicaid provider taxes.

Published Feb. 22; Subject to moratorium through Mar. 31, 2009.

CMS proposed rule to eliminate federal funding of Medicaid GME

Published May 23, 2007; Final rule subject to moratorium through Mar. 31, 2009.

CMS final rule changing how states raise Medicaid matching funds through IGTs, CPEs and UPLs.

Published May 29, 2007; Subject to moratorium through Mar. 31, 2009.

CMS final rule requiring state Medicaid programs to use national drug codes for Medicaid hospital outpatient services.

Published July 17, 2007; Effective Jan. 1. Many programs granted implementation delays.

CMS proposed rule to narrow definition of Medicaid hospital outpatient services.

Published Sept. 27, 2007; Final rule TBD.

HRSA proposed rule changing designation of medically underserved and health professional shortage areas.

Published Feb. 29; Rule withdrawn July 23.

CMS proposed rule on HIPAA transaction standards Version 5010 and NCPDP D.0.

Released Aug. 15; Effective Apr. 1, 2010.

CMS proposed rule to adopt ICD-10 codes.

Released Aug. 15; Effective Oct. 1, 2011.

IRS final instructions and worksheets for Form 990, Schedule H and other schedules tax-exempt hospitals must file, including J on executive compensation.

AHRQ final rule on patient safety organizations

Expected Fall 2008.

HOT TOPIC

HOT TOPIC

AHA urges quick implementation of ICD-10 code sets.

The Department of Health and Human Services (HHS) on Aug. 22 published a long-awaited proposed rule that, effective Oct. 1, 2011, would replace the ICD-9-CM code sets used to report health care diagnoses and procedures in electronic health care transactions with the greatly expanded ICD-10-CM diagnosis and ICD-10-PCS procedure code sets.

ICD-10-CM is the most current diagnosis classification system developed by the National Center for Health Statistics for use in the U.S., and is based on the ICD-10 standard coding conventions developed by the World Health Organization in 1989. In addition, the Centers for Medicare & Medicaid Services (CMS) developed ICD-10-PCS as a replacement to the ICD-9-CM procedure codes. New procedures and diagnoses can be easily incorporated as new codes for both existing and future clinical protocols.
Responding to the proposed rule, AHA Executive Vice President Rick Pollack said, "America's hospitals strongly support moving forward to ICD-10, a new coding system that will allow for better patient quality through improved health technology and data collection."

That same day, HHS issued a separate proposed rule adopting the updated X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions, such as health care claims. Version 5010 is needed to use the ICD-10 codes.

"As health care becomes increasingly complex, the current system, ICD-9-CM, is outdated and nearing its capacity to accommodate the addition of new codes," said Pollack. "This significant shortcoming impedes the adoption of new health technology, hinders quality data collection and analysis and creates less accurate reimbursement.  The adoption of ICD-10 is long overdue and the replacement to ICD-9-CM has been discussed over the past 10 years."

Comments on both proposed rules are due to CMS by Oct. 21.

AHA recommends using hospital-based PHP data to set payment rates

The AHA last week said it is pleased the Centers for Medicare & Medicaid Services (CMS) proposed creating two new ambulatory payment classifications (APC) for partial hospitalizations to account for the intensity of services in its calendar year 2009 outpatient prospective payment system (PPS) proposed rule, but warned CMS' proposed payment rates would result in "untenable" reductions in payments for partial hospitalization program (PHP) services.

The proposed APC payment rates would be $140 for APC 0172 Level 1 Partial Hospitalization (three services) and $174 for APC 0173 Level 2 Partial Hospitalization (four or more services), compared with a rate of $203 in 2008.  The proposed payment rates are calculated by combining community mental health center and hospital-based PHP median cost data.
The AHA predicted that many hospitals would have to reconsider providing these services as a result, and many PHPs would be forced out altogether.

"As payment rates decline, access to care will erode, particularly in rural areas," the AHA said. "Partial hospitalization is a critically important service that is intended to be just a step below inpatient psychiatric services, and these economic incentives are undermining the ability of hospitals to continue to provide the appropriate clinical intensity of PHP services." 

The AHA recommended that CMS instead only use hospital-based PHP data to
determine the rates at which PHP services would be paid in hospital-based settings.
A final rule is expected by Nov. 1 and will take effect Jan. 1. To read the AHA's comments on the proposed rule, go to the AHA Web site, www.aha.org, and click
on "What's New."