CMS Issues Final Decisions on Supervision Levels for Select Services Based on Recommendations of the Hospital Outpatient Payment Panel – On May 22, 2012, CMS posted a notice on its website informing providers that the agency had made final decisions on the supervision levels for select hospital outpatient services based on recommendations of the Hospital Outpatient Payment Panel (Panel). CMS established a process in the FY 2012 Outpatient Prospective Payment System (OPPS) final rule for obtaining and implementing the recommendations of the Panel regarding the supervision levels for certain outpatient hospital therapeutic services. The objective of the Panel—which is composed of 19 members who are representatives of the provider community—is to recommend to CMS and the public the “supervision level that will ensure the appropriate quality and safety for delivery of a given therapeutic service.” After meeting with the Panel, CMS posted on its website the agency’s preliminary decisions regarding the supervision levels of various outpatient hospital therapeutic services for public comment. The preliminary decisions, among other things, proposed the adoption of the Panel’s recommendation to change the requirement for approximately 20 mental health services be changed from direct supervision to general supervision. In its final decisions, the agency finalized this proposal by changing the requirements for those mental health services from direct supervision to general supervision. CMS also altered the requirements for a number of other hospital therapeutic services from direct supervision to general supervision, including:
· HCPCS code 51701, Insertion of non-indwelling bladder catheter (e.g., straight catheterization for residual urine)
· HCPCS code 90471, Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
· HCPCS code 90472, Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)
· HCPCS code 90473, Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
· HCPCS code 90474, Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)
· HCPCS code 99406, Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
· HCPCS code 99407, Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
However, CMS confirmed its rejection of the Panel’s recommendation to designate HCPCS code 94640, pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes, as a non-surgical extended duration therapeutic service—which requires an initial period of direct supervision. CMS’s final supervision decisions are available here.
Reporter, Adam Robison, Houston, +1 713 276 7306, firstname.lastname@example.org.
Insurers Commit to Primary Care Initiative, Says CMS – On June 6, 2012, CMS announced in a press release that 45 commercial, federal and state insurers have agreed to participate in CMS’s Comprehensive Primary Care (CPC) initiative. The CPC initiative, which was introduced in September 2011, is a four-year, public-private collaboration aimed at delivering high-quality primary care to Medicare beneficiaries. A committed investment in primary care, says the press release, will lead to better health outcomes and lower long-run program costs.
Under the CPC initiative, CMS will pay certain primary care practices a monthly care management fee, which is initially set at $20 per Medicare beneficiary. The primary care practices also will receive increased compensation from participating insurance plans. These payments are conditioned upon the primary care practice’s provision of “enhanced services” for its patients. Such services include using electronic health records, offering longer hours, and creating and implementing individualized care plans for beneficiaries with multiple chronic diseases and high needs.
The 45 insurers that have committed to the CPC initiative represent the following seven geographical markets: Arkansas (statewide); Colorado (statewide); New Jersey (statewide); New York (Capital District-Hudson Valley Region); Ohio and Kentucky (Cincinnati-Dayton Region); Oklahoma (Greater Tulsa Region); and Oregon (statewide). CMS will select 75 qualified primary care practices in each of the designated markets to participate in the initiative. The application deadline for interested primary care practices is July 20, 2012.
The CMS press release is available by clicking here. More information regarding the CPC initiative—including a link to the application pre-screening tool for interested primary care practices—is available by clicking here.
Reporter, Greg Sicilian, Atlanta, +1 404 572 2810, email@example.com.
CMS Announces Electronic Method for Submission of Medicare Graduate Medical Education Affiliation Agreements – CMS recently announced that Medicare Graduate Medical Education (GME) Affiliation Agreements and modifications of existing GME Affiliation Agreements may now be submitted electronically. Hospitals participating in a Medicare GME Affiliated Group must submit the GME Affiliation Agreement to their Medicare contractor and to CMS's Central Office no later than July 1 of the residency program year during which the GME Affiliation Agreement will be in effect. See 42 C.F.R. § 413.79(f)(1). In the 2010 Inpatient Prospective Payment System (IPPS) final rule, CMS finalized a policy to allow for the submission of GME Affiliation Agreements electronically to CMS’s Central Office. 75 Fed. Reg. 50042, 50299 (Aug. 16, 2010).
According to the CMS announcement, GME Affiliation Agreements for the July 1, 2012 - June 30, 2013 academic year must be received by July 1, 2012 no later than 11:59 pm ET. Amendments to July 1, 2011 - June 30, 2012 GME Affiliation Agreements must be received by June 30, 2012. CMS encourages the submission of GME Affiliation Agreements electronically. CMS stated that it will not accept faxes of GME Affiliation Agreements.
While CMS instructs hospitals to e-mail both GME Affiliation Agreements and modifications to existing GME Affiliation Agreements to Medicare_GME_Affiliation_Agreement@cms.hhs.gov, CMS requests that hospitals clearly indicate in the subject line of the e-mail whether the e-mail submission is for a July 1, 2012 - June 30, 2013 GME Affiliation Agreement or an amendment to a July 1, 2011 - June 30, 2012 GME Affiliation Agreement. Hospitals submitting GME Affiliation Agreements electronically will receive an automatic reply confirming CMS’s receipt of the agreement.
CMS reminds hospitals that they must continue to submit copies of GME Affiliation Agreements to their Medicare contractors using the procedures specified by each contractor.
To view the CMS announcement, click here. To access the August 16, 2010, IPPS final rule, click here.
Reporters, Stephanie F. Johnson, Atlanta, +1 404 572 4629, firstname.lastname@example.org and Lauren E. Slive, Atlanta, +1 404 572 5212, email@example.com.
K&S Bi-Weekly Publication, Washington Insight – Since February 2012, King & Spalding has been publishing a bi-weekly newsletter, Washington Insight, containing information about emerging issues of importance in the Administration, the Executive Branch and Congress. This most recent edition contains Governor Bob Ehrlich’s regular commentary along with a very timely and valuable article written by Ambassador Lloyd Hand concerning the impending budget crisis facing America today. Lloyd’s career in Washington, D.C. began when he served on then Senate Majority Leader Lyndon Johnson’s Senate staff; he went on to serve as the Chief of Protocol in the Johnson White House, managed the Washington affairs for a major industrial corporation, and has been appointed to serve on numerous boards and commissions. Today, he is one of the most respected and highly regarded advocates in Washington and is an important part of King & Spalding’s ability to represent its clients’ interests in Congress and the Executive Branch. In addition to Lloyd’s article, George Crawford authored an article shedding additional light on the economic challenges facing Congress and the White House in this election year.
To view the June 6 Washington Insight, please click here. If you are interested in receiving Washington Insight, please contact Lauren Donoghue at firstname.lastname@example.org.
Reporter, Lora L. Greene, New York, +1 212 556 2174, email@example.com.
2012 Managed Care Update Roundtable – On Friday, June 15, 2012, King & Spalding will be hosting an Atlanta-based Roundtable focused on recent developments related to managed care, including contracting, antitrust developments, tiered provider networks, and litigation updates. We are also offering a Webinar option for the Roundtable. The Roundtable will include the following topics:
- Marketplace Developments Affecting Contracting and Contract Enforcement
- Tiered Networks: Dealing with the New Market Dynamic
- Rate Confidentiality and Consumer Transparency
- Recent Antitrust Class Actions Against Blue Cross
- Antitrust Agency Skepticism Regarding ACOs
- Trends in Out-of-Network Reimbursement After Ingenix
- Managed Care Litigation Update
In-person attendance is limited, so please register soon to reserve seats for your organization. You do not have to be a client to attend, and there is no charge. You can register to attend in person or by Webinar by visiting http://www.kslaw.com/HealthcareRoundtable.
This bulletin provides a general summary of recent legal developments. It is not intended to be and should not be relied upon as legal advice.
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