On the Regulatory Radar Screen

CMS proposed rule on rural health clinic payment system changes.

Released June 26, 2008; Effective TBD.

National rollout of Medicare Recovery Audit Contractor program.

Phase 1 states begin March 1; Phase 2 states
begin Aug. 1.

CMS proposed rule on inpatient PPS and LTCH PPS changes for FY 2010.

Published April 1; Effective Oct. 1.

CMS proposed rule on inpatient rehabilitation PPS changes for FY 2010.

CMS LTCH PPS supplement to FY 2010 proposed rule.

Published June 3; Effective Oct. 1.

CMS interim final rule on LTCH PPS for FY 2009.

Published June 2; Effective June 3.

Published May 12; Effective Oct. 1.

Released July 1; Effective Jan. 1, 2010.

CMS proposed rule on home health PPS for CY 2010.

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

HHS has delayed enforcement  of hold harmless provisions through June 30, 2010.

CMS final rule on intergovernmental transfers, certified public expenditures and upper payment limits.

Published May 29, 2007; Needs to be reissued; Sense of Congress resolution in ARRA urging HHS not to complete rule.

HHS proposed rules on the definition of "meaningful user" as a requirement for hospitals to receive health IT stimulus funding beginning in FY 2011.

HOT TOPIC

HOT TOPIC

Health IT panel revises 'meaningful use' definition for EHR

The federal Health Information Technology Policy Committee recently accepted revised recommendations for an initial definition of "meaningful use" of electronic health records (EHR).

Among the changes made in the recommendations are reducing the computerized physician order entry (CPOE) criteria from all orders to 10% of orders in the first year. The Meaningful Use workgroup of the Policy Committee also introduced the concept of "adoption year."

Using the concept, 2011criteria apply not just to 2011, but also to a provider organization's first "adoption year." That means if a provider cannot be ready for incentive payments until 2012 or 2013, the organization still will start with 2011 criteria.

Under the revised definition, at least 10% of all orders must be entered by the provider using CPOE by 2011 (the original draft specified all orders) and incentive payments would be suspended if a provider has been found to violate HIPAA and has not remedied the problem. The previous draft specified that payments would be suspended if a provider was reported to have violated HIPAA.

While the revisions offer a more flexible phase-in to EHR implementation, the AHA is concerned that the timeline for EHR adoption remains unrealistic for many hospitals that currently lack health IT systems.

The definition is important because hospitals and other providers must demonstrate meaningful use of EHRs to qualify for Medicare and Medicaid incentive payments starting in 2011 under the 2009 "American Recovery and Reinvestment Act." If "meaningful use" is not achieved, hospitals and physicians are subject to penalties starting in 2015.

The recommendations next go to the Office of the National Coordinator for Health Information Technology then to the Centers for Medicare &Medicaid Services (CMS), which will develop rules to implement the incentive programs. A proposed rule is expected by the end of this year.

HHS rescinds Medicaid outpatient, delays provider tax rules

Responding to concerns raised by the AHA and other hospital groups, the Department of Health and Human Services (HHS) recently delayed planned Medicaid provider tax policy changes until next July and rescinded proposed Medicaid rules limiting outpatient hospital and clinic benefits and ending reimbursement for transporting Medicaid-eligible children to school. The department also scrapped provisions of a Medicaid interim final rule restricting access to case management services.

The 2009 American Recovery and Reinvestment Act blocked the department from implementing the Medicaid regulations before July 1. The rules were issued in 2007 under the Bush administration and met strong opposition from the AHA and many lawmakers on Capitol Hill. The Centers for Medicare & Medicaid Services (CMS) May 1 proposed rules to rescind the Medicaid outpatient, school transportation and case management regulations and to delay provider tax provisions that were of concern to hospitals.

The AHA expressed strong support for the agency's decision to scrap the rules, which would have narrowed the definition and scope of outpatient services under the program, and curbed case management services that some states offer Medicaid patients. The AHA also strongly supports the year-long delay in enforcing "hold-harmless" financing arrangements under the rule limiting taxes that states levy on providers to help pay the state share of Medicaid costs. Keeping a lid on enforcement of the Medicaid provider tax regulation has been an AHA priority.

In May 29 comments to CMS on its proposal to delay the rule, the AHA said the only thing better than the plan to delay the provider tax rule would be for the agency to scuttle the rule altogether. The association said the rule would make it more difficult for states and providers to understand whether a provider tax program under development could meet the agency's approval.  HHS said it delayed the provider tax regulation to give CMS more time to determine whether states need additional clarification or guidance.