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 to update the Medicare Hospice Wage Index for fiscal year (FY) 2010.

Released April 21, 2009; Effective Oct. 1, 2010.

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

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

Expected April 2009; Effective Oct. 1, 2009

CMS proposed rule on skilled nursing facility PPS changes for FY 2010.

Expected April 2009; Effective Oct. 1, 2009

Expected May 2009; Effective July 1, 2009

Expected 2009; Effective TBD.

CMS final rule to revise current rules governing Medicaid provider taxes

Published Feb. 22, 2008; Subject to moratorium through June 31, 2009.

CMS proposed rule to eliminate federal funding of Medicaid GME.

Published May 23, 2007; Congress expressed disapproval in American Recovery and Reinvestment Act (ARRA), but did not take action to bar HHS from implementing final rule.

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

Published May 29, 2007; Needs to be reissued; Congress expressed disapproval in ARRA, but did not take action to bar HHS from implementing final rule.

CMS final rule narrowing the definition of Medicaid hospital outpatient services.

Published Nov. 7, 2008; Subject to moratorium through June 31, 2009.

CMS final rule implementing Medicaid disproportionate share hospital reporting and auditing requirements.

Published Dec. 19, 2008; Effective Jan. 19, 2009.

DoD final rule on Tricare OPPS.

HHS final rule on state matching requirements for the Hospital Preparedness Program.

Expected 2009; Effective 2009.

HHS, Labor and Treasury proposed rules or requests for information on implementing mental health parity.

Expected Spring/Summer 2009.

HOT TOPIC

HOT TOPIC

Tricare rule set to take effect this week.

A Department of Defense (DoD) final rule cutting outpatient payments by $458 million to hospitals providing services under Tricare, the military’s insurance program for uniformed service members and their families, is set to take effect May 1. The final rule, released Dec. 8, carries out a 2002 National Defense Authorization Act mandate to model Tricare payments for outpatient services on Medicare’s outpatient prospective payment system (OPPS). With few exceptions, the
rule adopted Medicare’s ambulatory payment classification (APC) system and its APC payment amounts for reimbursement. It includes a phase-in to the new outpatient payments system with temporary increases in payments for emergency department and clinic visits. Hospitals that participate
in Tricare will receive higher transitional payments that will decline over a four-year period, while other hospitals will receive lower payments that will decline over a three-year period.  Also, certain participating hospitals may receive additional temporary boosts in payment if they are deemed essential for military readiness and support during military operations. The AHA contends that these transitional provisions are not enough to mitigate the significant payment reductions hospitals will experience. The AHA continues to press for changes, including limiting
the annual amount by which reimbursement rates may fall after the initial year and adding protections for hospitals that have a disproportionate share of Tricare patients.

AHA wants to put the lid on six Medicaid regulations.

The AHA is keeping pressure on federal policymnakers to scuttle six Medicaid regulations – two currently under congressional moratorium, three pending final rules and one recently issued final rule – that would cut safety-net hospital funding by
billions of dollars, significantly hindering access to care for low-income and vulnerable
populations. The AHA recently joined four other national hospital groups in writing the Department of Health and Human Services (HHS) that these rules, issued during the Bush administration, will harm patient and community care. The 2009 American Recovery and Reinvestment Act (ARRA) imposed a moratorium until July 1 on Medicaid rules for outpatient services and provider taxes. The ARRA also contains a nonbinding resolution asking HHS to set aside proposed rules limiting Medicaid payments for public providers to cost and federal Medicaid
reimbursement for certain rehabilitative services, as well as a rule to eliminate
graduate medical education payments. One other rule restricting the type and nature
of the hospital costs that states can reimburse through disproportionate share payments
took effect earlier this year. The AHA and other national hospital associations
urge the Obama administration to rescind the rule.