Health Headlines: Also in the News - August 2014

by King & Spalding

Hospital IPPS Final Rule Not Yet Released – As of the time this edition of Health Headlines was sent to press, CMS has not yet released the hospital inpatient prospective payment system (IPPS) final rule for FY 2015. According to the common understanding of the statute, in order for the final rule to be effective at the beginning of FY 2015, it would have had to have been released on or before August 2, 2014, which is the date that is 60 days before October 1, 2014. Since enactment of the statutory 60-day requirement, CMS has never failed to publish the inpatient rule at least 60 days prior to October 1. At this time, we do not know what explanation CMS has for the delay in publishing the rule and whether CMS will contend that the rule will be effective October 1 notwithstanding its failure to publish the rule by August 2. We expect the rule to be released soon.

CMS Issues SNF Final Rule for FY 2015 – On July 31, 2014, CMS released the final Medicare FY 2015 payment rule for skilled nursing facilities (SNFs). The final rule adopts a net market basket update of 2.0%. The agency also discussed the status of its efforts to identify an alternative payment methodology for SNF therapy services and declined to offer a timeline for development of the new model. The final rule is effective October 1, 2014, and is expected to be published in the Federal Register on August 5, 2014. A display copy is available here.

CMS Issues IPF Final PPS Rule for FY 2015 – On July 31, 2014, CMS released Medicare’s final inpatient psychiatric facilities (IPF) PPS rule. CMS announced that the 2.9% estimated market basket update will be reduced by 0.5% for economy-wide productivity and 0.3%, as required by Section 1886(s)(2)(A)(ii) of the Social Security Act. The FY 2015 per diem rate will be $738.21, the national urban cost-to-charge ratio (CCR) ceiling will be 1.6582, and the national rural CCR ceiling will be 1.8590. The final rule is expected to be published in the Federal Register on August 6, 2014. A display copy is available here.

CMS Issues IRF Final PPS Rule for FY 2015 – On July 31, 2014, CMS released a final rule updating the prospective payment rates for inpatient rehabilitation facilities (IRFs) for FY 2015. Among other things, the rule finalizes a policy to collect data on the amount and mode of therapy provided in the IRF setting according to therapy discipline, revises the list of diagnosis and impairment group codes that presumptively meet the “60 percent rule” compliance criteria, provides a way for IRFs to indicate on the IRF-Patient Assessment Instrument (IRF-PAI) whether the prior treatment and severity requirements have been satisfied for arthritis cases to presumptively meet the “60 percent rule” compliance criteria, and revises and updates quality measures and reporting requirements under the IRF quality reporting program (QRP). The final rule is expected to be published in the Federal Register on August 6, 2014. A display copy is available here.

CMS Extends Moratoria on HHAs, Ambulance Suppliers – On July 29, 2014, CMS announced that it will extend its current enrollment moratoria on new ground ambulances in the Houston and Philadelphia metropolitan areas and new home health agencies in the metropolitan areas of Chicago, Fort Lauderdale, Detroit, Dallas, Houston, and Miami. CMS said the extension is necessary because the significant potential for fraud, waste, and abuse continues in these areas. A copy of CMS’s press release is available here.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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