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Monday, May 24, 2004
The Centers for Medicare & Medicaid Services (CMS) released a proposed rule for the 2005 Medicare inpatient prospective payment system in the May 18 Federal Register.
The proposed rule would implement major payment and policy changes for acute care hospitals required by the comprehensive Medicare modernization legislation signed into law in December 2003. CMS will accept comments regarding the proposed rule until July 12, and a final rule will be published later this year.
OHA sent a bulletin (04-009) detailing the proposed changes along with an attached analysis to all hospital CEOs last week. According to CMS, the proposed changes would increase payments for inpatient services in fiscal year 2005, offer additional financial relief to rural hospitals, and create a link between the quality of services offered to Medicare beneficiaries and payment for those services.
OHA’s annual review of Medicare and Medicaid policy and payment changes will be held Tuesday, Oct. 5 at the Villa Milano in Columbus. For more information on the proposed rule or to submit comments, visit www.cms.hhs.gov. OHA’s bulletins are also available to members online at www.ohanet.org/bulletins/. (Charles Cataline, charlesc@ohanet.org)
CMS Clarifies Quality Reporting Requirements
Hospitals with no cases to report in the Center for Medicare & Medicaid
Services (CMS) quality initiative program can still receive a full
Medicare inpatient prospective payment system update according to CMS
clarification last week.
CMS will allow hospitals with relevant data for some but not all of the 10 required measures to submit the available data and CMS will verify no other data was available by checking prior billing records and other information. Hospitals with no data to report for any of the measures must fill out an additional form before June 1. The form is online at www.cms.hhs.gov/quality/hospital/.
Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, hospitals are required to participate in the Reporting Hospital Quality Data for Annual Payment Update to receive the full update. (Rosalie Weakland, rosaliew@ohanet.org)
Tuesday, May 25, 2004
The Centers for Medicare and Medicaid Services (CMS) is examining the payment for direct Graduate Medical Education and Indirect Medical Education resident positions, and teaching hospitals that have expanded their residency programs since 2002 should take immediate action to avoid inappropriate reductions.
Under the Medicare Modernization Act, CMS must redistribute resident slots from hospitals not using their full allotment. To determine whether hospitals are using all resident positions, CMS may use hospitals’ cost reporting period ending on or before Sept. 30, 2002. Teaching hospitals that have expanded residency programs since 2002 are advised to request that CMS use a later cost reporting period. Letters of request should be signed by the hospital’s CFO and sent to the hospital’s Medicare fiscal intermediary care of the audit manager and must be received by June 4, 2004. For more information, visit www.cms.hhs.gov/providers/hospital.asp. (Jonathan Archey, jonathana@ohanet.org)
Ohio Hospitals Have New Energy Option
OHA Solutions, OHA’s new group purchasing organization, signed a
contract with Stand Energy Corporation to provide natural gas to member
hospitals that select Stand as a supplier. OHA’s new energy committee
pursued a contract with Stand based on the prices outlined in its
proposal. Stand has been a natural gas supplier in the Ohio market for
20 years.
OHA will continue to provide hospitals with additional information,
allowing them to make an informed decision on whether to change
suppliers. For more information on Stand, visit
http://standenergy.com.
For more information on OHA’s energy committee or the contract with
Stand, contact Rick Sites at
ricks@ohanet.org or 614.221.7614.
(Rick Sites,
ricks@ohanet.org)
Wednesday,
May 26, 2004
House Votes for OHA Tax-Exempt Bond Bill
OHA’s proposed legislation regarding tax-exempt bonds was passed by the
Ohio House yesterday. House Bill 239, sponsored by Rep. Tony Core (R-Rushsylvania),
would modify the statute regarding the issuance of tax-exempt bonds,
amending the revised code to authorize the Director of the Department of
Development or the Ohio Higher Educational Facility Commission to issue
tax-exempt bonds.
The legislation also confirms and validates amendments to the law governing hospital agencies held unconstitutional on procedural grounds, expands the definition of "costs of hospital facilities" in the above law, and specifies that a trustee, officer, or director of a hospital agency does not have an interest in the profits or benefits of an agreement between hospital agencies solely by virtue of being a trustee, officer, or director of one of the participating hospital agencies. HB 239 now heads to the Senate. (Bridget Gargan, bridgetg@ohanet.org)
CMS Holds Open Door Forum for Hospital Billing Practices
The Centers for Medicare & Medicaid Services (CMS) will hold a special
Open Door Forum, “Billing Practices for the Uninsured and Underinsured,”
from 11 a.m. to 12:30 p.m. on Tuesday, June 1.
Hospitals and health care service providers are invited to participate in the forum, which will provide a detailed overview of several key components involved in providing discounts to the uninsured and underinsured. Topics will include flexibility in applying discounts for reasons other than indigence, technical issues related to billing, and fraud and abuse issues. The Office of the Inspector General will also discuss its recent guidance on this practice.
Participants can join the forum by phone or in person. Those participating by phone can call 1-800-837-1935 and are not required to RSVP unless they would like to present a comment or question. For more information on the CMS Open Door Forums, visit www.cms.hhs.gov/opendoor/.
Thursday,
May 27, 2004
House Bill 215, intended to build upon previous legislative work to help Ohio’s health care providers obtain affordable medical malpractice insurance, was sent to Gov. Taft Wednesday after passage in the Ohio Senate and House.
OHA and the Ohio State Medical Association supported the legislation, which includes several provisions that provide moderate reform. The bill was originally designed to implement medical review screening panels, but now authorizes the Ohio Department of Insurance (ODI) to collect data on judgments and settlements, and requires that expert witnesses providing testimony practice the same specialty as the defendant and have expertise on the subject of the trial. OHA will work closely with ODI to develop rules for the elements of data collection.
The bill will also prohibit either a physician or defendant’s prior statements of sympathy to be used as evidence.Prior to the 31-0 Senate vote, senators tabled an amendment offered by Senator Marc Dann (D-Liberty Twp.) limiting the initial number of defendants who could be named in a medical malpractice claim, but preserving the right of a plaintiff to add additional defendants once the discovery process gets underway. Gov. Taft is expected to sign the legislation into law. For more information on Ohio’s medical malpractice crisis, visit www.ohanet.org/med-mal/. (Bridget Gargan, bridgetg@ohanet.org)
Senate Passes Home Medical Equipment Bill
The Ohio Senate passed legislation yesterday requiring non-accredited
home medical equipment providers, which provide patients with
life-sustaining equipment, to be licensed by the Ohio Respiratory Care
Board. The board will establish standards and fees for the approximately
100 HME providers it will license. Licensed entities will be subject to
inspections and penalties for failing to meet state standards.
OHA had been opposed to the bill as it moved through the House of Representatives, as earlier versions of the bill would have required all HME providers in the state to be licensed by the Respiratory Care Board. OHA removed its opposition after obtaining an amendment to exempt from licensure HME providers accredited by the Joint Commission on Accreditation of Healthcare Organizations or other national accrediting entity. Of the approximately 500 HME companies operating in Ohio, nearly 250, most of which are owned by hospitals, are accredited by JCAHO. The bill will require accredited providers to register with the board, but they will not be subject to inspections, penalties, or regulatory oversight of the board. House Bill 105, sponsored by Rep. Thom Collier (R-Mount Vernon), now heads to the governor for final approval. (Jeff Klingler, jeffk@ohanet.org)
House Votes to Raise Screening Mammogram Payment Cap
The Ohio House of Representatives this week passed OHA-sponsored
legislation increasing the payment cap on screening mammographies to
$106, with an opportunity for an annual, medical inflation-based
increase each year. The bill, House Bill 331, was introduced Rep. Jean
Schmidt (R-Loveland) at the request of OHA and a state radiologist
group.
Since 1992, group health, public employee and employer-based health plans have been required by Ohio law to cover screening mammograms for women within specific age and risk groups. The statute established an $85 cap on the amount insurers have to pay for the diagnostic test, an amount that has not been increased in more than a decade.
The payment covers both the technical and professional components of the diagnostic test, and it is presumed the payment is designed to also cover any required digitization of the image. The House Health and Family Services Committee also amended the legislation to require insurance companies to pay 130 percent of Medicaid rates for mammograms. The bill now goes to the Senate. (Bridget Gargan, bridgetg@ohanet.org)
Friday,
May 28, 2004
A preliminary model for the 2004 Hospital Care Assurance Program is now available on the OHA Web site at www.ohanet.org/hcap/. The draft model lists Omnibus Budget Reconciliation Act caps, preliminary assessment amounts, preliminary total payment amounts, and net gains by hospital. This model has not yet been finalized. (Ryan Biles, ryanb@ohanet.org)
Medicare Improves Service For Discount Card Program, Reports Savings
The Centers for Medicare & Medicaid Services (CMS) announced additional
steps to improve service for Medicare beneficiaries deciding whether a
discount card is right for them.
Additional services include adding 400 more customer service representatives to answer phone calls on the 1-800-MEDICARE hotline, bringing the total to over 1,800, and enhancing the “Price Compare” database at www.medicare.gov. The database will be more visible from the Medicare Web site and the “drug dictionary” of drugs included on Price Compare is being expanded. The additions were made in response to the large volume of hotline callers and web site visitors
After two weeks of offering the program, CMS reported the average discount price across all Medicare-approved cards providing prices declined by 11.5 percent for brand-name drugs and 12.5 percent for generic drugs. For more information about the Price Compare program, visit www.medicare.gov. (Jonathan Archey, jonathana@ohanet.org)
Concealed Carry Phone Seminar Coming Up
Hospitals can learn how to respond to legislation allowing certain
Ohioans to carry concealed weapons, the requirements for exemption, and
specific policies and practices for complying with the law by tuning
into an upcoming OHA telephone seminar. The phone briefing is June 4
from 10-11 a.m. Visit
www.ohanet.org/education/education_programs.asp#phone or call
614.221.7614 to register.