Expiration of the Long Term Care Hospital Development Moratorium: A Lasting Development Opportunity?

Posted by Jason Greis on January 5, 2013 under Articles | Be the First to Comment

Under the Medicare, Medicaid and SCHIP Extension Act of 2007 (the Act), as amended, Congress imposed an initial three-year moratorium on the establishment of new Long Term Care Hospitals (LTCH), on LTCH satellite facilities and on increases in the number of beds in existing LTCH facilities, unless an exception to the moratorium applied. This moratorium was subsequently extended for two years by the Patient Protection and Affordable Care Act (ACA).  The Centers for Medicare and Medicaid Services (CMS) recently announced, in its Final Rule updating fiscal year (FY) 2013 Medicare payment policies and rates for inpatient stays at general acute care hospitals and LTCHs that the LTCH development moratorium would expire as of Decem ber 29, 2012.  The moratorium has since sunsetted. Read More...

CMS Rule Expands Long-Term Care Facility Administrators’ Responsibility to Report Facility Closures

Posted by Jason Greis on March 2, 2011 under Articles | Be the First to Comment

On February 18, 2011, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule (Interim Rule) implementing Section 6113 of the Patient Protection and Affordable Care Act (PPACA).  The Interim Rule, which becomes effective March 23, 2011, requires administrators of long-term care facilities (LTCF), including skilled nursing facilities (SNF) eligible for reimbursement under Medicare and nursing facilities (NF) eligible for reimbursement under Medicaid, to submit prior written notification of an impending LTCF closure to the Secretary of the U.S. Department of Health and Human Services (Secretary), the state’s long-term care ombudsman and residents of the facility and their legal representatives or other responsible parties.  LTCF administrators that do not comply with the new notice requirements may face sanctions, including civil monetary penalties of up to $100,000 and exclusion from participation in Federal health care programs.  In addition, LTCFs must have related policies in place to avoid being cited for survey deficiencies. Read More...

NCQA Releases Draft Criteria for Accountable Care Organizations (ACOs)

Posted by Jason Greis on November 9, 2010 under Articles | Be the First to Comment

 The National Committee for Quality Assurance (NCQA), a private, not-for-profit organization that accredits and certifies health plans and other healthcare related organizations published on Oct. 19, 2010, its 2011 Draft Accountable Care Organizations Criteria. The draft criteria describe the standards NCQA believes ACOs should meet in order to ensure that an ACO has the infrastructure necessary to function as an accountable entity and achieve improvements in quality and reductions in costs. The draft criteria were developed with the guidance of a multistakeholder Accountable Care Organization Task Force assembled by NCQA. Read More...

CMS Issues Stark Act Voluntary Self-Referral Disclosure Protocol – 9 Key Concepts

Posted by Jason Greis on October 17, 2010 under Articles | Be the First to Comment

The Patient Protection and Affordable Care Act (PPACA) requires the Secretary of the Department of Health and Human Services (HHS), with the Office of the Inspector General (OIG) of HHS, to establish a protocol for healthcare providers and suppliers to disclose actual or potential violations of Section 1877 of the Social Security Act (Stark Act). Under the Stark Act, healthcare providers and suppliers may not refer patients to any entity for certain services if the physician has a financial relationship with that entity, unless an exception for such referral applies. Read More...

ACOs and the Shared Savings Program: Some Common Misconceptions

Posted by Jason Greis on October 2, 2010 under Articles | Be the First to Comment

Section 3022 of the Patient Protection and Accountable Care Act (the Act) creates the Shared Savings Program for Medicare. Under the Shared Savings Program, which is to take effect no later than Jan. 1, 2012, Accountable Care Organizations (ACOs) that meet certain requirements established by the Secretary of Health and Human Services will be eligible to receive additional payments from Medicare where certain performance guidelines are met and cost-savings targets are achieved. The amount of the additional payment will be a percentage of the difference between the estimated per capita Medicare expenditures for patients assigned to the ACO and the cost-savings per capita Medicare expenditures threshold. Read More...

2011 Medicare Payment Update for Post-Acute Care Providers

Posted by Jason Greis on August 3, 2010 under Articles | Read the First Comment

The Centers for Medicare & Medicaid Services (“CMS”) has recently released various notices and final rules updating 2011 Medicare payment rates for post-acute care providers, including long-term acute care hospitals (“LTACHs”), inpatient rehabilitation facilities (“IRFs”), skilled nursing facilities (“SNFs”), home health agencies (“HHAs”) and hospices.  These Medicare rate updates generally implement negative payment adjustments mandated by the Patient Protection and Affordable Care Act (Pub. L. No. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111-152) (together, “PPACA”).  Yet in spite of these adjustments, SNFs, hospices, IRFs and LTACH have fared relatively well with collective Medicare payment increases totaling $919 million, with HHAs offsetting these reimbursement gains by suffering a proposed $900 million Medicare reimbursement cut for calendar year 2011. Read More...