Regulatory Review

REGULATORY REVIEW

Joint Replacement Front and Center in OPPS/ASC Proposed Rule

Advances in medical technology have expanded the types of patients who can be treated outside the hospital. Despite these advances, the Centers for Medicare & Medicaid Services’ (CMS) payment policies have traditionally lagged innovation, and many procedures, such as total joints, are currently on the inpatient-only (IPO) list.


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MACRA Is Here

In last year’s November- December Focus magazine we outlined the Medicare Access and CHIP Reauthorization Act, commonly known as MACRA. This act, passed in 2015, instituted new mechanisms for Medicare physician payment, replacing the old Sustainable Growth Rate (SGR) formula. With the arrival of a new administration, as well as the June release of proposed updates, it seems worthwhile to reiterate MACRA’s overarching structure, highlight some new developments and give an indication of how it might affect clinicians operating in ASCs in the coming years.


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Got OAS CAHPS Questions?

In July, the Centers for Medicare & Medicaid Services (CMS) proposed to delay the mandatory implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) under the ASCQR Program for CY 2018 data collection in the 2018 Proposed Medicare Payment Rule. A lot of questions remain about the survey.


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CPI-U and Secondary Rescaling

Beginning January 1, 2008, the Centers for Medicare & Medicaid Services (CMS) began paying ASCs for the facility services they provide to Medicare beneficiaries using a system that is linked primarily to the Hospital Outpatient Department (HOPD) payment system, also known as the Hospital Outpatient Prospective Payment System (OPPS).


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Safeguarding PHI

In 2016 alone, there were 329 Health Insurance Portability and Accountability Act of 1996 (HIPAA) breaches of protected health information (PHI) that affected 500 or more individuals. Two hundred and fifty-four of those breaches involved electronic protected health information (ePHI).


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Patient Experience Survey Coming to ASCs

While many ASCs conduct their own patient satisfaction surveys, there is currently no single instrument that assesses patient experiences in outpatient surgical settings. This will change beginning next year when facilities will need to start using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) survey to meet ASC Quality Reporting (ASCQR) Program requirements.


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Analyzing CMS’ Final Emergency Preparedness Rule

The Centers for Medicare & Medicaid Services (CMS) accommodated ASCA’s comments in several ways in its final rule on Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. The rule establishes national emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers.


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Medicare’s 2017 Final Payment Rule

The Centers for Medicare & Medicaid Services (CMS) issued its final payment rule regulating 2017 ASC Medicare payments on November 1, 2016. Provisions in that rule went into effect January 1, 2017.


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Massachusetts Proposes DoN

Massachusetts has proposed a Determination of Need (DoN) regulation that would prohibit freestanding ASCs from applying for a DoN for any proposed project unless they are affiliated with or in a joint venture with an acute care hospital. The affiliation described in the proposed regulation broadly includes: capital expenditures, substantial change in service, original license, DoN-required service or DoN-required equipment. Massachusetts enacted a moratorium on DoNs for ASCs in 1994. Since then, the number of Medicare-certified ASCs in the state has decreased from 63 to 56. The proposed regulations would lift this moratorium, which prevented ASCs from applying for DoNs. This type of “controlled expansion” has been proposed only in Massachusetts. Moreover, ASCs in the state are the only stakeholders subject to such a restriction.


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MACRA Is Just Around the Corner

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was hailed at the time of its enactment for repealing the Sustainable Growth Rate (SGR), the much maligned annual payment adjustment factor that perennially forced Congress to approve legislation to avoid steep, often double-digit cuts to Medicare physician payments. This new law profoundly alters how and how much physicians will be paid for services furnished to Medicare beneficiaries and how physicians will interact with the program. These changes are expected to alter payment and impose substantial new administrative obligations on physician groups and, potentially, realign the market for physician services. For ASCs, these changes present some new and unique challenges and opportunities.


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Patient Experience Survey Coming to ASCs

ASCs pride themselves on the high-quality care they provide and the high level of satisfaction that their patients report. Patients appreciate the convenience of ASCs and the fact that performing only outpatient elective procedures better controls the environment and limits patient exposure to potential health care acquired infections.


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Medicare Proposes Quality Reporting Changes

ASCs began reporting quality data to Medicare in 2012. There were five quality measures, all of which could be submitted on the claim forms that ASCs already submit to Medicare. Four years later, the number of measures in the ASC Quality Reporting (ASCQR) Program has more than doubled, and if the seven new measures referenced in the 2017 ASC proposed payment rule that are intended for inclusion starting in 2018 are finalized, the number will have almost quadrupled.


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CMS Adopts 2012 Life Safety Code

The Centers for Medicare & Medicaid Services (CMS) recently adopted. provisions of the 2012 editions of the Life Safety Code (LSC) (NFPA 101) and the Health Care Facilities Code (NFPA 99) in order to “simplify and modernize the construction and renovation process for affected health care providers and suppliers, reduce compliance-related burdens, and allow for more resources to be used for patient care.”


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Serious Reportable Events

Today, “never events” are referred to by a variety of terms, including “adverse patient events,” “patient safety events,” “sentinel events” and “serious reportable events” (SRE). While there are minute differences in the definitions of these terms, they aim to capture injuries that are caused by avoidable errors while providing medical care. ASC clinicians and administrators are familiar and experienced with documenting and reporting these events, but state and federal legislation and regulations requiring they do so are relatively modern developments.


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HIPAA Enforcement

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its Breach Notification, Privacy, and Security Rules are well-known to health care providers and facility administrators. The lesser known Enforcement Rule contains provisions relating to investigations, hearings and penalties and takes effect when, despite a facility’s comprehensive and well-documented HIPAA compliance program, something goes wrong. Observing the Enforcement Rule process can provide valuable lessons as your ASC evaluates its HIPAA compliance program.


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ASC Payment Rates

Chances are you already know that the Centers for Medicare and Medicaid Services (CMS) ties ASC reimbursement rates to its hospital outpatient department (HOPD) rates. Do you also know what goes into setting the HOPD rates, how ASC rates differ from HOPD rates and who advises CMS on how this payment system should look?


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Data, Changes to Regulations Needed to Expand ASC-Payable List

Advances in medical technology have expanded the types of patients who can be treated outside the hospital. Despite these advances, the Centers for Medicare & Medicaid Services’ (CMS) payment policies often lag behind innovation, with many procedures—such as total joints—still on the inpatient-only list.


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Medicare’s 2016 Final Payment Rule

The Centers for Medicare & Medicaid Services (CMS) issued its final payment rule regulating 2016 ASC Medicare payments in late October last year. Provisions in that rule went into effect January 1, 2016.


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On the Regulatory Side

Trying to predict all of the regulatory requirements that may change for ASCs in 2016 would require clairvoyant abilities that most do not possess. It is possible, however, to look to proposed rules and language in the past to determine what might be coming our way in 2016.


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Track the Latest Regulatory and Legislative News for ASCs

Visit ASCA's web site every week to stay up to date on the latest government affairs news affecting the ASC industry. Every week, ASCA's Government Affairs Update newsletter is posted online for ASCA members to read. The weekly newsletter tracks and analyzes the latest legislative and regulatory developments concerning ASCs.

www.ascassociation.org/GovtAffairsUpdate.