Tag Archives | PPACA

CMS Comments on Compliance, QAPI Regulations

During yesterday’s Open Door Forum, Jeanette Kranacs, the Director of the Division of Institutional Post-Acute Care for the Centers for Medicare and Medicaid Services (“CMS”) commented that CMS will not be issuing instructions to surveyors on evaluating compliance and ethics programs until the regulations have been promulgated.  CMS was required to have final regulations and various tools in place as of March 2012, but has not yet released any regulations on the ethics and compliance programs for skilled nursing facilities (“SNFs”).   Continue Reading →

CMS Expected to Postpone Compliance Program Enforcement

The Centers for Medicare & Medicaid Services (CMS) has unofficially announced it will not be enforcing the upcoming March 23rd compliance program requirements until final regulations are published.  As required under the Affordable Care Act, nursing facilities are required to have a compliance program in place by March 23, 2013.  Despite ambiguity in the actual statute, which states a facility must have a compliance program in place “on or after” March 23rd, this is widely accepted in the industry as the date for the requirement to be effective.    Continue Reading →

CMS Releases Final Rule Requiring Providers to Include NPI on Enrollment and Claim Filings

The Centers for Medicare & Medicaid Services (CMS) just released a final rule requiring all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs.  The final rule will be published in the April 27th Federal Register, and the rule will become effective 60 days after publication, June 26.

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CMS Seeks Savings Through Changes in Medicaid Drug Payments

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that enacts a provision of the Patient Protection and Affordable Care Act (PPACA) that seeks to make Medicaid reimbursement for medications more transparent and more closely aligned with what pharmacies pay for the drugs.  In a press release, CMS states the rule will save states and taxpayers $17.7 billion on prescription drugs over the next five years.  The regulations would also increase the rebates paid by drug makers that participate in Medicaid and would establish rebates for drugs provided to enrollees in Medicaid managed-care plans.  Comments will be accepted on the proposed rule until April 2, 2012, with a final rule scheduled for 2013.

Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.

Administration Recommends Only Two Sections of PPACA be Overturned if SCOTUS Rules Unconstitutional

The Department of Justice (DOJ) has recommended to the Supreme Court of the United States (SCOTUS) that only the provisions of the Patient Protection and Affordable Care Act (PPACA) that require insurers to accept everyone regardless of health status and to apply “community rates” be overturned if the Justices rule that the law’s mandate is unconstitutional.   Continue Reading →

CMS Clarifies Guidance on PPACA Mandatory Medicaid Terminations

The Centers for Medicare & Medicaid Services (CMS) released updated guidance on Section 6501 of the Patient Protection and Affordable Care Act (PPACA) that requires state Medicaid agencies to terminate the participation of any individual or entity if such individual or entity is terminated under Medicare or any other state Medicaid plan.   Continue Reading →

Physician Assistants Now Permitted to Perform SNF-Level Certifications, Recertifications

This week, the Centers for Medicare & Medicaid Services (CMS) updated Section 40.1 of Publication 100-1, the Medicare General Information, Eligibility and Entitlement Manual, to reflect Section 3108 of the Patient Protection and Affordable Care Act (PPACA).  This update permits physician assistants to perform the initial certifications and recertifications of a beneficiary’s need for skilled nursing facility (SNF) level care.

This update’s implementation date is February 13, 2012, and is effective for services furnished on or after January 1, 2011.   Continue Reading →

For New Cost Report Periods, PPACA Requires Direct Care Expenditure Accounting

Under the Patient Protection and Affordable Care Act (PPACA), skilled nursing facilities (SNFs) are required to seperately report expenditures for wages and benefits for direct care staff (breaking out (at a minimum) registered nurses, licensed professional nurses, certified nurse assistants, and other medical and therapy staff).  CMS recently posted updates to the Provider Reimbursement Manual detailing the changes, and guidance on completing the new cost report forms.    Continue Reading →

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