Monitoring the Pulse of Health Care and Life Sciences
On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released a final rule (Rule), which includes modifications to Medicare payment policies and rates.
One area that is discussed in the rule is with regards to the payment of certain items and services when provided by certain off campus provider based…
Telehealth for Treatment of Substance Use Disorders
As part of the CY 2019 Medicare Physician Fee Schedule (PFS), the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule with comment period to expand the use of telehealth for the treatment of substance use disorders and co-occurring mental health disorders. Existing law provides for reimbursement of telehealth services only if the originating site is located in a rural health professional shortage area, is not in a metropolitan statistical area or is an entity that participates in a federal telemedicine demonstration project. The originating site must also be one of a specific type of facility, such as a hospital, physician’s office or skilled nursing facility. With respect to telehealth services used to treat a substance use disorder or co-occurring mental health disorders, the interim final rule removes the originating site geographic restrictions and permits a patient’s home to be an originating site. When the patient’s home is used as the originating site for telehealth services, Medicare will pay no facility fee. The interim final rule is effective for telehealth services performed on or after July 1, 2019. CMS is requesting comments on the interim final rule, and the comment period closes January 22, 2019.
Continue Reading 2019 Physician Fee Schedule Rule Review: Use of Telehealth Expanded
On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018 (the Act), which included a number of important health law provisions..
AKS and CMP Violations
Under the Act, Congress doubled the statutory civil fines for certain violations of the Anti-kickback Statue (AKS) and adjusted certain fines under the Civil Monetary Penalty (CMP) Law. The Act also increased the maximum criminal penalty from $25,000 to $100,000 and increased the maximum incarceration period from five years to ten years.
Continue Reading Bipartisan Budget Act Revises Stark Law, Increases Penalties for AKS and CMP Law Violations, and Expands Telehealth Coverage
On June 16, 2016, the Office of Inspector General (OIG), Department of Health and Human Services, issued a report on the Centers for Medicare & Medicaid Services’ (CMS) oversight of provider-based facilities. In the report, the OIG concluded that although CMS is taking steps to improve its oversight, vulnerabilities nevertheless remain.
As part of its Bipartisan Budget Act of 2015, Congress had eliminated provider-based status for new off-campus outpatient departments of a provider. The Centers for Medicare & Medicaid Services’ (CMS) provider-based rules currently allow a hospital or health system to treat certain off-campus facilities as part of the hospital or health system for purposes of reimbursement. In general, CMS reimburses provider-based facilities at a higher rate than freestanding facilities. Under the Bipartisan Budget Act of 2015, provider-based status will no longer be available for items and services provided in an off-campus outpatient department of a hospital on or after January 1, 2017; with one important caveat — off-campus outpatient departments that were billing as provider based prior to November 2, 2015, as well as services provided in a dedicated emergency department, are excluded from this new limitation.
Continue Reading OIG’s 2016 Report on Provider-Based Facilities
