Federal Regulations

 

February 17, 2011
CMS Publishes Final Rule on CHIP Allotment Methodology

In the February 17 issue of the Federal Register, CMS published a final rule outlining methodologies and procedures for determining states FY09 – FY15 allotments and payments for the Children’s Health Insurance Program (CHIP).

Effective Date: April 18, 2011
Link to the Final Rule
Link to Additional Information

February 2, 2011
Final Rule with Comment Period on Fraud Prevention in Medicaid, Medicare and CHIP

CMS published a final rule with comment period implementing provisions of the ACA that address fraud, waste and abuse in the Medicare, Medicaid and CHIP programs by setting forth screening processes, compliance program requirements, and punitive initiatives targeted at suppliers and providers in these programs.  The rule also includes guidance for states on implementation of the ACA provisions requiring the termination of certain providers and suppliers from Medicaid, CHIP and Medicare if said providers or suppliers have previously been terminated from one of the other applicable programs. 

Effective Date: March 25, 2011
Comment Date: April 4
Link to the Final Rule
Link to Additional Information

November 29, 2010
Final Rule with Comment Period on Medicare Physician Fee Schedule CY 2011

CMS published a final rule with comment period in the Federal Register addressing changes to the physician fee schedule and other Medicare Part B payment policies to ensure that CMS payment systems are updated to reflect changes in medical practice and the relative value of services.   The rule finalizes the CY 2010 interim relative value units (RVUs) and issues interim RVUs for new and revised procedure codes for CY11.  It also addresses certain provisions of MIPPA, the Chiropractic Services Demonstration program, as well as payments under the Ambulance Fee Schedule, the Ambulatory Surgical Center payments system, the Clinical Laboratory Fee Schedule, payments to end-stage renal disease facilities and payments to Part B drugs.  Significantly, the final rule implements the ACA’s waiver of the Part B deductible and coinsurance that would otherwise apply for most preventive services, and extends Medicare coverage to include an annual wellness visit. 

Effective Date: January 1, 2011
Comment Date: January 3, 2011
Link to the Final Rule
Link to Additional Information

November 24, 2010
Final Rule with Comment period on Medicare CY 2011 Payment Rates

CMS published in the Federal Register a final rule with comment period that will update payment policies and rates for both hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) for calendar year (CY) 2011.  The final rule with comment period also implements several provisions of the ACA that are effective in 2011, such as Section 6001’s provisions narrowing access to the ‘rural provider’ and ‘whole hospital’ exceptions to the physician self-referral law and the ACA’s graduate medical education provisions.

Effective Date: January 1, 2011
Comment Date: January 3, 2011
Link to the Final Rule
Link to Additional Information

November 17, 2010
Final Rule on 2011 Payment Changes for Medicare Home Health Services

The final rule published in the Federal Register sets forth an updated to the Home Health Prospective Payment System (HH PPS), updates the wage index used under the HH PPS, and in accordance with the ACA, updates the HH PPS outlier policy.  In addition, this rule revises the home health agency (HHA) capitalization requirements, adds clarifying language to the “skilled services” section, finalizes a 3.49 percent reduction to rates for CY 2011 to account for changes in case-mix, and incorporates new legislative requirements regarding face to face encounters with providers related to home health and hospice care. 

Effective Date: January 1, 2011
Link to Final Rule             
Link to Additional Information

November 9, 2010
Final Rule on Withdrawal of Determination of AMP

CMS published a final rule withdrawing two provisions from the “Medicaid Program; Prescription Drugs” final rule published in the July 17, 2007 Federal Register, as well as withdrawing the definition of “multiple source drug” as it was revised in a final rule published in the October 7, 2008 Federal Register. 

Effective Date: December 15, 2010
Link to the Final Rule
Link to Additional Information