New Federal and State Regulations and CMS Alleged Overpayments

For more information about this blog post, please contact Khaled J. KleleLatoya Caprice Dawkins, or Ryan M. Magee.

New Jersey State Regulation Expanding Graduates of International Medical Schools

51 N.J.R. 1597(a) – Proposed Regulation -- This proposal by the State Board of Medical Examiners (Board) is to update the eligibility requirements for graduates of international medical schools who seek licensure or authorization to engage in the practice of medicine as residents.  If approved, the proposed amendments would allow the Board to rely on recognized accrediting bodies for international medical schools that adhere to standards substantially similar to the bodies that currently accredit domestic medical schools. Currently, the Board relies on education licensing agencies such as the Liaison Committee on Medical Education (LCME) and the American Osteopathic Association (AOA). The proposed amendments would allow graduates of international schools to rely on accreditation from regionally recognized bodies that have standards comparable to those of LCME.  Comments are due by January 3, 2020.

Federal Regulations

84 FR 59746-01 - Proposed rule - The Office of Federal Contract Compliance Programs (OFCCP) issued a proposed rule to amend its regulations pertaining to its authority over TRICARE health care providers aimed at increasing access to care for uniformed service members and veterans.  The proposed rule suggests that OFCCP lacks authority over federal health care providers who participate in TRICARE and, therefore, OFCCP seeks to establish a national interest exemption from Executive Order 11246, Section 503 of the Rehabilitation Act of 1973, and the Vietnam Era Veterans' Readjustment Assistance Act of 1974 for health care providers with agreements to furnish medical services and supplies to individuals participating in TRICARE.   Comments are due by December 6, 2019.

84 FR 60478-01 – Final Rule -  This final rule brings up to date the home health prospective payment system (HH PPS) payment rates and wage index for calendar year (CY) 2020.  Besides boosting payments to Home Health Agencies, it also provides for a permanent home infusion therapy benefit to be implemented beginning in 2021 that includes professional services, patient education and training, and patient monitoring for the provision of home infusion therapy. The final rule also changes existing regulations to allow therapist assistants instead of only therapists to perform maintenance therapy.   In addition, the final rule implements the Patient-Driven Groupings Model (PDGM), a revised case-mix adjustment methodology, for home health services.  It puts into place a change in the unit of payment from 60-day episodes of care to 30-day periods of care, as required by section 51001 of the Bipartisan Budget Act of 2018 and finalizes a 30-day payment amount for CY 2020.  The final rule is effective January 1, 2020.

84 FR 60648-01 – Final rule - This final rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for CY 2020 and updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI).  ESRD facilities will see a 1.7% increase in PPS payments in 2020 or a $4.06 increase from the current $235.27 base rate.  In addition, certain new and innovative equipment and supplies used to care for an ESRD patient will qualify for an add-on payment adjustment in the hopes that ESRD facilities will provide innovative therapies.  Importantly, it changes the methodology for calculating fee schedule payment amounts for new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services, and a methodology for making adjustments to the fee schedule amounts established using supplier or commercial prices if such prices decrease within 5 years of establishing the initial fee schedule amounts.  The final rule not only streamlines the requirements for ordering DMEPOS items, but also develops a new list of DMEPOS items potentially subject to a face-to-face encounter.  The final rule becomes effective January 1, 2020.

CMS Seeks $54.4 Million for Inpatient Claims

Last week, the OIG issued a report recommending that CMS direct Medicare contractors to recover $54.4 million in alleged overpayments after discovering several acute-care hospitals transferred patients to certain post-acute-care settings, such as skilled nursing facilities, but claimed the higher reimbursements associated with discharges to home.  The Medicare contractors are to identify any claims for transfers to post-acute care in which incorrect patient discharge status codes were allegedly used and recover any overpayments.