NYUMC Office of Compliance

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NYUHC Regulatory Information Bulletin

Here’s to #3!  The regulatory environment’s ever-changing landscape offers a wealth of material from which to draw.  Hopefully you are finding the information useful and informative.  Please keep in mind that each RIB is time-sensitive. That is, the links on the web may become obsolete at any time.    Please use the links and review the information as soon as possible.  Also, previous issues of RIB will soon be available on the Compliance Website.  And, as a reminder, RIB cannot be viewed on a Blackberry.  Happy reading!

Editor’s Corner!

Volume 1, Issue 3

Fascinating Additions to Federal Law . . .

· CMS Makes Corrections to Final Rule on Inpatient Psychiatric Facilities Prospective Payment System for Rate Year 2007.  CMS published a corrected wage index,  typographical errors, and more!

· CMS Launches Effort to Combat Medicaid Fraud & Abuse.  As part of the Deficit Reduction Act, the Medicaid Integrity Program will use contractors to review the actions of those seeking payment from Medicaid, conduct audits, identify overpayments and educate providers and others on program integrity and quality of care.  See the facts here.

· Interrupted Stays for Inpatient Rehabilitation Facilities (IRF).  CMS released a Special Edition MLN Matters to highlight their IRF interrupted stay policy.  A case level payment adjustment is made under the IRF PPS if the patient has an interrupted stay.  An interrupted stay is defined as those cases in which a Medicare beneficiary is discharged from the IRF and returns to the same IRF within three consecutive calendar days.

· CMS Issues Notice Clarifying Compliance for Human Subjects Research .  International entities conducting research funded by HHS must comply with the Common Rule even if the entity also complies with other standards.

The RIB is e-mailed monthly to managers and above.  To remove your name from our mailing list, or for questions or comments, please e-mail the Office of Compliance’s Regulatory Information & Education area or call (212) 404-4070.

►DHHS has developed a new Web-based decision tool that guides potential caregivers and first responders through a series of questions to decide how HIPAA privacy regulations apply to a particular disclosure. 

►►The Facility Guideline Institute recommends that new construction of hospitals include private rooms to reduce infection and medication errors.  These guidelines are used as the basis of  regulations in 42 states. 

· NYS Medicaid Fraud Provisions.  Gov. Pataki is expected to sign the long-anticipated fraud legislation.  It adds a new Health Care Fraud section to the Penal Law and establishes a compliance program requirement for health care providers among other elements.  See the Senate version.

· NYSAP-DRG Updates.  On July 12th, NYS DOH published an emergency rule to update the NYSAP-DRG patient classification system to be consistent with changes made to the DRG classification system used by the Medicare Prospective Payment System.  This rule modifies existing DRGs and adds new DRGs to more accurately reflect the pattern of health resource use.   The rule was effective June 27, 2006.  See page 31.

Notable New York Laws & Regulations . . .

►The Bush administration says it plans sweeping changes that could cut Medicare payments to hospitals by 20-30% for many complex treatments and new technologies. Federal officials said that biases & distortions in the current system create financial incentives for hospitals to treat certain patients, on whom they could make money, and to avoid others, who are less profitable.  In a statement, CMS vows to proceed slowly to minimize implementation impact to hospitals. 

►►RFID tags may soon be used in all surgical instruments and sponges.  Radio frequency identification devices can be located after suturing through use of a wand that beeps when passed close by. 

· LCD 3041: Update to Physical Medicine & Rehabilitation Effective 8/17/06.

· LCD 3500:  Update to Breast Imaging Effective 7/01/06.

· LCD 13918:  Bariatric Surgery Update.  Effective 8/11/06

· FDA: Voluntary Recall of Medtronic’s Model 8731 Intrathecal Catheter & Model 8598 Intrathecal Catheter Distal Revision Kit

· FDA:  Approves Oncaspar, First Treatment for Hunter Syndrome, new OTC sunscreen & more!

· Changed Deadline for Medicare GME Affiliation Agreements

July  25, 2006

Revises law to authorize physician assistants to issue inpatient medical orders without countersignature if PA is working or is extended privileges in a hospital and if deemed appropriate by the supervising physician or the hospital. Comment through 9/25/06.