NYUMC Office of Compliance

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NYUHC Regulatory Information Bulletin

Volume 1, Issue 7

Fascinating Additions to Federal Law . . .

· Hospital Discharge Appeal Rights.  CMS issued a final rule that sets forth requirements for how hospitals must notify Medicare beneficiaries who are hospital inpatients about their hospital discharge rights. With an implementation date of July 1, 2007, this final rule requires that hospitals use a revised version of the Important Message from Medicare (IM), an existing statutorily required notice, to explain discharge rights.  Hospitals must issue the IM within two days of admission and must obtain the signature of the beneficiary (or his/her representative). In cases where the IM is delivered more than two days before discharge, hospitals will be required to give the beneficiary a copy of the signed IM before discharge. For beneficiaries who request an appeal, the hospital will be required to deliver a more detailed notice.

· Hospital Conditions of Participation (CoPs) modified by CMS.  The revised CoPs, effective January 26, 2007, concern completion of history and physical exams (H&Ps), authentication of verbal orders, securing medications, and completion of post-anesthesia evaluations.  Among other things this final rule requires that all orders (also verbal) be dated, timed and authenticated; allows hospitals increased flexibility in the storage of non-controlled substances; and allows post-anesthesia evaluations to be completed by any practitioner qualified to administer anesthesia, rather than only the individual who administered the anesthesia.

· CMS Finalizes CY 2007 OPPPS.  On November 24, 2006, CMS issued a final rule that describes changes to the amounts and factors used to determine the payment rates for hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2007 and result in an overall rate increase of about 3%. The rule also implements required reporting on quality measures for hospital inpatient and outpatient services and revises the current list of procedures that are covered when furnished in a Medicare-approved ambulatory surgical center.  And many other interesting items . . .

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.

· The Berger Commission has recommended that the state close 9 hospitals and require restructuring of 48 others.  Locally recommend closures include Cabrini, St. Vincent Downtown, Parkway, and Victory Memorial.  In all, the moves would eliminate 4,200 hospital beds, or 7% of the current supply.  Read the report.

· The Department of Education promulgated §77.9, an emergency rule effective November 23rd, that clarifies the process through which licensed physical therapists who have practiced full-time for three years or more can provide PT services without a referral from a physician, nurse practitioner, dentist or podiatrist.  The rule requires that a licensed PT present the patient with a form prior to providing such services and is limited to a maximum of 10 visits or 30 days whichever happens first.

·  NYS Medicaid Update for December 2006

Notable New York Laws & Regulations . . .

· HHS OIG audit finds that 11 certified transplant centers in nine states received about $47 million in unallowable and unsupported organ acquisition costs between 1997 and 2002.

· Preventive Services Covered by Medicare for CY 2007 & Educational Products.

· MSP Provider Billing Requirements for CAP drug charges; effective 1/1/07

· NCA: Intracranial Stenting and Angioplasty

· MM5263:  Reporting reduced cost and no-cost medical devices under the OPPPS.

· Revisions to the Implementation of  the UB-04

· Inpatient Psychiatric Services Revised Coverage Rules

· Find out how the Prescription Drug Marketing Act applies to pharmacies and physician’s offices.

· LCD8897: Erythropoietin

· Outpatient Rehab Therapy Coverage Revisions; effective 12/09/06

 November 30, 2006

OIG’s objective was to determine the extent to which the State agency made Medicaid payments on behalf of beneficiaries who did not meet Federal and State eligibility requirements. The State agency (1) made some Medicaid payments on behalf of beneficiaries who did not meet Federal and State eligibility requirements and (2) did not always adequately document eligibility determinations. As a result, for the 6-month audit period from January 1 through June 30, 2005, OIG estimates that the State agency made 4,217,888 payments totaling $230,375,748 (Federal share) on behalf of ineligible beneficiaries. OIG also estimated that case file documentation did not adequately support eligibility determinations for an additional 15,289,843 payments totaling $2,820,569,979 (Federal share). OIG did not recommend recovery due to a legal technicality, however they did recommended that the State agency (1) reemphasize to beneficiaries the need to provide accurate and timely information and (2) require its district office employees to verify eligibility information and maintain appropriate documentation in its case files.  Learn more.

►Researchers and others are working to develop ways to objectively measure patient-reported symptoms (e.g., sleeplessness, feeling sluggish, mood changes), dubbed "patient-reported outcomes," or PROs.  The FDA is encouraging medical researchers to use questionnaires to collect PROs in clinical trials to help determine how well a new drug or medical device is working.  For more on this initiative, read our feature titled "The Importance of Patient-Reported Outcomes … It's All About the Patients."

Just a quick note to explain the tardiness of this issue.  The Editorial staff has been having computer problems that resulted in having the hard drive re-built.  Thus, due to technical glitches, this is late.  A million apologies!

Editor’s Corner!