NYUMC Office of Compliance

If it concerns you, it concerns us.

In an effort to keep all hospital staff informed of the latest and greatest regulatory changes, we have developed this e-mail tool.  The RIB e-mail will be distributed monthly with urgent updates being disseminated as needed.  You will notice that there are live links throughout this newsletter.  Please use these links to see the source document or to obtain additional information.

RIB will not contain policy or procedural changes in response to any regulatory changes. As a manager, RIB can be used as a catalyst for discussion in your department about changes that may need to be made in response to regulations.  If additional assistance is needed to implement any of these regulatory changes, please use the information below to contact someone from our office.  Happy reading!

Welcome to RIB’s Premiere Issue!

Volume 1, Issue 1

Fascinating Additions to Federal Law . . .

· CMS Proposed Regulation for Rusk will amend existing regulations regarding the 3-year phase-in of the 75 % compliance threshold and delays the imposition of the full 75 % threshold by 1 year; will update payment rates; increase the outlier threshold for high cost outlier cases from $5,129 to $5,609; and describes their efforts to integrate post acute benefit structures in a way that will provide for more consistent patient classification and consistent payment for services to regardless of the setting.  Click to read the proposed rule.

· CMS proposed a rule to revise FY2007 Occupational Mix Adjustment to the Wage Index.  It would revise the method for calculating the occupational mix adjustment announced in the FY 2007 Hospital IPPS proposed rule by applying the occupational mix adjustment to 100 percent of the wage index using the new occupational mix data collected from hospitals.   Click here to read the proposed rule.

· Payment for Carotid Artery Stenting Post-Extension Studies after a review by the FDA.  CMS now requires that the FDA issue a letter stating that the study is scientifically valid & will generate clinically relevant, post-market data after which CMS will issue a letter to the study sponsor indicating that the study under review will be covered.  Transmittal #951

To remove your name from our mailing list, or for questions or comments, please e-mail Compliance’s Regulatory Information & Education area or call (212) 404-4070.

Did you know?  That CMS administrator, Mark McClellan, told the Senate Finance Committee that he would like Medicare to stop reimbursing hospitals & physicians for procedures & services resulting from "never events," which are serious medical errors such as wrong-site surgeries, mismatched blood transfusions, & preventable post-operative deaths. CMS "is undertaking" an analysis of never events & hopes to have a coverage decision soon.

Charity Care Law Passed stating that NY general hospitals with inpatient revenue of $25M+ and who receive funds from the state’s indigent care pool are limited in the amount they can charge low-income, uninsured patients.  Beginning next year, the law will require these hospitals to create standard financial aid protocols that reduce hospital charges for low-income individuals without health insurance, or for individuals who have otherwise exhausted their health insurance benefits and who can demonstrate an inability to pay full charges. Further, the legislation allows general hospitals to discount or reduce co-payments and deductibles from those individuals demonstrating such a hardship.

 

The legislation mandates that individuals with incomes below at least 300% of the federal poverty level will not incur charges that exceed the greater of what would have been paid for the same services by Medicare, Medicaid, or the non-government payor that incurred the highest volume of claims from the hospital in the previous year.  Hospital charges will then be further adjusted according to income level and the federal poverty levels.  The legislation will permit general hospitals to develop policies for considering exceptions to these general rules on a case-by-case basis with such policies subjected to the prior review and approval of the Commissioner of Health (the Commissioner) of the NYS Department of Health (DOH).  See full text of the law.

Notable New York Laws & Regulations . . .

Did you know?  Medco Health Solutions, Inc. says that 68% of physicians surveyed stated that they would prefer prescribing a drug that has been on the market at least 10 years, even if the costs among possible medication options are equal.

· Bariatric Surgery For Treatment of Morbid Obesity

· Cardiac Rehabilitation Programs

· VNS Therapy for Depression

· Cardiovascular Nuclear Medicine

· Gemzar ©

· Non-Invasive Vascular Diagnostic Studies

CMS Issued Coverage Decisions of Note

May 22, 2006

NYS DOH Proposed Regulations

(Comment thru 1st July 2006)

· Establishes minimum technical standards for Non-Transplant Anatomic Banks.

· Requires hospitals to develop a Language Assistance Program  to ensure meaningful access to the hospital’s services for all patients who require language assistance.

· Increases the limit on the Cytotechnologists Work Standard per revised CLIA regulations.

· Reimbursement for Medicaid services provided during an erroneously determined lapse in coverage.