CMS Finalizes New Medicare Provider Type: Rural Emergency Hospitals

The Centers for Medicare & Medicaid Services finalized a new provider designation for rural hospitals,  “Rural Emergency Hospitals,” in its Outpatient Prospective Payment System rule on Tuesday, November 1. Effective January 1, 2023, this new designation will allow certain eligible rural hospitals and Critical Access Hospital to receive a 5% payment increase for their services.  This new designation is meant to increase payments to rural hospitals to avoid potential closures and provide essential services to their communities. However, under this new designation, the hospitals cannot provide acute inpatient care.

The full text of the final rule is available here:

Written by Catherine B. Moore.

No Surprises Act Update: Louisiana Enforcement

The No Surprises Act “NSA” went into effect January 1, 2022, and protects most consumers enrolled in individual and group health insurance plans from surprise medical bills in certain circumstances.  Enforcement of the NSA generally involves both state and federal governments. The NSA originally allows the states to enforce the provisions of the NSA unless the state is unable to do so. In that scenario, the federal government will enforce the provisions of the NSA in that state.

Based on survey responses and CMS communications between the Centers for Medicare & Medicaid Services and the Louisiana Department of Insurance, “CMS understands that Louisiana lacks authority to enforce the [NSA] provisions.” Therefore, CMS “will assume direct enforcement of these new protections.” Louisiana is one of a handful of states that has deferred enforcement of all provisions of the NSA to the federal government.

We will continue to monitor enforcement of the NSA on a federal level as it relates to enforcement in Louisiana.

Written by Catherine B. Moore.

CMS Use of Sub-Regulatory Guidance Challenged

The Medicaid Fiscal Accountability Rule has become the zombie of federal reimbursement regulation. After it was withdrawn, CMS has nevertheless attempted to gradually implement it through a variety of “this has always been the law” positions. Hopefully, the litigation described in this article will bring some clarity, or at least provide some tools that will help us find clarity on this issue.

Written by Gregory D. Frost.

CMS Terminates Medicare Provider Agreement For Failing to be “Primarily Engaged” in Providing Services to Inpatients

As mentioned in a previous article Recent CMS Guidance Could Jeopardize Medicare Provider Agreement, the Centers for Medicare & Medicaid Services (“CMS”) recently issued Survey and Certification Memo: 17-44-Hospitals (“S&C 17-44”) which requires hospitals to have a minimum of two inpatients at the time of survey, as well as an average length of stay (“ALOS”) and average daily census (“ADC”) of two over the past twelve months. At the time of that article (February 2018), CMS had not yet issued any public notices of intent to terminate a hospital’s Medicare Provider Agreement for failing to be “primarily engaged” in providing services to inpatients.  That has since changed. Continue reading

OIG Report Shows Many Incidents of Potential Abuse or Neglect Unreported in SNFs

The U. S. Department of Health and Human Services (HHS), Office of Inspector General (OIG) recently published an Early Alert report regarding the preliminary results of an ongoing study of potential abuse or neglect in Medicare-certified Skilled Nursing Facilities (SNFs). In the report dated August 24, 2017, the OIG determined that the Centers for Medicare & Medicaid Services (CMS) has inadequate procedures to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs are properly identified and reported. The OIG audit is continuing, but the preliminary results were issued because of the importance of detecting and combating elder abuse. Continue reading