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Federal Regulatory, Legislative and Reimbursement Report – July-August-September 2015


  • Emergency Medication Kits
    • The federal regulation at 42 CFR 483.60 (F425) requires that the facility provides or obtains routine and emergency medications and biologicals in order to meet the needs of each resident.   In Kentucky, procedures and State laws allow the facility to maintain a limited supply of medications for use during emergency or after-hours situations (refer to 902 KAR 20:048, Section 4, (5) (e)). Whether provided on a routine, emergency, or “as needed” basis, timeliness of provision and administration will be a key consideration. Delayed provision of a medication may impede timely administration and thus adversely affect a resident’s condition. The facility, in collaboration with the consultant pharmacist, must enact policies and procedures to ensure prompt acquisition of medications for its residents. Factors that may help determine timeliness and guide acquisition procedures include:
  • Availability of medications to enable the continuity of care for anticipated admissions or transfers of residents from acute care or other institutional settings;
  • Status of the resident including the severity or instability of his/her condition, significant changes in condition, discomfort, risk factors, current signs and symptoms, and the potential impact of any delay in acquiring the medications;
  • The category of the medication (e.g., antibiotics, analgesics, etc.);
  • The availability of medications in the facility’s emergency supply; and
  • The ordered start time for a medication. click here
  • Medicare DMEPOS Competitive Bidding
    • The Centers for Medicare & Medicaid Services (CMS) recently announced the bidding timeline for the Round 1 2017 competition of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program, as required by law. CMS also has launched a comprehensive bidder education program, designed so that DMEPOS suppliers interested in bidding receive the information and assistance they need to submit complete and competitive bids in a timely manner.
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  • Additional Participants in Pilot Project to Improve Care and Reduce Costs for Medicare
    • The Centers for Medicare & Medicaid Service (CMS) recently announced that over 2,100 acute care hospitals, skilled nursing facilities, physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies transitioned from a preparatory period to a risk-bearing implementation period in which they assumed financial risk for episodes of care.
    • The participants include 360 organizations that have entered into agreements with CMS to participate in the Bundled Payments for Care Improvement initiative and an additional 1,755 providers who have partnered with those organizations. CMS defines an episode of care as the set of services provided to treat a clinical condition or procedure, such as a heart bypass surgery or a hip replacement.
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  • Surveys Focused on Medication Safety Systems and Adverse Events
    • The Centers for Medicare and Medicaid Services (CMS) released memo 15-47 NH announcing they have begun pilot testing focused surveys to look at nursing home systems for “problem prone” and high risk medications. An Adverse Drug Event Trigger Tool is also in development and not yet retrievable from the CMS QAPI webpage. The background section of the memo references the February 2014 OIG report, “Adverse Events in Skilled Nursing Facilities”; where it was reported that 37% of adverse events were related to medication.
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  • CMS Issues Final Rule on 2016 Medicare Payment Rates
    • The Centers for Medicare and Medicaid Services (CMS) recently issued the final rule for 2016 Medicare skilled nursing facility payment rates.
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  • Medicaid Managed Care Regulations
    • The federal Medicaid managed care regulations have not been updated since 2002. Since that time, states have significantly expanded their managed care programs and Medicaid eligibility has expanded for millions of adults under the Affordable Care Act (ACA). The Centers for Medicare & Medicaid Services (CMS) has proposed rulemaking underway designed to modernize federal Medicaid managed care regulations.
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  • FY 2016 Hospice Payment Final Rule Initiates Major Change in Reimbursement
    • The Centers for Medicare and Medicaid Services (CMS) recently released the FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements final rule, which will increase payments to hospice by $160 million in fiscal year 2016, or 1.1% more than the previous year.
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  • CMS Releases Proposed Physician Payment Rule
    • CMS recently released the first proposed update to the physician payment schedule since the repeal of the Sustainable Growth Rate through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The proposal includes a number of provisions focused on person-centered care, and continues the Administration’s commitment to transform the Medicare program to a system based on quality and healthy outcomes.
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 Legislative Update

  • PACE Innovation Act Introduced in U.S. House of Representatives
    • The PACE Innovation Act of 2015 (HR 3243) was introduced by Rep. Christopher Smith (R-NJ-4), Rep. Earl Blumenauer (D-OR-3), Rep. Kevin Brady (R-TX-8), and Rep. Jim McDermott (D-WA-7), with 15 other representatives.
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