NYUMC Office of Compliance

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NYUHC Regulatory Information Bulletin

Volume 2, Issue 4

Fascinating Additions to Federal Law . . .

· CMS INCREASES PAYMENTS TO INPATIENT REHABILITATION FACILITIES FOR FISCAL YEAR 2008 under a final rule.  The IRF PPS final rule updates payment rates and modifies payment policies for services furnished to Medicare beneficiaries for discharges occurring on or after October 1, 2007 through September 30, 2008.  The rule’s provisions are estimated to increase Medicare payments to approximately 1,220 IRFs in FY 2008 by approximately $150 million. 

· CMS published the final rule on ASC Payment Rates for 2008.  The rule, effective January 1st, significantly  expands the list of procedures for which Medicare payments may be made, adding approximately 790 procedures.  Concurrently published was a proposed rule to align the OPPS and the ASC Payments Systems.

· CMS ANNOUNCES PAYMENT REFORMS FOR INPATIENT HOSPITAL SERVICES IN 2008.  CMS issued a final rule on the 2008 IPPS that restructures the inpatient diagnosis-related groups (DRGs) to account more fully for the severity of each patient’s condition. In an attempt to improve the quality of care, the rule also includes important provisions to ensure that Medicare no longer pays for the additional costs of certain preventable conditions acquired in the hospital.  See also final wage index and related tables.

· Present on Admission (POA) REPORTING.  In Change Request 5679, CMS discusses the details of transmitting POA Indicators on claims.  POA Indicators are required on all inpatient hospital claims with discharge dates on or after October 1, 2007.  If the patient lacked the condition at admission, but acquires it in the hospital such that it would increase the DRG or create an outlier, CMS will not pay this additional money.  CMS deems these post-admission acquisitions as preventable conditions.  The full list is in the IPPS final rule (e.g., catheter-associated UTIs, vascular-associated UTIs, pressure ulcers, and mediastinitis).

The RIB is e-mailed monthly to Directors 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.

· NYS Legislature passed and Gov. Spitzer signed a bill requiring that office surgical practices be accredited and report adverse events.  The new law is based on the recommendations of a committee convened by the DOH in response to  a 2002 report released by the Federation of State Medical Boards.

· NYS’ Social Security Number (SSN) Protection Law takes effect January 1, 2008.  It prohibits hospitals (and other businesses) from printing an individual’s SSN on any card or tag required to access services, requiring an individual to transmit his/her SSN via Internet unless the connection is secure/encrypted, printing an individual’s SSN on any items mailed to the individual unless state or federal law requires it, and intentionally communicating a SSN to the general public or otherwise making the number available.  Moreover, much like the HIPAA Privacy Act, hospitals are required to take reasonable measures to ensure that only those employees needing it for a legitimate business purpose have access to SSNs.  Click here for more information.

· Governor Spitzer signed legislation to broaden the rights of health care consumers, physicians and hospitals associated with managed care health plans.  The new legislation provides key legal protections to address long-standing problems of patients caught in the middle between hospital and insurer disputes.  It also helps untangle the complicated maze of rules that have been developed by hospitals and insurers so that clear and timely health care decisions can be made.  Gov. Spitzer sees this improved coordination among all stakeholders in the healthcare system as a step closer to universal health coverage for all New Yorkers.  The legislation amends sections of the Public Health Law, Social Services Law, and the Insurance Law.  The full text of the new legislation can be found by clicking here and searching for the text of Bill Number S03986A.  It becomes effective April 1st.

Notable New York Laws & Regulations . . .

· Deployment of the NPI has been delayed.  Click here for more information.

· Proposed rule that details the OPPS Rates for CY2008.

· NCD: Use of Erythropoiesis Stimulating Agents in Cancer Conditions.

· AHRQ’s proposal to Charter Value Exchanges for Value-driven Health Care.

· LCD: Velcade™ for Injection

· Informed consent recommendations for Source Plasma donor participating in  plasmapheresis or immunization programs.

· MM5665:  PET Scan Coding

August 6, 2007