Welcome

This is Volume I, Issue 7 of the SCHA Regulatory Update - a monthly newsletter designed especially for CEOs and top administrative staff. This newsletter summarizes the major regulatory issues and agency actions taking place each month (September 2009), provides a direct link for additional information, and identifies the appropriate SCHA staff member who will provide more detailed information about the specific issue if you or a member of your staff wants to know more.

To be certain we are providing you with the information you need, in the way you need it, please let us hear your feedback on the newsletter as well as the website.

Headlines:

1. APU
2. OIG Update
3. Audit Updates
4. "Meaningful" Progress Toward Electronic Health Information Exchange
5. DSH Payments
6. 2010 Medicaid Fee Service Rates
7. The Joint Commission
8. New look for Licensing Cards for New SC Nurses
9. Commission to Certify Health Care Interpreters
   
   

1. APU

All SC hospitals will receive their full FY 2010 APU
CMS has posted the lists of hospitals qualifying and not qualifying for their full FY2010 APU (as well as those choosing not to participate) on the QualityNet Web site. There are 127 hospitals not receiving the full APU for FY 2010, including 48 hospitals that chose not to participate in the reporting program, and another 79 hospitals that CMS determined did not meet one or more program requirements as outlined in the IPPS payment rule. CMS sent notification letters to all 127 hospitals and verified that each hospital received the letter before posting the list on QNet today. Hospitals can submit a reconsideration request to CMS through November 1. Information on how to submit a reconsideration request was included in the letter and is posted on QNet. South Carolina is one of the few states which had all acute care hospitals receiving their full APU.

SCHA contact: Karen Reeves, kreeves@scha.org

2. OIG Update

2010 Office of Inspector General (OIG) Work Plan
Please be sure to study the full Work Plan for all items under the eye of HHS. This is a good way to find audit issues for your hospital that will be reviewed by the many auditors looking at the services you provide.

New Work Plan Medicare Items for Hospitals

• Hospital Ownership of Physician Practices
• Hospital Payments for Nonphysician Outpatient Services Under the Inpatient PPS
• Inpatient Rehabilitation Facility Submission of Patient Assessment Instruments
• Duplicate Graduate Medical Education Payments
• Hospital Admissions with Conditions Coded Present on Admission
• Hospital Readmissions
• Observation Services During Outpatient Visits

New Work Plan Medicaid Items for Hospitals

• State Medicaid Agency Policies to Deny Payment for Hospital-Acquired Conditions

Link to 2010 Work Plan: http://oig.hhs.gov/publications/docs/workplan/2010/Work_Plan_FY_2010.pdf

SCHA contact Diane Paschal, dpaschal@scha.org

3. Audit Updates

Recovery Audit Contractor (RAC)
Connie Leonard reported to the hospital associations that CMS is considering the use of the tax identification number (TIN) for medical record requests instead of the NPI, as currently used. I am sure the use of the Excel spreadsheet is very inefficient for the RACs to manage provider review eligibility from the claims file. Connie did also say the update will be posted to the website as soon as the decision is finalized.

CMS is also planning to publish an update to the final results of the appeals submitted in the RAC demonstration project before the end of the year.

SCHA contact Diane Paschal, dpaschal@scha.org

Medicaid Audits
CMS Medicaid Integrity Program (MIP) Update:
Several hospitals have now received result letters from Booz Allen Hamilton of no findings for the audit conducted. We have also been told that CMS has the review reports under consideration. CMS Medicaid Integrity Group (MIG) representative, Robb Miller, reported that hospitals with no findings would be receiving reports. Here is the audit report time line, as reported by Booz Allen Hamilton and shared by a SC hospital:

Robb Miller, CMS, has confirmed Health Integrity, LLC has been named the new Medicaid Integrity Contractor (MIC) for MIP Regions III and IV, replacing Booz Allen Hamilton. Health Integrity is required to be operational in about 45 days, per CMS.

Health Integrity, LLC is based in Maryland and is partnered with Clifton Gunderson LLP (SC DSH auditor) and Navigant Consulting, a few names you may be familiar with in the health care world. Health Integrity, LLC is also the Zone Program Integrity Contractor (ZPIC) for Zone 4, encompassing Colorado, New Mexico, Oklahoma, and Texas.

Here is a link to their website: http://www.healthintegrity.org/index.html

SCHA contact Diane Paschal, dpaschal@scha.org

HMS State Level Program Integrity Audits
Audrey Lutts with HMS has confirmed hospitals can expect record requests to begin in October 2009. Readmissions were confirmed as one of the beginning reviews during our August 20 educational event. Please be sure to keep your contact information updated with HMS.

SCHA contact Diane Paschal, dpaschal@scha.org

4. "Meaningful" Progress Toward Electronic Health Information Exchange

This message from Dr. David Blumenthal, National Coordinator for Health Information Technology was released October 1, 2009 stating that CMS is expected to publish a formal definition of meaningful use, for the purposes of receiving the Medicare and Medicaid incentive payments, by December 31, 2009. At that time, the public will be able to comment on the definition, and such comments will be considered in reaching any final definition of the term. Since December 31, 2009 is CMS' deadline to produce this definition of "meaningful use", this announcement simply informs hospitals that they should not expect the matter to be resolved ahead of schedule.

Blumenthal wrote, "Ultimately, we believe "meaningful use" should embody the goals of a transformed health system. Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality." "Armed with an understanding of the discussion of meaningful use as it unfolds, providers can begin to consider how their own practices or organizations might be reshaped to enhance the efficiency and quality of care through the use of an electronic health record system."

Even though the additional Medicare and Medicaid reimbursement to hospitals from the Recovery Act is dependent on compliance with the term "meaningful use", hospitals will be required to move forward towards this intangible goal for some time to come, with little or no funding.

SCHA contact: Barney Osborne, bosborne@scha.org

New Program to Certify EHR Products under ARRA
The Certification Commission for Health Information Technology plans to launch a preliminary certification program for electronic health record products in late October. The certification will be based on the recommendations of the two committees advising DHHS on how to define meaningful HER use. If the final requirements differ from these recommendations, the certification commission will offer vendors preliminary certifications based on incremental inspection to bring their certifications into alignment with the final rules. Hospitals should be aware of this certification program because it is anticipated vendors will soon begin seeking certification and will use the preliminary certification in marketing efforts.

SCHA contact: Jim Walker, jwalker@scha.org or Barney Osborne, bosborne@scha.org

5. DSH Payments

2010 Disproportionate Share Payments
Traditionally the South Carolina Department of Health and Human Services would have requested hospital-specific uninsured data for the computation of Disproportionate Share distributions by now. The distribution of 2010 funds will be particularly challenging since this is the first accumulation of data since the December 18, 2008 DSH Audit Law was released requiring the inclusion of Medicaid fee-for-service, Medicaid Managed Care and dual eligible costs and payments. The new definitions of what CMS considers “uninsured” is also an issue for review. This is also the first full year’s data accumulation since the Medicaid program began auto assigning Medicaid eligibles to Managed Care Organizations. Reporting this data will be each hospital’s responsibility. Obtaining this data could be a challenge for many hospitals.

Currently, SCHA is advocating the wishes of the Reimbursement Council for the distribution process for 2010. Further communications will be released as information develops.

SCHA contact: Barney Osborne, bosborne@scha.org

6. 2010 Medicaid Fee for Service rates

In 2010 SCDHHS will continue to utilize the current 2009 base rate data. Hospital-specific multipliers however have been calculated separately for inpatient accounts and outpatient accounts. SCHA has reviewed the theories applied in those estimations and reviewed a sample of actual hospital multipliers. You may have already received a report of your new multipliers including a calculation of the multipliers.

SCHA contact Barney Osborne, bosborne@scha.org

7. The Joint Commission: Posting of prepublication versions of the 2010 standards

Below are links to prepublication versions of the 2010 standards for all Joint Commission accreditation programs. These standards will remain posted at least through December 1, 2009, when the print manuals are delivered to accredited organizations, and the E-dition is updated. Accredited organizations should direct questions to the Standards Interpretation Group at (630) 792-5900 or via the online form.

The October 2009 issue of The Joint Commission Perspectives (provided online free of charge) includes a special section on the CMS-related changes made to the standards and survey process since March 2009 as part of CMS’ review of The Joint Commission’s application for renewal of its hospital deeming authority. The changes include:

• The Accreditation Survey Findings Report was modified to include both Joint Commission and Medicare requirements identified as being less than fully compliant at the time of survey (effective July 1, 2009).
• Accreditation awards are being aligned with the CMS Certification Numbers (CCNs). The Joint Commission is contacting each affected hospital to discuss how to realign their accreditation award in accordance with their CCN by the effective date of July 15, 2010.
• Modifications to The Joint Commission’s Medicare recommendation letter to inform CMS that a new or existing Medicare provider has participated in a deemed status survey and that The Joint Commission is making a recommendation regarding Medicare certification as a result.
• Specificity was added to the hospital standards as a way to demonstrate equivalency with the Medicare hospital requirements. New elements of performance (EPs) were created and others were revised. The majority of the revisions are minor editorial changes that include adding notes to standards and EPs to further clarify the intent of requirements.
  

Note: Also posted is a document of the changes made to standards relating to credentialing and privileging by proxy and telemedicine, which are not effective until July 15, 2010. Please note that while revisions have been made to these standards and they will be implemented July 15, 2010, The Joint Commission continues to engage CMS and members of Congress regarding the issue of credentialing and privileging by proxy as it relates to telemedicine providers and users. There is no final agreement or change to federal regulation at this time; therefore, The Joint Commission must survey to the current Medicare requirements regarding credentialing and privileging.

SCHA contact: Karen Reeves, kreeves@scha.org

8. New Look for Licensing Cards for New SC Nurses

The SC State Board of Nursing is in the process of ordering new nursing license cards for nurses newly licensed through examination or endorsement. The new cards are not expected to arrive from the vendor for at least another five to seven weeks. Until the new cards arrive, the SC BON is using a different type of license. The nurses will still be given a pocket card, but the card is white with the state seal on it. It will not have the pink or light red background that everyone is accustomed to seeing. The section with the address information is blue. This information and additional information about online licensure verification is being emailed directly to SCONL members, other CNOs, VPs and Directors of HR in the near future.

SCHA contact: Susan Outen, souten@scha.org or Jim Walker, jwalker@scha.org

9. Commission to Certify Health Care Interpreters

Health care professionals, interpreters and other stakeholders recently launched the Certification Commission for Healthcare Interpreters, which will work to assure competency and proper training for health care interpreters through an accredited professional certification program. The certification program will be based on data from the field regarding knowledge, skills, performance and employers' expectations, rather than on a specific training program or a vendor's service package. The commission also will collaborate with the National Council on Interpreting in Health Care to develop national training standards for health care interpreters who help health care practitioners communicate with patients with limited English proficiency. At this time, it is not expected that this certification will become mandatory, but rather another way to validate that interpreters which hospitals are using have the skills necessary to meet the needs of patients and providers. AHA and SCHA will continue to monitor the work of this Commission.

SCHA contact: Jim Walker, jwalker@scha.org