PROGRAM (CAP)
FOR PART B DRUGS ENROLLMENT DEADLINE IS JUNE 2, 2006
This is just a reminder that the Competitive Acquisition Program for Part B drugs for Medicare physicians will be open for enrollment only until June 2, 2006. Participating physicians will be given the opportunity to obtain and bill for Medicare Part B covered drugs through either the CAP program or through the average sales price (ASP) system. More information is available at CMS/CAP.
REGARDING SPECIALTY HOSPITALS
The Secretary of Health and Human Services, Michael O. Leavitt, has submitted an interim report to Congress entitled "Development of a Strategic Plan Regarding Physician Investment and Specialty Hospitals," as required by Deficit Reduction Act of 2005 (DRA). HHS was required to develop and implement a strategic plan concerning whether physician investments in specialty hospitals should continue to be permitted, especially in light of the recently alleged quality of care concerns.
The interim report addresses several issues critical to the process of providing equitable reimbursement to hospitals and specialty hospitals as follows:
1.Addressing hospital DRG payments to adequately reflect severity of illnesses;
2.Increasing the number of procedures that can be performed in ambulatory surgery centers, but adjusting ambulatory surgery centers fees to adequately reflect relative complexity or severity for cases done in both ambulatory surgery centers and the hospitals;
3.Determining whether specialty hospitals are required to provide EMTALA services for cases falling within their specialty; and
4.Obtaining further data regarding physician investment and use of specialty hospitals.
This report is available on the CMS website and at Interim Report.
Further progress towards malpractice or tort reform was delayed, perhaps permanently, by the failure of the Senate to approve cloture. The Medical Care Access Protection Act of 2006
(S. 22) and the Healthy Mothers and Healthy Babies Access to Care Act (S. 23), both sponsored by Republicans and both of which would impose limits on non-economic damages, although
S. 23 is directed only to obstetricians and gynecologists, are now stalled in the Senate with little hope of receiving 60 votes necessary to cloture, given that Republicans control only 55 seats. Cloture is the parliamentary procedure by which debate on a particular item is ended, and the matter put to a vote; involving cloture in the Senate requires a super-majority vote.
FOR CARDIAC REHABILITATION PROGRAMS
Effective for services performed on or after March 22, 2006, the Centers for Medicare and Medicaid Services (CMS) is updating Section 20.10 of the Medicare National Coverage Determinations Manual (NCD Manual) to include additional clinical indications for which cardiac rehabilitation services are covered. The NCD Manual now includes a comprehensive description of the services that must be provided as part of a comprehensive cardiac rehabilitation program, extends the window of time during which the services must be provided, and restructures the language in an effort to improve clarity. The new revision can be viewed at Cardiac Rehabilitation Programs NCD Manual.
The Centers for Medicare and Medicaid Services (CMS) has posted new and revised versions of its provider/suppliers/practitioner Medicare enrollment forms (855s). These new forms were issued immediately after the final regulations defining the requirements of the enrollment process were published on April 21, 2006, as noted April 27, 2006 on the Med Law Blog. The revised forms are effective April 30, 2006. The CMS forms emphasize that the application process should be directed through the appropriate physical intermediary (FI) or carrier, rather than CMS.
Continue Reading...Med Law Blog is published by Michael Cassidy
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