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Office of Management and Budget Details Spring 2014 Agency Rule List

This week, the White House Office of Management and Budget (OMB) detailed the Spring 2014 Agency Rule List, including a number of updates on proposed rules for the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS). VNAA members should pay particular attention to two proposed rules regarding home health and hospice.

First is an update to the Home Health Agency Conditions of Participation (CMS-3819-P). This proposed rule would revise the existing Conditions of Participation that Home Health Agencies must meet to participate in the Medicare program. The new requirements would focus on the actual care delivered to patients by HHAs, reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality standards, and eliminate unnecessary procedural requirements. These changes are an integral part of efforts to improve patient safety and achieve broad-based improvements in the quality of care furnished through Federal programs, while at the same time reducing procedural burdens on providers.

Also of note is the FY 2015 Hospice Payment Rate Update (CMS-1609-P) .This proposed rule would update the hospice payment rates and the wage index for fiscal year 2015. A summary by VNAA is available here. VNAA will hold a Hospice Roundtable call related to this update on June 9. To register for this call, click here.

VNAA compiled a list of rules relevant to its membership below and will keep members informed of any activities surrounding them:

Proposed Rule Stage

Medicare Shared Savings Program; Accountable Care Organizations (CMS-1461-P)

This proposed rule would address changes to the Medicare Shared Savings Program and contains provisions relating to Medicare payments to providers of services and suppliers participating in Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. These changes would apply to existing ACOs and approved ACO applicants participating in the program beginning January 1, 2016.

CY 2015 Home Health Prospective Payment System Refinements and Rate Update (CMS-1611-P)

This annual proposed rule would update the 60-day national episode rate based on the applicable home health market basket update and case-mix adjustment. It also would update the national per-visit rates used to calculate low utilization payment adjustments (LUPAs) and outlier payments under the Medicare prospective payment system for home health agencies. These changes would apply to services furnished on or after January 1, 2015.

Medicaid Managed Care (CMS-2390-P)

This proposed rule would align Medicaid Managed Care regulations with existing commercial, Marketplace, and Medicare Advantage regulations. This rule would also implement certain Indian protections under section 5006 of the American Recovery & Reinvestment Act.

Contract Year 2016 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs (CMS-4174-P)

This proposed rule would set forth programmatic and operational changes to the Medicare Advantage (MA) and prescription drug benefit programs for contract year 2016.

Final Rule Stage

Face-to-Face Requirements for Home Health Services; Policy Changes and Clarifications Related to Home Health (CMS-2348-F)

This final rule revises the Medicaid home health service definition as required by section 6407 of the Affordable Care Act of 2010 to add a requirement that physicians document the existence of a face-to-face encounter (including through the use of telehealth) with the Medicaid eligible individual within reasonable timeframes. In addition, this rule amends home health services regulations to clarify the definitions of included medical supplies, equipment and appliances, and clarify that States may not limit home health services to services delivered in the home, or to services furnished to individuals who are homebound.

Methods for Assuring Access to Covered Medicaid Services (CMS-2328-F)

This rule creates a standardized, transparent process for States to follow as part of their broader efforts to "assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area" as required by section 1902(a)(30)(A) of the Social Security Act (the Act). This rule also recognizes, as States have requested, electronic publication as an optional means of communicating State plan amendments (SPAs) and proposed rate-setting policy changes to the public.

Medicare Shared Savings Program; Final Waivers (CMS-1439-F)

This final rule establishes waivers of the application of the Physician Self-Referral Law, the Federal anti-kickback statute, and certain civil monetary penalties (CMP) law provisions to specified financial arrangements involving accountable care organizations (ACOs) under the Medicare Shared Savings Program. The Affordable Care Act authorizes the Secretary to waive certain fraud and abuse laws as necessary to carry out the provisions of section 1899 of the Act (the Medicare Shared Savings Program).

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