CMS releases 2009 cap amount early.

Hospices wondering whether they'll have trouble with exceeding the per beneficiary cap this year shouldn’t have to wonder much longer. The Centers for Medicare & Medicaid Services issued the 2009 hospice cap amount early “to assist the hospice industry in planning and budgeting,” it says on its Web site. The cap amount is $23,014.50.

CMS also includes its methodology for the cap calculation “so that hospices can compute the amount themselves in the future if they so desire.”

That calculation methodology could be changing, however. In its proposed rule in the April 24 Federal Register, CMS floats the idea of revamping how it determines the cap amount.

“Until recently, hospices rarely exceeded the aggregate cap,” CMS notes in the rule. But now hospices have more patients with longer lengths of stay and exceed the cap more often.

The Medicare Payment Advisory Commission “found that for-profit ownership, smaller patient loads, and being a freestanding facility were correlated with longer lengths of stay and the consequent likelihood of exceeding the aggregate cap,” CMS points out in the rule.

CMS is considering changes to how it counts the unduplicated census number for the cap and requiring hospices to calculate and report their own cap. Comments on the rule are due June 22.

The 2009 cap notice is at www. cms.hhs.gov/center/hospice.asp. CMS will issue the amount officially in its 2010 rate notice this summer, it says. The proposed rule is at http://edocket.access.gpo.gov/2009/pdf/E9-9417.pdf .

In other news…

• CMS dealt a hard hand to acute inpatient hospitals and long-term care hospitals in its proposed 2010 PPS payment rule (see the last issue of Medicine & Health), but there are some items that could help soften the blow to hospitals paid under IPPS/LTCH PPS.

Under current Medicare law, hospitals that successfully report the 2010 quality measures included in the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program will get the full IPPS/LTCH PPS update, the Centers for Medicare & Medicaid Services said in its statement on the proposed IPPS/LTCH PPS rule. Hospitals that do not participate in the quality reporting program will get the update less 2 percentage points.

Last year 97 percent of participating hospitals received the full update. The proposed rule adds four new measures for which hospitals must submit data under the RHQDAPU program to receive the full market basket update. Two of these measures are additions to the existing Surgical Care Improvement Project measure set, and CMS believes that the other two measures will promote hospital participation in nursing-sensitive care and stroke care registries.

CMS is also proposing changes to regulations affecting payment adjustments to teaching hospitals (hospitals that offer graduate medical education programs), and disproportionate share hospitals (hospitals that provide care to a disproportionate share of low income patients), and to clarify the regulations implementing the Emergency Medical Treatment and Labor Act (EMTALA). In addition, the proposed rule describes five applications for new technology add-on payments and CMS’ preliminary findings about those technologies.

• May 19^th was World Hepatitis Day, CMS announced in an email to providers. Hepatitis B is a highly infectious disease caused by the Hepatitis B virus (HBV). Chronic HBV infection can lead to cirrhosis of the liver, liver cancer, liver failure, and death.

Medicare covers the Hepatitis B vaccine and its administration for Medicare beneficiaries with an intermediate to high risk of contracting the disease. CMS has also created several educational products to help Medicare providers understand this benefit, including: the Adult Immunizations Brochure at www.cms.hhs.gov/MLNProducts/downloads/adult_immunization.pdf and the Medicare Preventive Services Quick Reference Information at www.cms.hhs.gov/MLNProducts/downloads/qr_immun_bill.pdf

• CMS has released payment updates for inpatient psychiatric facilities for rate year 2010 (beginning July 1, 2009). CMS-1495-NC titled “Inpatient Psychiatric Facilities Prospective Payment System Payment Update for Rate Year Beginning July 1, 2009 (RY 2010)” went on display on May 1. 

The display copy is currently available at www.cms.hhs.gov/InpatientPsychFacilPPS/IPFPPSRN/itemdetail.asp?itemID=CMS1222134&. For more information about the inpatient psychiatric facilities prospective payment system, go to www.cms.hhs.gov/InpatientPsychFacilPPS/01_overview.asp.

• Congress is paying attention to speech-language pathology telehealth services. Rep. Mike Thompson (D-Calif.) recently introduced H.R. 2068, the Medicare Telehealth Enhancement Act of 2009, which would provide Medicare reimbursement for telehealth services conducted by SLPs and audiologists, announced an email to members from the American Speech-Language Hearing Association. Telehealth consists of monitoring patients remotely, so this legislation would also expand care access (and Medicare reimbursement) to urban and suburban areas, ASHA pointed out.