CMS Proposes Changes to Inpatient Hospital Payment Rates and Stark Regulations; OIG Issues Guidance Documents

April 16, 2008

2009 Proposed IPPS Rule
On Monday, April 14, the Centers for Medicare and Medicaid Services (CMS) posted on its Web site the proposed Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates (the 2009 Proposed IPPS Rule). In this rule, CMS proposes changes to inpatient hospital payment rates as well as Stark rule changes. CMS has stated that it will use the IPPS rule as a vehicle for announcing future Stark changes. In addition to its proposed updates to DRG and wage index information, the 2009 Proposed IPPS Rule includes proposals and requests for comments relating to the following issues:

• Disclosure of physician ownership in hospitals;
• Changes to the postacute care transfer policy;
• Reporting of hospital quality data for annual hospital payment update;
• Applicability of EMTALA requirements to hospital inpatients;
• Changes to the EMTALA physician on-call requirements;
• Changes to the Physician Self-Referral (Stark) Law, including requests for comments relating to:
  • Modifications to the "stand in the shoes" provisions of Stark II, Phase III;
  • A proposal for a gainsharing arrangement exception;
  • Modifications to the definitions of "physician" and "physician organization;" and
  • Issues relating to physician-owned implant and other medical device companies

An unofficial version of the 2009 Proposed IPPS Rule may be found at http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/CMS-1390-P.pdf. The official version is scheduled for publication in the Federal Register on April 30, 2008. Comments are due by no later than June 13, 2008.

Phelps Dunbar will be sending out a more detailed description of the Stark proposed revisions shortly. If you would like to receive a copy of the Stark section of the 2009 Proposed IPPS Rule in pdf form, please e-mail Kim Cappleman at capplemk@phelps.com.

OIG Open Letter to Health Care Providers
On Tuesday, April 15, the Office of Inspector General (OIG) issued an Open Letter to Health Care Providers concerning changes to the OIG's Provider Self-Disclosure Protocol (SDP). The letter states that the OIG believes that these "refinements and clarifications to OIG's policies" will increase the efficiency of the SDP and benefit providers who choose to self-disclose. The open letter may be found at http://www.oig.hhs.gov/fraud/docs/openletters/OpenLetter4-15-08.pdf.

Draft OIG Supplemental Compliance Program Guidance for Nursing Facilities
Also on April 15, the OIG posted its Draft OIG Supplemental Compliance Program Guidance for Nursing Facilities. This document supplements the existing compliance guidance issued in 2000. The draft guidance focuses on the following issues as they relate to nursing facilities:

Fraud and abuse laws, including False Claims Act for failure to provide quality care; Submission of accurate claims; Compliance with the Anti-Kickback statute; and Other compliance issues.

The draft guidance may be found at:
http://oig.hhs.gov/fraud/docs/complianceguidance/NurseCPGIIFR.pdf