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Payment Matters
July 30, 2010
CMS Releases Proposed Rule for IME/GME Provisions in the Health Care Reform Legislation
By: Thomas W. Coons and Mark A. Stanley
CMS's 2011 OPPS Proposed Rule gives effect to the IME/GME provisions contained in the new health care reform legislation. The Proposed Rule follows the framework laid out in the legislation, which we discussed previously. Nevertheless, teaching hospitals will be interested in the details of CMS's plan to implement the changes under the legislation, particularly those pertaining to the redistribution of residents from closed hospitals and from hospitals that have not "used" all of their FTE slots. The Proposed Rule will be published in the Federal Register on August 3, and CMS will accept comments through August 31.
Training in Non-Provider Settings
The health care reform legislation removed the onerous payment and reporting obligations that CMS has imposed on providers when their residents train in non-provider settings. A provider no longer has to reimburse a non-provider site for its training costs, so long as the provider covers all costs for the residents' salaries (or stipends) and fringe benefits.
Click to continue...CMS Clears Up Stark Deadline Confusion and Proposes Implementing Regulations for Whole Hospital and Rural Provider Stark Exceptions
By: Julie E. Kass and Kristin Cilento Carter
Clearing up some of the confusion surrounding deadlines for compliance, CMS issued proposed rules for implementation of the health care reform legislation changes to the whole hospital and rural provider exceptions to the Stark Law as part of the Cost Year (CY) 2010 OPPS/ASC Proposed Rule. The health care reform legislation amended the rural provider and "whole hospital" ownership exceptions to effectively bar future physician investment in hospitals, while providing a limited grandfathering provision for existing hospitals that have physician investment and a provider agreement by December 31, 2010.
CMS notes that it received numerous inquiries regarding how the following various deadlines in the statute work together.
- The hospital must have physician owners and investors, and a Medicare provider agreement in effect as of December 31, 2010.
- The percentage of the total value of ownership or investment interests held in the hospital, or any entity whose assets including the hospital, by physician owners and investors in the aggregate must not exceed such percentage in effect on March 23, 2010.
