U.S. Politics CMS proposed rule
Dale Anderson
Description
Collection
Title:
U.S. Politics CMS proposed rule
Creator:
Dale Anderson
Date:
10/18/2010
Text:
I had a number of responses requesting a link to the AOPA page which explains the new CMS proposed rule. So here's the link and the letter.
View this newsletter online here
AOPA in Advance
Breaking News for O&P Professionals
October 14, 2010
SPECIAL EDITION
O&P News
AOPA
High Priority Tracking CMS' Proposed Rule Implementing Anti-Fraud
Provisions of the Health Care Reform Law That Would Have Significant
Impact on O&P Patient Care Facilities
On September 23, the Centers for Medicare and Medicaid Services issued proposed regulations intended to implement new anti-fraud provisions of the Patient Protection and Affordable Care Act (the health care reform law enacted earlier this year). These
proposed regulations have an important potential impact on orthotic
& prosthetic providers, particularly because they would assign all
DMEPOS providers to one of three risk categories.
DMEPOS providers/companies that are publicly traded on the NYSE or NASDAQ would be considered limited risk.
Currently enrolled (revalidating) DMEPOS Medicare providers would be recognized as moderate risk. (Applicable
date for most currently enrolled providers would be March 23, 2012,
although an earlier date of March 23, 2011 would apply for those
currently enrolled providers whose revalidation cycle results in
revalidation between March 23, 2011 and March 23, 2012).
Newly enrolling suppliers and providers of DMEPOS will be assigned to the high risk category. (Applicable date would be March 23, 2011.)
So,
all AOPA patient care facility members would be subject to assignment
to one of these three risk categories, and the most extensive aspects of
the rules would potentially apply to newly enrolling O&P patient
care facility providers.
Comments on the proposed rule must be submitted by November 16, 2010. CMS expects to have these new rules take effect on or after March 23, 2011. Be assured that AOPA will be preparing and submitting comments to CMS on this important proposal. We
believe there are several aspects of the proposal which would be
excessively burdensome to O&P providers, and most especially our small business entities. CMS
has neither provided the data nor made the convincing case that its
proposed changes will deliver results to justify the extent the rules
would intrude on normal patient care and business practices.
AOPA's outside counsel, at Alston & Bird,
which recently was fortunate enough to add to its team working on your
behalf, Ms. Kim Brandt, former Director of Program Integrity at CMS, has
prepared a very comprehensive summary of these regulations. We have taken that memo, highlighted the portions that are of greatest significance to O&P care providers.
Click here to access and read the Alston & Bird summary memo.
Here are a few of the key proposals of which you should be aware and which will doubtless be prompting comments from AOPA:
CMS could suspend payments to a provider where a credible allegation of fraud exists. What that means is less than clear. For
example, could one competitor make an allegation that another
competitor was defrauding CMS, and would that alone trigger a suspension
of payments? Suspensions are targeted to 180 days-for
many companies--eliminating Medicare payments for that long would
threaten their very existence.
The regs would give CMS the ability to impose a temporary moratorium on potentially high risk providers and suppliers with no rights of judicial review of the agency's decision
As noted above,
all providers and suppliers would be placed in one of three risk levels
(i.e., limited, moderate and high), based on an assessment of their
overall risk of fraud, waste and abuse. It is proposed
that ALL newly enrolling DMEPOS providers and suppliers would go into
the high risk category, and currently enrolled DMEPOS providers
generally would go in the moderate risk category. There
would be an exception to these placements for companies that are
publicly traded on the NYSE or NASDAQ, which would be assigned to the
lowest, limited risk group. Providers in the moderate risk category would be subject to multiple controls, including license verifications and unscheduled
site visits; newly enrolling DMEPOS providers would be subject to
criminal background checks and fingerprinting in order to begin to
receive Medicare payments. AOPA will strongly object to this risk assignment provision, among other reasons, because: (1) orthotics and prosthetics
is not part of DME, and has significantly lower fraud and abuse risks;
(2) there has not been sufficient consideration of the impact of number
of years in business, or accreditation/certification status as factors
that diminish risk.
All providers
(excluding physicians and certain non-physician providers) would be
assessed a $500 annual fee to fund screening and program integrity costs
at CMS. Medicare contractors would not begin processing
the paperwork to support continued eligibility to receive payments
until the enrollment application fee is received and credited to the
United States Treasury.
Clearly, this is a very critical and onerous proposed rule. We encourage all members to review the full memo from Alston & Bird, and to submit your own comments on this proposal. Comments can be sent by two means, but the Department of Health and Human Services requires that you must choose only one way, and not both ways, to send comments. Comments may be submitted electronically to this Web site by clicking on the Submit a comment button and following the instructions provided by the Web site. Or comments may be submitted via regular mail and must be sent to the following address:
(In order to be considered, comments must received by CMS no later than 5 p.m. EST, November 16, 2010.)
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-6028-P
P.O. Box 8020
Baltimore, MD 21244-8020
Of special note, be certain that any comment submitted references file code CMS-6028-P.
Be
assured that AOPA, both on its own behalf, as well as in concert with
other members of the O&P Alliance, will be fighting diligently to
try to persuade the agency to reduce the excesses of this proposal. We
will urge a more realistic approach that cracks down on fraudulent
providers, without either considering every provider to be a crook, or
adding huge regulatory burdens that could put honest, legitimate,
hard-working O&P providers out of business.
Questions? Contact Steven Rybicki at <Email Address Redacted> or (571) 431-0835.
Send Us Your News!
The next AOPA in Advance
will arrive in your inbox on October 19. So if you have a new employee
or a new office, tell us! Share your news with the over 15,000 readers
of the O&P Almanac and AOPA In Advance newsletter. Contact Steven Rybicki at <Email Address Redacted>
330 John Carlyle St., Suite 200, Alexandria, VA 22314
Tel: (571) 431-0876, Fax: (571) 431-0899
www.AOPAnet.org
View this newsletter online here
AOPA in Advance
Breaking News for O&P Professionals
October 14, 2010
SPECIAL EDITION
O&P News
AOPA
High Priority Tracking CMS' Proposed Rule Implementing Anti-Fraud
Provisions of the Health Care Reform Law That Would Have Significant
Impact on O&P Patient Care Facilities
On September 23, the Centers for Medicare and Medicaid Services issued proposed regulations intended to implement new anti-fraud provisions of the Patient Protection and Affordable Care Act (the health care reform law enacted earlier this year). These
proposed regulations have an important potential impact on orthotic
& prosthetic providers, particularly because they would assign all
DMEPOS providers to one of three risk categories.
DMEPOS providers/companies that are publicly traded on the NYSE or NASDAQ would be considered limited risk.
Currently enrolled (revalidating) DMEPOS Medicare providers would be recognized as moderate risk. (Applicable
date for most currently enrolled providers would be March 23, 2012,
although an earlier date of March 23, 2011 would apply for those
currently enrolled providers whose revalidation cycle results in
revalidation between March 23, 2011 and March 23, 2012).
Newly enrolling suppliers and providers of DMEPOS will be assigned to the high risk category. (Applicable date would be March 23, 2011.)
So,
all AOPA patient care facility members would be subject to assignment
to one of these three risk categories, and the most extensive aspects of
the rules would potentially apply to newly enrolling O&P patient
care facility providers.
Comments on the proposed rule must be submitted by November 16, 2010. CMS expects to have these new rules take effect on or after March 23, 2011. Be assured that AOPA will be preparing and submitting comments to CMS on this important proposal. We
believe there are several aspects of the proposal which would be
excessively burdensome to O&P providers, and most especially our small business entities. CMS
has neither provided the data nor made the convincing case that its
proposed changes will deliver results to justify the extent the rules
would intrude on normal patient care and business practices.
AOPA's outside counsel, at Alston & Bird,
which recently was fortunate enough to add to its team working on your
behalf, Ms. Kim Brandt, former Director of Program Integrity at CMS, has
prepared a very comprehensive summary of these regulations. We have taken that memo, highlighted the portions that are of greatest significance to O&P care providers.
Click here to access and read the Alston & Bird summary memo.
Here are a few of the key proposals of which you should be aware and which will doubtless be prompting comments from AOPA:
CMS could suspend payments to a provider where a credible allegation of fraud exists. What that means is less than clear. For
example, could one competitor make an allegation that another
competitor was defrauding CMS, and would that alone trigger a suspension
of payments? Suspensions are targeted to 180 days-for
many companies--eliminating Medicare payments for that long would
threaten their very existence.
The regs would give CMS the ability to impose a temporary moratorium on potentially high risk providers and suppliers with no rights of judicial review of the agency's decision
As noted above,
all providers and suppliers would be placed in one of three risk levels
(i.e., limited, moderate and high), based on an assessment of their
overall risk of fraud, waste and abuse. It is proposed
that ALL newly enrolling DMEPOS providers and suppliers would go into
the high risk category, and currently enrolled DMEPOS providers
generally would go in the moderate risk category. There
would be an exception to these placements for companies that are
publicly traded on the NYSE or NASDAQ, which would be assigned to the
lowest, limited risk group. Providers in the moderate risk category would be subject to multiple controls, including license verifications and unscheduled
site visits; newly enrolling DMEPOS providers would be subject to
criminal background checks and fingerprinting in order to begin to
receive Medicare payments. AOPA will strongly object to this risk assignment provision, among other reasons, because: (1) orthotics and prosthetics
is not part of DME, and has significantly lower fraud and abuse risks;
(2) there has not been sufficient consideration of the impact of number
of years in business, or accreditation/certification status as factors
that diminish risk.
All providers
(excluding physicians and certain non-physician providers) would be
assessed a $500 annual fee to fund screening and program integrity costs
at CMS. Medicare contractors would not begin processing
the paperwork to support continued eligibility to receive payments
until the enrollment application fee is received and credited to the
United States Treasury.
Clearly, this is a very critical and onerous proposed rule. We encourage all members to review the full memo from Alston & Bird, and to submit your own comments on this proposal. Comments can be sent by two means, but the Department of Health and Human Services requires that you must choose only one way, and not both ways, to send comments. Comments may be submitted electronically to this Web site by clicking on the Submit a comment button and following the instructions provided by the Web site. Or comments may be submitted via regular mail and must be sent to the following address:
(In order to be considered, comments must received by CMS no later than 5 p.m. EST, November 16, 2010.)
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-6028-P
P.O. Box 8020
Baltimore, MD 21244-8020
Of special note, be certain that any comment submitted references file code CMS-6028-P.
Be
assured that AOPA, both on its own behalf, as well as in concert with
other members of the O&P Alliance, will be fighting diligently to
try to persuade the agency to reduce the excesses of this proposal. We
will urge a more realistic approach that cracks down on fraudulent
providers, without either considering every provider to be a crook, or
adding huge regulatory burdens that could put honest, legitimate,
hard-working O&P providers out of business.
Questions? Contact Steven Rybicki at <Email Address Redacted> or (571) 431-0835.
Send Us Your News!
The next AOPA in Advance
will arrive in your inbox on October 19. So if you have a new employee
or a new office, tell us! Share your news with the over 15,000 readers
of the O&P Almanac and AOPA In Advance newsletter. Contact Steven Rybicki at <Email Address Redacted>
330 John Carlyle St., Suite 200, Alexandria, VA 22314
Tel: (571) 431-0876, Fax: (571) 431-0899
www.AOPAnet.org
Citation
Dale Anderson, “U.S. Politics CMS proposed rule,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/231960.
