- Feedback on Scope of Practice
The Centers for Medicare & Medicaid Services (CMS) is seeking additional input and recommendations regarding elimination of specific Medicare regulations that require more stringent supervision than existing state scope of practice laws, or that limit health professionals from practicing at the top of their license.
We are seeking additional feedback in response to part of the President’s Executive Order (EO) #13890 on Protecting and Improving Medicare for Our Nation’s Seniors. The EO specifically directs HHS to propose a number of reforms to the Medicare program, including ones that eliminate supervision and licensure requirements of the Medicare program that are more stringent than other applicable federal or state laws. These burdensome requirements ultimately limit healthcare professionals, including Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs), from practicing at the top of their professional license.
In response to suggestions we have already received regarding supervision, scope of practice, and licensure requirements, CMS has made a number of regulatory changes in several payment rules, including the CY 2020 Physician Fee Schedule, Home Health, and Outpatient Prospective Payment System final rules. These changes include, but are not limited to: redefining physician supervision for services furnished by PAs, allowing therapist assistants to perform maintenance therapy under the Medicare home health benefit and reducing the minimum level of physician supervision required for all hospital outpatient therapeutic services.
We are proud of the work accomplished, and now we need your help in identifying additional Medicare regulations which contain more restrictive supervision requirements than existing state scope of practice laws, or which limit health professionals from practicing at the top of their license. If you submitted comments on these topics to our 2019 Request for Information on Reducing Administrative Burden to Put Patients over Paperwork, thank you! We are reviewing those submissions.
We welcome any additional recommendations. Please send your recommendations to PatientsOverPaperwork@cms.hhs.gov with the phrase “Scope of Practice” in the subject line by January 17, 2020.
We also continue to welcome your input on ways in which we can reduce unnecessary burden, increase efficiencies and improve the beneficiary experience, and request that input on such topics only be sent to this email address with the phrase “Scope of Practice” in the subject line if they relate to the specific areas in regulation which restrict non-physician providers from practicing to the full extent of their education and training.
New Beneficiary Notices Initiative MailboxCMS launched the new CMS Beneficiary Notices Initiative (BNI) mailbox portal for beneficiary notices and related policy questions. Please note this mailbox portal replaces the BNI mailbox, BNImailbox@cms.hhs.gov. The purpose of this new BNI mailbox portal is to provide a more efficient method for responding to provider, industry, and stakeholder questions. The new BNI mailbox portal provides links to a variety of resources and links to other CMS mailboxes and e-mail addresses. CMS encourages you to review the available resources before submitting a question to ensure that we have not already provided information on the specific topic in question. Please also refer to the list of other CMS mailboxes and email addresses to ensure that you direct your question to the most appropriate area of expertise. Providers, industry, and other stakeholders may submit questions to the BNI mailbox portal effective immediately. Please access the new BNI mailbox.
January 2020 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks available on the 2020 ASP Drug Pricing Files webpage.
Medicare Expired Legislative Provisions Extended and Other Bipartisan Budget Act of 2018 Provisions
On February 9, 2018, President Trump signed into law the Bipartisan Budget Act of 2018. This new law includes several provisions related to Medicare payment.
With regard to payment for outpatient therapy services, the law repeals application of the Medicare outpatient therapy caps but retains the former cap amounts as a threshold above which claims must include the KX modifier as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record; and retains the targeted medical review process, but at a lower threshold amount. It also extends several recently expired Medicare legislative provisions affecting health care providers and beneficiaries, including the Medicare physician fee schedule work geographic adjustment floor, add-on payments for ambulance services and home health rural services, changes to the payment adjustment for low volume hospitals, and the Medicare dependent hospital program.
In addition, with regard to Section 53111 – Medicare Payment Update for Skilled Nursing Facilities, the Centers for Medicare & Medicaid Services has received questions from stakeholders about the impact of the FY 2019 Skilled Nursing Facility (SNF) update due to section 53111 of the BBA of 2018. To help answer these questions, we are providing information about the estimated market basket update for FY 2019 based on currently available data. This estimate may be updated in the Notice of Proposed Rulemaking for the FY 2019 SNF Prospective Payment System (PPS).
Read the full summary (PDF).
- New Option for Submission of Medicare Cost Reports
As part of the Centers for Medicare & Medicaid Services (CMS) commitment to decrease the hours and dollars clinicians and providers spend on CMS-mandated compliance and increase the proportion of tasks that CMS customers can do digitally, a new web portal will be made available to submit a Medicare Cost Report (MCR). Specifically, Part A providers will have the option to electronically transmit their MCR through the Medicare Cost Report e-Filing (MCReF) system. MCReF will be available for cost reporting periods ending on or after December 31, 2017.New Option for Cost Report Submission (PDF)
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