Under the Social Security Act , Medicaid Disproportionate Share Hospital (DSH) payments to hospitals cannot exceed the uncompensated cost of providing inpatient and outpatient hospital services to Medicaid-eligible and uninsured individuals. The 2008 DSH final rule required state reports and audits to ensure the appropriate use of DSH payments and compliance with the DSH limit imposed at Section 1923(g) of the Social Security Act .
On October 20, 2011, the Centers for Medicare and Medicaid Services (CMS) issued its final rule for Accountable Care Organizations (ACO) under the Medicare Shared Savings Program enacted in 2010 as part of the Patient Protection and Affordable Care Act . The proposed rule for this program, published April 7, 2011, created a large number of comments that have led to several significant changes to the final regulations
Recent changes to Medicare Part A mean skilled nursing facilities (SNFs) and their therapists must remain vigilant to make sure therapy services are provided consistently. The Centers for Medicare & Medicaid Services clarified an End of Therapy Other Medicaid Required Assessment (OMRA) must be completed for Medicare Part A patients who miss three consecutive days of therapy services, using an assessment reference date (ARD) of the first, second or third day after the last therapy treatment. The approaching holidays may create difficulties delivering therapy services on a regular schedule as therapy staff take time off or skilled residents spend extra time with family.
Independent hospitals have successfully faced difficult circumstances in the past, but new challenges are pushing the hospital industry onto more difficult footing. Fundamental, long-term industry challenges, including competitive disadvantages in size and scale, limited access to capital and competition for and with physicians, have increased the need for independent hospitals to re-examine their operational and financial strengths and weaknesses
On October 5, 2011, the Department of Health and Human Services Office of Inspector General (OIG) issued its work plan for 2012, which outlines specific focus areas for the OIG next year.
The final rule for changes to the hospital inpatient acute care prospective payment system (PPS) for federal fiscal year 2012 was released by the Centers for Medicare & Medicaid Services (CMS) in early August. This release included two changes related to the amount of defined benefit pension costs a hospital is allowed to claim on its Medicare cost report. One of the changes relates to calculating allowable pension costs claimed on a PPS hospital’s wage index.
The Centers for Medicare & Medicaid Services (CMS) has made some very restrictive interpretations of what costs are eligible for electronic health records (EHR) incentive payments for critical access hospitals (CAHs). These interpretations could seriously limit CAH options for obtaining, financing and paying for a viable EHR system and limit the incentive payments Medicare will pay. The problems revolve around the language in Section 1814(l)(3)(C) of the Social Security Act .
The U.S. Department of Defense (DOD) is attempting to reduce active military and veteran health care costs by reducing reimbursement to sole community hospitals (SCHs) for inpatient services provided to TRICARE beneficiaries
On August 1, 2011, the Centers for Medicare & Medicaid Services (CMS) published the final rule for changes to the hospital acute care prospective payment system (PPS) for federal fiscal year (FY) 2012. As was discussed in a prior BKD article on this topic, CMS included several changes affecting the hospital wage index computation for FY 2013
Long-Term Care M&A Activity Accelerates With consecutive increases in transaction volume each of the last six quarters, long-term care (LTC) mergers and acquisitions (M&A) volume has been on a torrid pace following the 40-transaction jolt in fourth quarter 2009. This accelerated deal volume can be traced to a number of factors affecting buyers and sellers. What’s driving sellers: Increased regulation and reimbursement pressures Uncertainty about future reimbursement Aging facilities needing major renovations or replacement Improving valuations Beginning wave of baby boomer owners nearing retirement age What’s driving buyers: The need to spread overhead costs due to regulatory and reimbursement changes Availability of cheap financing The impending wave of baby boomers needing future care As the graphs below illustrate, after 110 transactions in 2010, there have already been 74 reported through the first half of 2011