Although compliance programs for skilled nursing facilities (SNFs) are not a new concept, the Patient Protection and Affordable Care Act , enacted March 23, 2010, requires nursing facilities to have a compliance and ethics program in operation by March 23, 2013, that effectively prevents and detects criminal, civil and administrative violations under the Social Security Act of 1935 and promotes quality of health care.
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 .
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 .
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