Blog: The Healthcare Law Blog

Effective January 1, 2017, certain rural hospitals joined the list of providers specifically exempted from the Corporate Practice of Medicine (“CPM”) ban in California, which otherwise prohibits the employment of physicians and other medical professionals by corporations and other artificial legal entities. By signing AB 2024 on September 23, 2016, Governor Jerry Brown amended California Business and Professions Code Section 2401, allowing applicable hospitals to directly employ physicians and bill for their services. According to the bill’s lead author, Assemblymember Jim Wood, the exception purports to create a pathway and incentive for physicians to practice in underserved rural communities.

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On October 10, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to State Survey Agency directors regarding implementation of a moratorium on the establishment of new long-term care hospitals (LTCHs) and LTCH satellites as well as bed increases to such facilities.

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California Medi-Cal enrollment has undergone significant changes, effective January 1, 2013. The California Department of Healthcare Services (“DHCS”) implemented new Medicaid enrollment requirements as part of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (“PPACA”).

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This piece is part of a series that will appear in the RAP Sheet over its next several issues that summarize hot topics in Medicaid enrollment on a state-by-state basis. In this issue, we bring you California, Florida, North Carolina, Virginia, and West Virginia.

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The Centers for Medicare & Medicaid Services (“CMS”) recently announced that it awarded Noridian Administrative Services the contract for administration of Medicare Part A and Part B fee-for-service claims for California, Nevada, Hawaii and the American territories of American Samoa, Guam and the Northern Mariana Islands. Noridian will also take over additional Medicare operational functions, including provider enrollment functions. According to CMS, the workload transfer is to be complete by early 2013. However, if Palmetto GBA protests the bid award, this could significantly delay implementation.

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The Centers for Medicare & Medicaid Services (“CMS”) has begun the process of revalidating most Medicare provider and supplier enrollments, which must be completed by 2015. This effort began making waves in the provider and supplier community when letters sent last fall from the Medicare Administrative Contractors (“MACs”) gave recipients 60 days to respond with a complete Medicare revalidation application. The consequences of failure to comply with a MAC request to revalidate include deactivation of a provider or supplier’s enrollment, which means that the Medicare revenue stream ceases.

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The Centers for Medicare & Medicaid Services (CMS) finalized changes for Medicare skilled nursing facility (SNF) payments for calendar year (CY) 2012. The final rule will be published in the August 8, 2011, Federal Register. CMS finalized an 11.1% decrease to SNF Medicare payments, reflecting the net effects of a downward recalibration of case-mix indexes, a market basket increase and a multi-factor productivity adjustment to the SNF prospective payment system (PPS) rates. In addition, CMS revised several SNF payment policies effective October 1, 2011.

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The Centers for Medicare & Medicaid Services (CMS) proposed changes for Medicare home health agency (HHA) payments for calendar year (CY) 2012. The proposed rule, which was published in the July 12, 2011, Federal Register, results in a net 3.35% decrease to HHA Medicare payments after taking into account the effects of both market basket and wage index updates and reductions in the home health prospective payment system (PPS) rates.

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On July 1, 2011, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule with policy and payment changes for Hospital Outpatient Departments (HOPDs) and Ambulatory Surgical Centers (ASCs). The proposed rule would affect Medicare payments commencing in calendar year (CY) 2012. The proposed rule will be published in the July 18, 2011, Federal Register.

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On July 1, 2011, the Centers for Medicare & Medicaid Services (CMS) issued proposed payment rate and policy changes for the Medicare physician fee schedule that would go into effect for calendar year (CY) 2012. The proposed rule will be published in the July 19, 2011, Federal Register. Highlights of the proposed changes are discussed below. Note that the proposed rule does not address CMS’ projected reduction of 29.5% to the conversion factor for CY 2012 that is based on the application of the sustainable growth rate (SGR). The reason is that this reduction can only be averted through a change in law. The President’s budget submission for fiscal year (FY) 2012 would extend current payment rates through Dec. 31, 2013.

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