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ACNM Policy Update - 6/2/2014

June 2, 2014


1.  CMS Releases FY 2015 Hospital Inpatient Prospective Payment System Proposed Regulation

2.  CMS Releases New Payment Methodology for Federally Qualified Health Centers

3.  CMS Releases Revisions to its Regulations to Reduce Complexity and Burden

4.  CMS Releases Final Regulation on Medicare Prescription Drug Benefit


1.  CMS Releases FY 2015 Hospital Inpatient Prospective Payment System Proposed Regulation

On May 15, the Centers for Medicare and Medicaid Services (CMS) published a proposed regulation establishing payment rates and policy revisions applicable to inpatient acute care hospital discharges occurring on or after October 1, 2014.  

ACNM has prepared a detailed Issue Brief outlining provisions of this regulation that are of particular concern to midwifery. Notable among them are proposals to include a quality measure of early elective delivery in the hospital value based payment program and also to include a breastfeeding and healthy term newborn measure in the inpatient quality reporting program.  

2.  CMS Releases New Payment Methodology for Federally Qualified Health Centers

On May 2, CMS published a final regulation implementing a revised payment methodology for Federally Qualified Health Centers (FQHCs). 

ACNM has prepared a detailed Issue Brief outlining provisions of this final regulation.  The regulation is estimated to result in a 32 percent increase in Medicare payments to FQHCs.  Since approximately 9 percent of FQHC total billing is paid for by Medicare, on average they can expect to see a 3 percent increase in their income as a result of this new payment system, though this increase will vary among individual FQHCs.  

3.  CMS Releases Revisions to its Regulations to Reduce Complexity and Burden

On May 12, CMS published a final regulation making various changes to the Medicare program.  These changes were prompted by an executive order requiring the various executive branch departments and agencies to make changes to reduce regulatory complexity and burden.

ACNM has prepared a detailed Issue Brief outlining pertinent provisions of this final rule.  Notable among them is a clarification with regard to which provider types can participate on hospital medical staff.  No significant changes, but a nice clarification and a clear indication that CMS favors inclusion of APRNs on hospitals' medical staffs.

4.  CMS Releases Final Regulation on Medicare Prescription Drug Benefit

On May 23, CMS published a final regulation with policies related to the Medicare Advantage and Medicare Part D prescription drug benefit.  One provision of this regulation may be of interest to midwives.

CMS has required that in order for a drug to be covered under the Part D program, the provider who writes the prescription must either be enrolled as a Medicare provider, or have an affidavit on file with Medicare indicating a decision to opt out of Medicare participation.  See this article for information on opting out of Medicare.  

Should you have questions about federal issues, please contact Jesse Bushman, ACNM’s Director of Advocacy and Government Affairs at jbushman@acnm.org or 240-485-1843.

Should you have questions about state issues, please contact Cara Kinzelman, ACNM’s Manager of State Government Affairs at ckinzelman@acnm.org or 240-485-1841.  


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