Medicare Program; Proposed Changes to the Hospital IPPS for Acute Care Hospitals & the LTCH PPS and Fiscal Year 2011 Rates; Effective Date of Provider Agreements & Supplier Approvals; and Hospital Conditions of Participation for Rehabilitation & Respiratory Care Services
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- Title
- Medicare Program; Proposed Changes to the Hospital IPPS for Acute Care Hospitals & the LTCH PPS and Fiscal Year 2011 Rates; Effective Date of Provider Agreements & Supplier Approvals; and Hospital Conditions of Participation for Rehabilitation & Respiratory Care Services
We are proposing to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. In addition, in the Addendum to this proposed rule, we describe the proposed changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital related costs. These proposed changes would be applicable to discharges occurring on or after October 1, 2010. We also are setting forth the proposed update to the rate of increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The proposed updated rate-of-increase limits would be effective for cost reporting periods beginning on or after October 1, 2010. We are proposing to update the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs). In the Addendum to this proposed rule, we also set forth the proposed changes to the payment rates, factors, and other payment rate policies under the LTCH PPS. These proposed changes would be applicable to discharges occurring on or after October 1, 2010. We are proposing changes affecting the Medicare conditions of participation for hospitals relating to the types of practitioners who may provide rehabilitation services and respiratory care services. We are proposing changes affecting the determination of the effective date of provider agreements and supplier approvals under Medicare. Finally, we are proposing to offer psychiatric hospitals, hospitals with inpatient psychiatric programs, and psychiatric facilities that are not hospitals increased flexibility in obtaining accreditation to participate in the Medicaid program. Psychiatric hospitals would have the choice of meeting the existing regulatory requirements to participate in Medicare as a psychiatric hospital or to obtaining accreditation from a national accrediting organization whose psychiatric hospital accrediting program has been approved by CMS. Hospitals with inpatient psychiatric programs would have the choice of meeting the existing regulatory requirements for participation in Medicare as a hospital or obtaining accreditation from a national accrediting organization whose hospital accreditation program has been approved by CMS. In addition, psychiatric facilities that are not hospitals would be afforded the flexibility in obtaining accreditation by a national accrediting organization whose program has been approved by CMS, or by any other accrediting organization with comparable standards that is recognized by the State.
- Posted
- Apr 20, 2010
- Comment period
- Apr 20, 2010 – May 7, 2010
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- May 3, 2010University of Colorado DenverSupportAcademic
Kandace Shepherd, a Physician Assistant and Senior Instructor at the University of Colorado Denver, supports the proposed ruling change. She argues that PAs should be allowed to provide respiratory care and rehabilitation without physician cosignature or oversight, as it is within their scope of practice and provides cost-saving care.
Read comment → - Apr 28, 2010Saint Thomas HospitalSupportIndividual
The commenter advocates for allowing Physician Assistants (PAs) and Nurse Practitioners (NPs) to write respiratory and rehabilitation orders without requiring a physician's co-signature. They argue that this change is necessary to reflect the current hospital environment and to reduce administrative burdens.
Read comment → - Apr 28, 2010OSF Saint Francis Medical CenterSupportIndividual
An Advanced Practice nurse (APN) working in critical care in Illinois supports the proposed changes to allow Nurse Practitioners and Physician Assistants to prescribe respiratory services. The commenter argues that the proposal should be expanded further to include Clinical Nurse Specialists or a broader term for all four recognized advanced practitioners in the state.
Read comment → - Apr 26, 2010Illinois Society of Advanced Practice NursesSupportIndividual
Cristin Rassi, an Advanced Practice Nurse, supports the proposed rule but argues that it should be expanded to include all Advanced Practice Registered Nurse (APRN) specialties, specifically Certified Clinical Nurse Specialists (CNS), Certified Registered Nurse Anesthetists (CRNA), and Certified Nurse Midwives (CNM). She emphasizes that these professionals already provide safe, high-quality care and should be allowed to order respiratory and rehabilitative services without a physician's co-signature.
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