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TOA
President's
Update
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By John T. Gill, MD
President, Texas Orthopaedic Association
Dear Members,
Earlier this week TOA released another
press release with our Get Active! Texas Health Care Campaign and I'd
like to share that press release with you:
Austin, Texas – “Born
to Run” Teams with the Get Active! Texas Public Health Campaign |
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RunTex Carrozza Foundation’s “Born to Run” curriculum kicks off its
first training symposium on Friday, January 18th at the RunTex location
on Barton Springs and Riverside. The RunTex coaching symposium is
co-sponsored by the Get Active! Texas public health campaign and by
Texas orthopaedic surgeons who are encouraging both children and adults
to participate safely in a variety of lifestyle and physical activities
which will lead to healthier musculoskeletal systems and help prevent
obesity.
The "Born to Run" program trains school “coaches” to teach children the
biomechanics of running and how to safely train for a race. More than
250 local schools in Texas have adopted the program for this spring.
Over 3,000 children will begin training this February for the Congress
Avenue Mile run. Orthopaedic surgeons are supportive of this wonderful
program which will help build bone mass early in the “Born to Run”
participants’ lives.
For more information on the “Born to Run” program or Get Active! Texas,
you can visit the websites of RunTex
www.runtex.org and
the Texas Orthopaedic Association
www.toa.org. We
encourage the schools in your community to Get Active! Texas because
children were born to run. The amount of exercise a person gets - from
the beginning of childhood and throughout his/her life – can affect
bones, muscles, joints, behavior, weight and much more. People of all
ages should have the appropriate amount of physical activity daily which
is essential for musculoskeletal health and obesity prevention.
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CMS Issues
Guidance For Off-Site Provider-Based EDs/Emergency Services
Hospitals
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By Michael Reed, MBA, MPA
In a bow to the increasing demand for
hospital emergency services, CMS late Friday afternoon issued a letter
to State Survey Agencies stating that provider-based off-site hospital
emergency departments (EDs), along with so-called “emergency services
hospitals,” are acceptable, so long as they comply with Medicare’s
Conditions of |
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Participation (CoPs) and,
where applicable, Medicare’s provider-based rules.
In most cases, these emergency departments would be owned
and operated by a Medicare-participating hospital. “The
expectation here is the same as for any department on the
hospital’s campus,” notes Friday’s CMS letter.
Among the Conditions of Participation include requirements
that the medical staff and nurses at the off-site EDs have
to belong to the hospital’s medical staff or nursing service
staff, respectively; and that the off-site ED must be part
of the hospital’s quality assessment/performance improvement
program. These requirements include EMTALA- related
provisions, such as requirements to provide medical
screening exams and stabilizing treatment, among others.
So-called “Emergency Services Hospitals,” which are not
separately defined under Medicare, have to satisfy the
statutory definition of a hospital as defined in the Social
Security Act. CMS’s letter interprets that in many if not
most cases, a hospital will meet this definition if 51
percent or more of its beds provide services to inpatients.
Responding to the letter, Federation General Counsel Jeff
Micklos welcomed CMS’s recognition of the significant burden
placed on hospital emergency departments caused by
increasing patient volume. However, CMS’s guidance for these
facilities should have been proposed to the field before
becoming a directive to state survey agencies.
“A state survey agency letter seems an inappropriate place
to announce the agency’s recognition of so-called emergency
services hospitals and a new interpretation of what it means
for a Medicare-participating hospital to be primarily
engaged in inpatient services” said Micklos. “These issues
are better dealt with through rulemaking.”
CMS’s guidance for these facilities applies immediately. A
CMS Memo containing the guidance is available
here. For more information, please contact Jeff
Micklos (jmicklos@fah.org).
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This Week In Texas: Mignon
McGarry Memos
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By Mignon McGarry
TOA Legislative Advocate
TOA Online Version: All Memos
January 17, 2008 Thursday
Speaker Tom
Craddick has a new Chief of Staff. Nancy Fisher, who has worked
for Craddick since he became Speaker of the House in 2003, will
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leave her post at the end of February. Terral Smith, a former
state representative who served as Legislative Director for then
Governor George Bush, will replace her March 1st.
Interim hearings are underway on the House side. The House
Select Committee on Higher and Public Education Finance held
hearings this week as did the House Public Health Committee and
the House Natural Resources Committee. Next week, the House
Committee on Financial Institutions and the House Natural
Resources Committee will hold hearings. Go to the House’s
website
to view committee agendas and to listen to live or archived
webcasts of these hearings.
Across the pink dome, things are relatively quiet as Texas
Senators await their Interim Charges. Some committees have begun
holding hearings despite the lack of official charges. The
Senate Committee on Criminal Justice will meet next week and the
Senate Committee on Transportation and Homeland Security will
hold its next hearing on February 5th. Agendas and webcasts are
available on the Senate’s
website.
Legislators with primary opponents are spending most of their
spare time in their districts, campaigning and raising money.
There are two Senators with primary opponents and 29 House
incumbents with primary opponents. Look for lots of news stories
on these races between now and primary day, March 4th.
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Informal Working Draft of Rules Relating to
Ambulatory Surgical Center Fee Guideline
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The Texas
Department of Insurance, Division of Workers' Compensation (TDI-DWC),
has prepared an informal working draft rule concerning reimbursements
for ambulatory surgical center services. The informal working draft
rule includes the removal of the temporary freeze of the current
version of §134.402, which was adopted in December 2007.
Comments on the
informal working draft rules will enable the TDI-DWC |
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to propose
formal rules to more effectively regulate the workers' compensation
system. Comments on the informal working draft rules are not
comments on any formal rules. System participants will have the
opportunity to comment on formal proposed rules after the rules are
published in the Texas Register.
The informal working draft rules are posted and can be
accessed on the agency website
here.
In order to
expedite the process, we encourage comments to the informal working
draft rules be submitted electronically via email to the address below.
We request that any informal comments be submitted by 5:00 p.m. on
February 8, 2008 via email to:
InformalRuleComments@tdi.state.tx.us.
The TDI-DWC will host a stakeholder meeting to consider
recommendations for payment adjustment factors for the ASC Guideline
rules on February 15, 2008, at 9:30 a.m. in the Public Hearing Room at
the TDI-DWC, 7551 Metro Center Drive, Austin, Texas 78744.
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Update Regarding the New 2008
Medicare Physician Fee Schedule Amounts
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The following is
another update to previous messages regarding the new 2008 Medicare
Physician Fee Schedule Amounts.
In two previous messages distributed to you, the Centers for Medicare
& Medicaid Services (CMS) indicated that the Medicare, Medicaid and
SCHIP Extension Act of 2007 replaced the scheduled 10.1 percent
reduction in the Medicare Physician Fee Schedule (MPFS) conversion
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factor with a 0.5 percent increase for dates of service beginning
January 1 through June 30, 2008. CMS has received a number of inquiries
asking whether physicians need to take any special action to get paid at
the rates required by the statute. Physicians do not need to take any
additional action in order for their MPFS claims to be paid at the new
rate that reflects the 0.5 percent increase in the conversion factor.
Medicare contractors are able to process claims for services paid under
the MPFS that contain dates of service January 1 and after with the new
2008 rates. No adjustments should be necessary. Your Medicare
contractors have been instructed to process, beginning January 7, all
claims with dates of service January 1, 2008, and after, that contain
MPFS services.
We are also taking this opportunity to reiterate two points made in
earlier messages:
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The new fees are expected to be posted on your local contractor’s
website no later than January 11, 2008. The “Medicare Physician Fee
Schedule Look-Up” link on the CMS Website, which allows you to
customize your search, will be updated with the new 2008 fees during
the week of January 21, 2008. However, the carrier specific public
use files are available now on the CMS Website for the new 2008 MPFS
rates at this
link.
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CMS
extended the participation decision period an additional 45 days. The
participation decision period now runs through February 15, 2008,
instead of ending on December 31, 2007. All participating status
changes will be effective January 1, 2008. Contractors will accept and
process any participation elections or withdrawals, made during the
extended enrollment period that are received or post-marked on or
before February 15, 2008.
To become a participating physician, complete the CMS-460 form which can
be found on the CD that was mailed to physicians in November. You can
also request the form from your local contractor. The form must be
completed, signed, and mailed to your local contractor and post-marked
by February 15, 2008. If you are changing your participation status to
non-participating, please send your request in a letter to your local
contractor, post-marked by February 15, 2008.
Contractors will not automatically make adjustments for providers who
change their participation status after January 1, 2008 (you should
begin billing claims according to the participation decision that you
have made). However, they will adjust claims based on participation
status changes that you bring to their attention.
An official CMS change request and an MLNMatters article will be
forthcoming.
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