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Advisory Council October 2019 Meeting Presentation: Clinical Subcommittee Update

Monday, October 21, 2019

Printer Friendly Version in PDF Format (4 PDF pages)


Clinical Subcommittee Update

Ellen Blackwell, MSW

Medicare Learning Network Connects

(Strategy 2.A)

Physician Fee Schedule (PFS) – Proposed Rule CMS 1715-P

  • Proposes new administrative claims based quality measure to the Merit-Based Incentive Payment System for 2023 and beyond, “All-Cause Unplanned Admission for Patients with Multiple Chronic Conditions;” ADRD and senile dementia is one of the conditions
  • Proposes changes to requirements for chronic care management care plan, and certain billing requirements
  • Proposes addition of Principal Care Management G codes, for patients with one serious, high risk chronic condition
  • Proposes increased payment for Transitional Care Management (TCM) services provided to beneficiaries following discharge from an inpatient stay or certain outpatient stays
  • Proposes replacing several CCM codes with Medicare-specific codes to allow clinicians to bill incrementally, reflecting additional time and resources required in certain cases, and to better distinguish illness complexity measured by time
  • Seeks comment on opportunities to expand the concept of bundling to improve payment for services under the PFS
  • Seeks comment on aligning quality measures across the Medicare Shared Savings Program and the Merit-based Incentive Payment System
  • Proposes changes to payment for Evaluation and Management Services coding to retain 5 levels for established patients, reduce to 5 levels for new patients, and streamline documentation
  • Comment closed September 27, 2019

Information at:
(Strategy 2.F)

Final Rule Revisions to Discharge Planning Requirements 3317-F

  • In September CMS released a final discharge rule that long-term care hospitals, critical access hospitals, psychiatric hospitals, children’s hospitals, cancer hospitals, inpatient rehabilitation facilities, and home health agencies must meet to participate in Medicare and Medicaid
  • The rule requires the process focus on patients’ individual goals and treatment preferences
  • Hospitals are mandated to ensure each patient’s right to access their medical records in an electronic format
  • The rule implements requirements from the IMPACT Act that include how facilities will account for and document a patient’s goals of care and treatment preferences
  • Facilities and home health agencies are also required to send specific medical information when patients are transferred, along with an evaluation of the patient’s need for post-acute care services

Information at:
(Strategy 2.F)

Omnibus Burden Reduction Final Rule 3346-F

  • In September CMS released a combined rule that finalized three proposed rules on program efficiencies, hospital and critical access hospitals, and fire safety in dialysis facilities
  • The rule will better support beneficiaries who need organ transplants
  • It streamlines hospital quality improvement and infection control programs
  • It reduces certain required activities like written orders, revises timelines, and reduces the frequency of reviews and program evaluations for certain facilities
  • Some facilities will have decreased requirements for emergency program annual review/training; long-term care facilities (nursing homes) will have annual review

Information at:
Strategy 2.F)

Improvements to Nursing Home Compare

  • Coming October 23 -- an abuse icon to more easily identify nursing homes with past citations for abuse, neglect, or exploitation
  • The icon, updated monthly, will indicate abuse that led to harm of a resident within the past year, and abuse that could have potentially led to harm of a resident in each of the last two years
  • There are many factors that indicate a nursing home’s quality
  • Nursing Home Compare already flags Special Focus Facilities, for nursing homes that have a history of poor care and may need increased oversight and enforcement

Information at: and
(Strategy 3.D)