REGULATORY REVIEW
Federal Agency Roundup Government organizations that provide guidance to ASCs BY ALEX TAIRA
Federal agencies, part of the executive branch of the government, issue many rules and regulations that affect ASCs. While some
agencies, like the Centers for Medicare & Medicaid Services (CMS) might be well known to ASCA members, oth- ers might be less familiar. With a new administration in control since January 20, this might be a good time to take a closer look at the responsibilities of the various federal agencies and offices that make and enforce the rules and regula- tory policies that affect your ASC.
Department of Health & Human Services The Department of Health & Human Services (HHS), a cabinet-level depart- ment, oversees the health and welfare of Americans. The agency provides healthcare coverage, promotes health- care quality, conducts public health research, stimulates advances in medi- cine and more. With a budget of more than $2.1 trillion, or roughly a quarter of the total federal budget, HHS is by far the largest federal agency in terms of spending. Most of the federal rules and regulations that affect ASCs are issued by HHS and its sub-agencies.
Centers for Medicare & Medicaid Services (CMS): CMS administers the federal healthcare programs: Medi- care, Medicaid and the State Children’s Health Insurance Program (CHIP). It is the primary federal agency that gov- erns the operation of ASCs. To receive Medicare payments, an ASC must be certified and approved by CMS. Certi- fication requirements include a National Provider Identifier (NPI), enrollment in Medicare (must be revalidated every five years) and compliance with Medi- care’s Conditions for Coverage (CfCs).
CMS pays for ASC facility services (nursing, recovery care, drugs, supplies, etc.) under a system linked to the hospi- tal outpatient prospective payment sys- tem (OPPS) that has been in place since 2008. Physician services are paid under a separate fee schedule. CMS adjusts the list of procedures eligible for payment in ASCs well as procedure-specific pay- ment rates annually. CMS also oversees the Ambulatory Surgical Center Quality Reporting (ASCQR) Program. Imple- mented in 2012, this program allows ASCs to report quality data on standard- ized measures. The program currently includes five active quality measures, of which one (ASC-11) is voluntary and one (ASC-12) is calculated automati- cally based on claims data. According to the Medicare Payment Advisory Commission
(MedPAC),
ASCs treated more than 3.5 million Medicare beneficiaries in 2018 with almost $5 billion in total payments. ASCA provides
several resources related to Medicare payments, includ-
ing a popular rate calculator that auto- matically incorporates your ASC’s local wage index to show exactly what you should expect to receive for every procedure. This and other resources can be found at
ascassociation.org/ federalregulations/medicarepayments.
Office of the National Coordina- tor for Health Information Technol- ogy (ONC): ONC supports the adop- tion, implementation and coordination of electronic health information (EHI) and health information
technology
(health IT). Its responsibilities include creating definitions, setting standards and tracking the adoption of elec- tronic health records (EHR) systems. The Health Information Technology for Economic and Clinical Health Act (HITECH) Act of 2009 charged ONC with the creation of a healthcare IT cer- tification program, which ONC uses to ensure that new technology is certi- fied to standards set by the secretary of health and human services. Currently, there is no ASC-specific certified EHR
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