March Legislative Update: Notices from CMS; APN & P.A. Prescribing Bills

Notices From CMS

Electronic Funds Transfer

Existing regulations 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers who expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through electronic funds transfer (EFT).  As part of CMS’s revalidation efforts, all suppliers and providers who are not currently receiving EFT payments are required to submit the CMS-588 EFT form with the Provider Enrollment Revalidation application, or at the time any change is being made to the provider enrollment record by the provider or supplier, or delegated official.

For more information about provider enrollment revalidation, review the Medicare Learning Network’s Special Edition Article #SE1126, titled “Further Details on the Revalidation of Provider Enrollment Information” at:  http://goo.gl/5bIHY.

More Information on the Switch to Version 5010 and D.0

The compliance deadline to upgrade to Version 5010 from Version 4010/4010A was Sunday, January 1, 2012.  CMS announced an enforcement discretion period for 90 days until Saturday, March 31, during which it would not initiate enforcement action with respect to any HIPAA-covered entity that is non-compliant with Version 5010, NCPDP Telecom D.0, and NCPDP Medicaid Subrogation 3.0 standards.  However, you should continue to upgrade your systems as promptly as possible in order to meet this deadline.

CMS suggests that in order to ensure a smooth upgrade prior to April, you will need to complete both phase I internal and phase II external testing of Version 5010 transactions.  As part of your external testing, you will need to conduct tests with outside trading partners, which include vendors, clearinghouses, billing services, and payers.  Your vendor is a critical partner in achieving Version 5010 compliance.

You should take the following steps to evaluate your vendor and vendor products to ensure a timely Version 5010 upgrade.
•Establish a tracking system and timeline for milestones.
•Review existing and new contractual obligations with vendors.
•Coordinate vendor capabilities with your practice needs and expectations.
•Evaluate ease of use of vendor products.

You might want to also ask your vendor some of the following questions about the Version 5010 upgrade to help assess your readiness for this upgrade.
•Have they upgraded their systems to meet Version 5010 standards?
•If they have not yet upgraded, when will they do so?
•What will be the cost for each upgrade?
•What versions of their software will be upgraded, and will these upgrades require any additional hardware upgrades?
•How often will updates occur and what is the delivery method?
•How are issues logged and how will they be addressed?
•Is there training available for new system changes and/or functionalities?

For additional information and resources about the Version 5010 upgrade, please visit the CMS website at:  http://goo.gl/tlUus.

Ohio Legislation

Update on Substitute Senate Bill 83: APN Prescribing Bill

Substitute Senate Bill 83 was favorably passed by the House of Representatives on Tuesday, February 14. Substitute Senate Bill 83 will allow APN prescribing of schedule II medications in the sites listed below.
1.  Hospital (3701.07 ORC)
2.  An Entity Owned or Controlled (in whole or in part) by a Hospital (or by an entity that owns or controls, in whole or in part, one or more hospitals)
3.  Health Care Facility Operated by the Department of Mental Health or the Department of Developmental Disabilities
4.  Nursing Home (3721.02 ORC or 3721.09 ORC)
5.  County Home or District Home Certified Under the Medicare/Medicaid Program (5155 ORC)
6.  Hospice Care Program (3712.01 ORC)
7.  Community Mental Health Facility (5122.01 ORC)
8.  Ambulatory Surgical Facility (3702.30 ORC)
9.  Freestanding Birthing Center (3702.51 ORC)
10.  Federally Qualified Health Center (3701.047 ORC)
11.  Federally Qualified Health Center Look-Alike (3701.047 ORC)
12.  Health Care Office or Facility Operated by the Board of Health (3709.05 ORC)
13.  Physician-Owned Practices – a direct care medical practice site compromised of one or more physicians, who are also the owners of the practice, where the APN providing services has a Standard Care Arrangement (SCA) with at least one of the physician owners who practices primarily at the site

At all other sites not part of the list, APNs will be limited to prescribing the schedule II medications to terminally ill patients, for a 24-hour supply and only after the physician initiates the prescription.

Because of the site restrictions, OPA sought and won an amendment to give liability protection to pharmacists against an APN who might write a schedule II prescription outside the allowable sites.

Please note: APNs may not begin to prescribe schedule II medications immediately. The bill would become effective three months after the governor signs the bill. OPA will advise members of the effective date of the bill and when APNs may begin to prescribe these medications.

HB 284:  P.A. Prescribing Bill

HB 284 which was introduced by Rep. Ann Gonzales would allow physician assistants (PAs), who work under physician supervision, to prescribe Schedule II controlled substances in specified locations.  It would allow them to provide medical care in emergencies without physician supervision.  The bill was stalled when it was amended to prohibit physician assistants from fitting or inserting some birth control devices or removing intrauterine devices, diaphragms and cervical caps. The provisions would reverse the original bill, which apparently reflects current law that does allows the practice by physician assistants.

P.A. prescribing site limitations mentioned in the bill include:

(1) a hospital registered with the Department of Health;
(2) a health care facility operated by the Department of Mental Health or the Department of Developmental Disabilities;
(3) a nursing home licensed by the Department of Health or a political subdivision;
(4) a county home or district home that participates in Medicare or Medicaid;
(5) a hospice care program;
(6) a community mental health facility;
(7) an ambulatory surgical facility;
(8) a freestanding birthing center;
(9) a federally qualified health care center;
(10) a health care office or facility operated by a board of health of a city or general health district or an authority having those duties.

The bill prohibits a physician assistant from prescribing any schedule II controlled substance to a patient in a convenience care clinic. Because of the site restrictions, OPA sought and won an amendment to give liability protection to pharmacists against a PA who might write a schedule II prescription outside the allowable sites.

If you have any questions or comments about the issues mentioned in this article, please contact Kelly Vyzral, Director of Government Affairs, at 614.389.3236 or kvyzral@ohiopharmacists.org.