IDTF rule changes proposed as part of 2008 Medicare physician fee schedule

The 2008 MPFS includes proposed changes to IDTF enrollment requirements, clarifying and amending some of the changes made last year (see the IDTF-related excerpt from the rulemaking discussion): 

1.  An IDTF must name its Medicare contractor as certificate holder on its liability insurance policy (provision is made for the self-insured).

2.  Most reportable changes (e.g. staff changes) must be reported within 90 days rather than 30 days.  Key changes — ownership, location, general supervision and adverse legal actions — must still be reported within 30 days.

3.  Specific requirements will be imposed regarding documentation of complaints and complaint investigations, parallel to those already in place for other provider types.

4.  CMS will eliminate the requirement that supervising physicians must be responsible for overall operation and administration of an IDTF, including employment of personnel and assuring regulatory compliance.  (It was all a misunderstanding, they say.)

5.  No retroactive effective date of enrollment earlier than the filing date of a complete enrollment application that is later approved.

6.  No sharing of space, equipment or staff with another provider organization; no subleasing of operations to another individual or organization.  (Intended to apply to fixed-site IDTFs; CMS is soliciting comments regarding applicability to mobile IDTFs.)

A few quick comments: 

Some of these proposed changes will be welcomed by IDTFs (OK, just #2 and #4).  The others would create new burdens.  The insurance certificate requirements represents new heights of meddlesomeness.  The complaint investigation requirements are not unreasonable.  The enrollment effective date change may pose cash flow issues for new IDTFs. 

The resource sharing restriction will be the most disruptive change.  If it is finalized as currently written, this new requirement may force the revisiting of many existing contractual relationships, and could prove to be rather disruptive to numerous established IDTFs and their business partners.

— David Harlow