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2008 Physician Quality Reporting Initiative

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the Physician Quality Reporting Initiative (PQRI) Web site has been reorganized to facilitate access and navigation to 2008 PQRI information and educational resources, including a 2008 PQRI Tool Kit. Key documents related to 2008 measure specifications have been retained and placed as downloadable documents within their corresponding sections. In addition, new documents that further inform eligible providers about 2008 PQRI have been added to the Web site. Information about the 2007 PQRI program, which ended on December 31, 2007, has also been reorganized with relevant documents pertaining to 2007 measures retained for reference.

We encourage all eligible providers to visit the Web site and become familiar with the 2008 materials at: http://www.cms.hhs.gov/PQRI.

Posted 1/27/08

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Social Security Numbers (SSNs) Should Not Be Reported in FOIA-disclosable NPPES Fields   PDF file

Posted Nov. 28, 2007

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Posted Nov 14, 2007

DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, Maryland 21244-1850

JSM/TDL-08048, 11-09-2007

MEMORANDUM

DATE: November 14, 2007

FROM: Director, Business Applications Management Group

Office of Information Services

Director, Medicare Contractor Management Group

Center for Medicare Management

SUBJECT: Mandatory Reporting of the National Provider Identifier (NPI) on all Part B Claims --

ACTION

TO: All Carriers, Part A and Part B Medicare Administrative Contractors

(A/B MACs), and Durable Medical Equipment MACs (DME MACs)

The Health Insurance Portability and Accountability Act (HIPAA) of 1996

(PL 104-191) requires that the Secretary of the Department of Health and Human Services (HHS) adopt standards providing for a standard unique health identifier for each health care provider for use in the healthcare system. The National Provider Identifier (NPI) final rule published on January 23, 2004, established this standard for a unique health identifier, announced the adoption of the NPI as that standard, and established implementation specifications for obtaining and using the NPI (45 CFR

Part 162, CMS-0045-F).

CMS has been assessing health care provider NPI compliance in Medicare claims. The majority of claims being sent by providers are being submitted with the NPI. CR 5607, Transmittal number 1238 dated May 11, 2007, required your shared system maintainer to provide you with user-controlled, datedriven logic to be able to begin rejecting claims, when directed by CMS, that do not contain an NPI for primary providers (i.e., billing, pay-to provider and rendering provider fields). All claims processing systems will continue to accept Legacy only, NPI only and NPI/legacy combination for secondary providers (i.e., referring, ordering, and supervising) until May 23, 2008 Joint Signature Memorandum/Technical Direction Letter (JSM/TDL)-08007 directed that institutional claims contain an NPI effective January 1, 2008. This JSM/TDL is directing carriers, A/B MACs, and DME MACs to begin rejecting claims received from providers/suppliers that do not contain either NPI only or NPI/legacy combination for primary providers beginning March 1, 2008. CMS has already begun providing advanced notification to providers. Upon receipt of this JSM, you are to post the following language to your list serv, bulletin board, website, and use it in communication to providers/suppliers:

2

“Effective March 1, 2008, your Medicare fee-for-service claims must include an NPI in the primary provider fields on the claim (i.e., the billing, pay-to provider, and rendering provider fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI. The secondary provider fields (i.e., referring, ordering and supervising) may continue to include only your legacy number, if you choose. Failure to submit an NPI in the primary provider fields will result in your claim being rejected, beginning March 1, 2008. In addition, if you already bill using the NPI/legacy pair in the primary provider fields and your claims are processing correctly, now is a good time to submit to your contractor a small number of claims containing only the NPI in the primary provider fields. This test will serve to assure your claims will successfully process when only the NPI is mandated on all claims.”

NOTE: MEDICARE ADMINISTRATIVE CONTRACTORS (MACs)

DME MAC Contract Numbers

Jurisdiction A ~ HHSM-500-2006-M0001Z

Jurisdiction B ~ HHSM-500-2006-M0002Z

Jurisdiction C ~ HHSM-500-2006-M0006Z

Jurisdiction D ~ HHSM-500-2006-M0004Z

A/B MAC Contract Numbers

Jurisdiction 3 ~ HHSM-500-2006-M0005Z

Jurisdiction 4 ~ HHSM-500-2007-M0001Z

Jurisdiction 5 ~ HHSM-500-2007-M0002Z

This Joint Signature Memorandum is being issued to you as technical direction under your MAC contract. This technical direction is not construed as a change or intent to change the scope of work under the contract and is to be acted upon only if sufficient funds are available. In this regard, your attention is directed to the clause of the General Provisions of the contract entitled Limitation of Cost,

FAR 52.232-20. If the Contractor considers anything contained herein to be outside of the current scope of the contract, or contrary to any of its terms or conditions, the Contractor shall immediately notify the Contracting Officer in writing as to the specific discrepancies and any proposed corrective action.

Should you require further technical clarification, you may contact your Project Officer. Contractual questions should be directed to your CMS Contracting Officer. Please copy the Project Officer and Contracting Officer on all electronic and/or written correspondence in relation to this technical direction letter.

If you have any questions, please contact Joy Glass on 410-786-6125 or

joy.glass@cms.hhs.gov or Marlene Biggs on 410-786-7880 or marlene.biggs@cms.hhs.gov .

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Posted Nov 9, 2007

The NPI is here.  The NPI is now.  Are you using it?

Requirement to Update Information in the National Plan and Provider Enumeration System (NPPES)

Health care providers who are covered entities under HIPAA are required by the National Provider Identifier (NPI) Final Rule to update their NPPES data.  The Final Rule [at (162.410(a)(4)] states that covered health care providers must notify the NPPES of changes in their required NPPES data elements within 30 days of the changes.  Failure to provide updated information may be considered an act of non-compliance with the NPI regulation, and a complaint may be filed against covered health care providers who do not comply with this provision, or any other provisions of the rule.

Most updates and changes can be made by health care providers over the web, using the User IDs and passwords they selected when they first applied for their NPIs.  If they applied on paper, most health care providers can submit updates or changes over the web and can select User IDs and passwords at the time of the update.  Certain changes or updates, however, must be made on paper (form CMS-10114), as they require the original signature of the health care provider or, for an organization health care provider, the signature of the Authorized Official.  Such changes include: 

1) Applications for NPIs, and all updates/changes, from individuals who do not have SSNs or who do not want to report their SSNs to NPPES;

2) All requests to deactivate NPIs;

3) All requests to reactivate NPIs;

4) All changes to incorrectly submitted SSNs;

5) All changes to incorrectly submitted dates of birth;

6) All changes to incorrectly submitted Employer Identifier Numbers (EINs);

7) All changes of EINs;

8) Password resetting changes due to changes to the Contact Person or Authorized Official.

When to Contact the NPI Enumerator for Assistance

Your health plans cannot assist you with NPI questions that should be directed to the NPI enumerator. However, the issues with which the NPI Enumerator can assist you are also limited to the following topics:

·         Status of an NPI application, update, or deactivation

·         Forgotten/lost NPI

·         Lost NPI notification  

·         Trouble accessing NPPES

·         Forgotten password/User ID

·         Need to request a paper application

Health care providers needing this type of assistance may contact the NPI Enumerator at 1-800-465-3203, TTY 1-800-692-2326, or email the request to the NPI Enumerator at CustomerService@NPIenumerator.com .

The NPI application is also a good source of information.  Please refer to the NPI application instructions for clarification on information to be submitted in order to obtain an NPI or update your record.  You can also refer to the 'Application Help' tab located on the NPPES website for additional assistance while you are online.

Resources for other kinds of questions can be found at the end of this document.

Please Note:  The NPI Enumerator’s operation is closed on federal holidays

Important Information for Medicare Providers

Medicare Announces a New “Key” NPI Date

This is an important message for physicians, other practitioners, providers, and suppliers that bill Medicare carriers, A/B Medicare Administrative Contractors (MACs), and DME MACs Using an Electronic Claim Form (ASC X12 837P) or Paper Claim Form (CMS-1500)

The Centers for Medicare & Medicaid Services (CMS) is pleased to report that the vast majority of Medicare claims are being sent to Medicare with a National Provider Identifier (NPI).  Moreover, the Medicare NPI crosswalk is successfully crosswalking NPIs to legacy numbers for most claims.  Given these favorable results, we are taking the next step towards full implementation of the NPI in Medicare. 

Effective March 1, 2008, your Medicare fee-for-service claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields).  You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim.  You may not submit claims containing only a legacy identifier in the primary fields. Failure to submit an NPI in the primary fields will result in your claim being rejected or returned as unprocessable beginning March 1, 2008.  Until further notice, you may continue to include legacy identifiers only for the secondary fields. 

Medicare Informational Warnings to Those Who Are Not Submitting NPIs On Claims

Since October 15, 2007, Medicare physicians, non-physician practitioners and other providers and suppliers who bill carriers and Medicare Administrative Contractors (MACs) using the ASC X12 837P or CMS-1500 receive informational warnings that indicate there was no NPI shown in the primary provider fields on your claim(s). Medicare is including these informational warnings on your pre-pass reject reports provided to you directly or to your bulletin board. 

Many Medicare physicians, non-physician practitioners, and other providers and suppliers are not using NPIs in their Medicare claims, even in the primary provider fields (Billing/pay-to and Rendering).  While, until March 1, you may continue to submit legacy identifiers in these fields, we strongly encourage you to begin using your NPI as well.   You may use the NPI/PIN pair or the NPI-only to identify the Billing/pay-to and Rendering Providers.  

Medicare informational warnings, called “Provider Identification Code Qualifier Invalid Value” messages, will be labeled M389, M390, M391, and/or M392, but, again, these are only reminders.  If you receive one of these messages and you are certain that your claim was submitted with an NPI, you may wish to contact your clearinghouse or billing agent to ascertain the reason behind the message.  It is possible that the clearinghouse or billing agent removed the NPI prior to submitting the claim to Medicare. You may also want to call your carrier/MAC to ask about the message and how you can correct future claims.

 

The informational warnings consist of one or more of the following messages: 

M389    2010AA  NM108   Billing Provider Identification Code Qualifier  Invalid value.  

The edit sets when the 2010AA loop and NM1 are submitted but NM108 does not contain XX. If the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA claim), the edit does not set.

M390    2010AB  NM108   Pay To Provider Identification Code Qualifier  Invalid value.  

The edit sets when the 2010AB loop and NM1 are submitted but NM108 does not contain XX. If the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA claim), the edit does not set.

M391    2310B   NM108   Claim Level Rendering Provider Identification Code Qualifier Invalid value.  

The edit sets when the 2310B loop and NM1 are submitted but NM108 does not contain XX. If the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA claim), the edit does not set.

M392    2420A   NM108   Detail Level Rendering Provider Identification Code Qualifier Invalid value.  

The edit sets when the 2420A loop and NM1 are submitted but NM108 does not contain XX. If the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA claim), the edit does not set.

Testing Claims With Only the NPI

If you already bill using the NPI/legacy pair in the primary fields and your claims are processing correctly, now is a good time to submit to your contractor a small number of claims containing only the NPI.  This test will serve to assure your claims will successfully process when only the NPI alone is mandated on all claims.  If the results are positive, begin increasing the number of claims in the batch.  If your claims reject, first go into the NPPES website located at https://nppes.cms.hhs.gov/ and validate that your information is correct and that you reported your Medicare legacy identifier(s) in the Other Provider Identification Numbers section.  Your Medicare legacy identifier(s) would be the number(s) that you used—prior to using the NPI—as the Billing/Pay-to and Rendering Providers.  If the NPPES information is correct and you reported your Medicare legacy identifier(s), call your contractor and ask that they validate what is in their system. 

Need More Information?

Not sure what an NPI is and how you can get it, share it and use it?  As always, more information and education on the NPI can be found through the CMS NPI page at www.cms.hhs.gov/NationalProvIdentStand on the CMS website.  Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.  Having trouble viewing any of the URLs in this message?  If so, try to cut and paste any URL in this message into your web browser to view the intended information. 

Note: All current and past CMS NPI communications are available by clicking “CMS Communications” in the left column of the www.cms.hhs.gov/NationalProvIdentStand website.

Getting an NPI is free - not having one can be costly.

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Posted Nov 9, 2007

MEDICARE FINAL RULE ANNOUNCES 2008 PHYSICIAN FEES AND REFORMS FOR ACCURATE PAYMENTS AND QUALITY

The Centers for Medicare & Medicaid Services (CMS) today issued a final physician payment rule designed to improve accuracy of Medicare payments and give physicians and health care professionals additional financial incentives to provide higher quality and value in the delivery of care.

Under the new rule, Medicare estimates that it will pay approximately $58.9 billion to about 900,000 physicians and other health care professionals. The revised payments, quality incentive rates and related policy changes, which will become effective January 1, 2008, are included in the Medicare Physician Fee Schedule (MPFS) final rule. The rule went on display today at the Federal Register.

The final rule, effective for services on or after January 1, 2008, will go on display today and will be published in the Federal Register on November 27, 2007.   The rule can be found at https://www.cms.hhs.gov/center/physician.asp .

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PLEASE NOTE.... posted Oct 24, 2007

Correction Notice for FY 2008 Inpatient Prospective Payment System (IPPS) Final Rule with Comment Period           posted OCT. 20, 2007

On September 28, 2007, CMS issued a correction notice (CMS-1533-CN2), which corrects technical errors that appeared in the FY 2008 IPPS final rule with comment period (CMS-1533-FC).  This correction notice was printed in the October 10, 2007 Federal Register.  This correction notice was developed prior to the enactment of the "TMA, Abstinence Education, and QI Programs Extension Act of 2007” on September 29, 2007, which, among other things, changed the IPPS MS-DRG documentation and coding adjustment from -1.2 percent to -0.6 percent for FY 2008. Consequently, the change to the documentation and coding adjustment for FY 2008 is not reflected in rates presented in the aforementioned correction notice.  CMS is in the process of implementing this change in the law and further information will be forthcoming.  Updated rates will be posted in the near future on the CMS website and our implementation of the "TMA, Abstinence Education, and QI Programs Extension Act of 2007” will be detailed in the Federal Register.

Claims Processing Information Under the IPPS and the Long Term Care Hospital (LTCH) PPS Related to the TMA, Abstinence Education, and QI Programs Extension Act of 2007

Medicare claims processing systems have incorporated the software updates to accommodate both the September 28, 2007 Correction Notice and the “TMA, Abstinence Education, and QI Programs Extension Act of 2007”, thus ensuring that claims with discharge dates of October 1, 2007 or later are processed with the correct rates. However, in order to provide sufficient time to fully test Medicare claims processing systems before claims under the IPPS are processed, those claims received by Medicare during the first few days of October may have a slight delay in payment by only a few days.  The extra couple of days will ensure accurate claims processing and obviate the need for reprocessing hospital claims.  Note, this legislation may affect short stay outlier (SSO) LTCH PPS claims because of the calculation of the “IPPS comparable amount,” but we do not foresee any delay in LTCH payments.

Below are links to the correction notice (CMS-1533-CN2) and the associated FY 2008 IPPS final rule with comment period (CMS-1533-FC):

Correction Notice (CMS-1533-CN2): http://www.cms.hhs.gov/AcuteInpatientPPS/IPPS/itemdetail.asp?itemID=CMS1203964

FY 2008 IPPS Final Rule with Comment Period (CMS-1533-FC): http://www.cms.hhs.gov/AcuteInpatientPPS/IPPS/itemdetail.asp?itemID=CMS1201726

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The Medicare Billing Information for Rural Providers, Suppliers, and Physicians informational resource, which consists of charts that provide billing information for Rural Health Clinics, Federally Qualified Health Centers, Skilled Nursing Facilities, Home Health Agencies, and Critical Access Hospitals, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network.  To place your order, visit www.cms.hhs.gov/mlngeninfo, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”

 Posted Oct. 20, 2007

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Flu Shot Reminder

Flu Season is upon us! Begin now to take advantage of each office visit as an opportunity to talk with your patients about the flu virus and their risks for complications associated with the flu. Encourage them to get their flu shot. It’s their best defense against combating the flu this season. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.) And don’t forget, health care professionals need to protect themselves also. Get Your Flu Shot. – Not the Flu. Remember - Influenza vaccination is a covered Part B benefit.  Note that influenza vaccine is NOT a Part D covered drug. For information about Medicare’s coverage of flu vaccine and its administration as well as related educational resources for health care professions, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website.

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Correction Notice for FY 2008 Inpatient Prospective Payment System (IPPS) Final Rule with Comment Period

 Posted Oct. 20, 2007

On September 28, 2007, CMS issued a correction notice (CMS-1533-CN2), which corrects technical errors that appeared in the FY 2008 IPPS final rule with comment period (CMS-1533-FC).  This correction notice was printed in the October 10, 2007 Federal Register.  This correction notice was developed prior to the enactment of the "TMA, Abstinence Education, and QI Programs Extension Act of 2007” on September 29, 2007, which, among other things, changed the IPPS MS-DRG documentation and coding adjustment from -1.2 percent to -0.6 percent for FY 2008. Consequently, the change to the documentation and coding adjustment for FY 2008 is not reflected in rates presented in the aforementioned correction notice.  CMS is in the process of implementing this change in the law and further information will be forthcoming.  Updated rates will be posted in the near future on the CMS website and our implementation of the "TMA, Abstinence Education, and QI Programs Extension Act of 2007” will be detailed in the Federal Register.

Claims Processing Information Under the IPPS and the Long Term Care Hospital (LTCH) PPS Related to the TMA, Abstinence Education, and QI Programs Extension Act of 2007

 Medicare claims processing systems have incorporated the software updates to accommodate both the September 28, 2007 Correction Notice and the “TMA, Abstinence Education, and QI Programs Extension Act of 2007”, thus ensuring that claims with discharge dates of October 1, 2007 or later are processed with the correct rates. However, in order to provide sufficient time to fully test Medicare claims processing systems before claims under the IPPS are processed, those claims received by Medicare during the first few days of October may have a slight delay in payment by only a few days.  The extra couple of days will ensure accurate claims processing and obviate the need for reprocessing hospital claims.  Note, this legislation may affect short stay outlier (SSO) LTCH PPS claims because of the calculation of the “IPPS comparable amount,” but we do not foresee any delay in LTCH payments.

Below are links to the correction notice (CMS-1533-CN2) and the associated FY 2008 IPPS final rule with comment period (CMS-1533-FC):

Correction Notice (CMS-1533-CN2): http://www.cms.hhs.gov/AcuteInpatientPPS/IPPS/itemdetail.asp?itemID=CMS1203964

FY 2008 IPPS Final Rule with Comment Period (CMS-1533-FC): http://www.cms.hhs.gov/AcuteInpatientPPS/IPPS/itemdetail.asp?itemID=CMS1201726

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Flu Shot Reminder

Flu Season is upon us! Begin now to take advantage of each office visit as an opportunity to talk with your patients about the flu virus and their risks for complications associated with the flu. Encourage them to get their flu shot. It’s their best defense against combating the flu this season. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.) And don’t forget, health care professionals need to protect themselves also. Get Your Flu Shot. – Not the Flu. Remember - Influenza vaccination is a covered Part B benefit.  Note that influenza vaccine is NOT a Part D covered drug. For information about Medicare’s coverage of flu vaccine and its administration as well as related educational resources for health care professions, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website.

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CMS Requests Public Comment on DRAFT Interpretive Guidelines for ESRD:

posted Oct. 20, 2007

The proposed End Stage Renal Disease (ESRD) Conditions for Coverage were published in the Federal Register on February 4, 2005.  Final rules have been drafted and are in the approval process.  The final rule must be published by February 4, 2008.  These new rules will require changes in the survey process, including the interpretive guidelines which help surveyors assure patient health and safety.

In preparation for implementation of the final rule, CMS has prepared DRAFT interpretive guidelines based on the proposed ESRD Conditions for Coverage.  CMS plans to revise these DRAFT interpretive guidelines after the final rule is published. 

In the meantime, CMS is giving the public an opportunity to comment on the DRAFT interpretive guidelines.  We wish to make clear, however, that this document is based on the proposed rule and will need to be revised to conform to any changes that might be made in the final rule.  We also wish to stress that while we welcome comments on these DRAFT interpretive guidelines, this opportunity to comment does not extend to comments that might be made on the proposed rule.  This is not an opportunity for further comment on the regulation language.  It is an opportunity for input for the surrogate “Draft Interpretive Guidelines” column.  CMS intends to consider suggestions offered as this document is adapted to the final rule once the final rule is published.

Instructions:

Download or print the DRAFT ESRD Interpretive Guidelines document at http://www.cms.hhs.gov/GuidanceforLawsAndRegulations/05_Dialysis.asp .  This document has three columns: 

• ID#:  Each row is labeled with a red “ID#” for ease of reference.
• Proposed Regulation:  The content in the “Proposed Regulation” column is from the proposed regulation published for comment February 4, 2005 and includes the language from the AAMI and CDC documents proposed to be adopted by reference.  The proposed regulatory language is included to remind commenters of wording in the proposed regulation. This is NOT an opportunity for further comments on the proposed regulations.  That comment period closed May 5, 2005.
• Draft Interpretive Guidelines:  This column includes draft interpretive guidelines based on the proposed regulations. 

To make comments on the Draft Interpretive Guidelines:

Download the DRAFT ESRD Interpretive Guidelines Comment Form at http://www.cms.hhs.gov/GuidanceforLawsAndRegulations/05_Dialysis.asp .  This form has two columns:

• In the first column labeled “ID#,” type the red ID number of the row about which you intend to provide comments.
• In the “Comment on Draft Interpretive Guidelines” column, you have the opportunity to comment on current draft recommendations.  Type any edits or suggestions to the “Draft Interpretive Guidelines” text in this row.  Type as much as you wish; the size of the space will expand to fit the text.  If you have comments on more sections than the number of rows provided, tab until a new row appears.

Mail or email your comment no later than 5 p.m. ET on October 22, 2007 to:

Center for Medicare & Medicaid Services

Survey and Certification Group - IG Comments

Attention: Debbie Davis

Mail Stop S2-12-25

7500 Security Blvd.

Baltimore, Maryland 21244-1850

Email: esrd@cms.hhs.gov

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FOR IMMEDIATE RELEASE                               

                                    July 2, 2007                                                                                     

 

CMS PROPOSES POLICY, PAYMENT CHANGES FOR

PHYSICIANS’ SERVICES IN 2008

 

            The Centers for Medicare & Medicaid Services (CMS) projects that it will pay approximately $58.9 billion to 900,000 physicians and other health care professionals in calendar year (CY) 2008, under a proposed rule released today that would revise payment rates and policies under the Medicare Physician Fee Schedule (MPFS).  This proposed rule is a further step in Medicare’s efforts to ensure that payment policies provide incentives to improve the quality of care.

    “This proposed rule builds on the changes the Centers for Medicare & Medicaid Services made last year to pay more appropriately for practice expenses and to transform Medicare into an active purchaser of higher quality services, rather than just paying for procedures” said acting CMS Administrator Leslie V. Norwalk, Esq.  “It also includes an important new initiative to encourage the use of electronic prescribing to improve the speed and accuracy of care furnished to beneficiaries, as well as proposals for additional quality measures for use in the Physician Quality Reporting Initiative in 2008.”

Comments will be accepted on the proposed rule until August 31, 2007, and a final rule will be published later in the fall.  The final rule will be effective for services on or after January 1, 2008.

The proposed rule (CMS-1385-P) can be viewed on the CMS Website at http://www.cms.hhs.gov/apps/ama/license.asp?file=/physicianfeesched/downloads/CMS-1385-P.pdf .

 The Press Release can  be obtained on the CMS Website at http://www.cms.hhs.gov/apps/media/press_releases.asp , and the Fact Sheet is posted at: http://www.cms.hhs.gov/apps/media/fact_sheets.asp .