The final regulation for the Revisit User Fee was published in the Federal Register on September 19, 2007 and becomes effective on that date.  It is important to note that because the law for the revisit user fee was created in a Continuing Resolution (a mechanism used by Congress to temporarily fund government programs when they are unable to pass permanent appropriations bills), and therefore the Continuing Resolution and the revisit user fee both expire at the end of the fiscal year – September 30, 2007.  In order for the user fee to continue beyond September 30, Congressional action is necessary.  AHCA continues to work in opposition to this revisit user fee and its implementation in fiscal year 2008 and we will keep members advised of this activity. 

The final regulation is very similar to what was originally proposed.  AHCA submitted comments on the proposed regulation, with significant input from members.  Unfortunately, the final regulation contains very few changes to the proposed regulation. 

The regulation applies to health care facilities that have been cited for deficiencies during initial certification, recertification, or substantiated complaint surveys and require a revisit to confirm that corrections to previously identified deficiencies have been corrected.

The preamble reflects that there were numerous comments expressing concern that these fees will divert funds needed and more appropriately used for patient care.  The Centers for Medicare & Medicaid Services (CMS) response to these concerns is “…the prospect of fees for revisits will result in greater compliance with quality of care requirements.”  Additionally, they state “The cost of a revisit fee can be compared favorably to the larger cost to beneficiaries from poor quality of care, or to the larger financial cost to providers from serious non-compliance with federal requirements.” 

The fees will be a set amount of $168 for off-site revisits (sometimes referred to as desk reviews) and $2,072 for on-site revisits.  Fees will be deducted from amounts otherwise payable to the provider or supplier.  The regulation also allows for CMS to devise other collection methods it deems appropriate.  The preamble states that for the immediate future, CMS will utilize a bill pay system.  Providers or suppliers who are assessed a fee will receive a notice in the mail which will include the amount of the assessed revisit fee and the revisit survey for which the fee is assessed.  The facility must remit the payment within 30 calendar days of the date of the notice.

There is a reconsideration process for revisit user fees that applies only when the provider believes an error of fact has been made – such as clerical errors, billing for a fee already paid, or assessment of a fee when there was no revisit conducted.  A request for reconsideration must be received within 14 calendar days from the date identified on the revisit user fee assessment notice.

If after reading the regulation, you have additional questions, please contact Lyn Bentley at lbentley@ahca.org.