CHA collaborates on policies and strategies for health care issues with the American Hospital Association and other national health care organizations. The association maintains a full-time presence in Washington, D.C., to effectively advocate on legislative and regulatory policy. CHA provides input on developing federal legislation and regulatory proposals, and helps shape national positions on important health care issues. Federal advocacy activities include the annual California Congressional Action Program held in Washington, D.C.
CHA has submitted the attached comments to the Centers for Medicare & Medicaid Services (CMS) and the California Department of Health Care Services (DHCS) regarding the revised enrollment strategy for Los Angeles County dual eligible beneficiaries into Cal MediConnect beginning in April 2014. CHA continues to raise concerns regarding access and network adequacy that, if not addressed, may undermine the success of the demonstration. Among CHA’s concerns under the revised enrollment strategy is that it relies exclusively on the Health Net network for passive enrollment for a five-month period.
The Medicare Payment Advisory Commission (MedPAC) has released draft recommendations on Medicare fee-for-service payment and policy changes for Congress to consider for calendar and federal fiscal year (FFY) 2015. MedPAC will meet in January to vote on its recommendations and will be watched closely by Congress as it looks for payment mechanisms for a long-term repeal of the Medicare sustainable growth rate for physician payments. For the second consecutive year, MedPAC has refused to consider the implications of sequester.
The House and Senate Budget Conference Committee announced on Tuesday an agreement to set new federal spending funding levels over the next two years. The Bipartisan Budget Act of 2013 would revise, and raise, limits on discretionary spending for fiscal years 2014 and 2015.
The House Ways and Means Committee today released legislative language to repeal and replace the sustainable growth rate (SGR), the formula for Medicare payments to physicians. The current formula has recommended drastic payment reductions that have required legislative action each year to block the cuts. This year, Congress has made a concerted effort to recast the SGR with quality and other measures that should preclude the annual draconian cuts. A date has not been set for consideration of the legislation, attached along with a summary, but the committee is expected to meet before Congress adjourns on Dec. 13. The Senate Finance Committee, scheduled to consider its plan on Dec. 12, has also released its chairman’s mark (attached).
The Centers for Medicare & Medicaid Services (CMS) has released the attached guidance regarding the new inpatient admissions and medical review criteria identifying a potential exception to the two-midnight rule. Responding to stakeholder suggestions, CMS states that, in the rare case a physician expects patients with newly initiated mechanical ventilation will only require one “midnight” of hospital care, inpatient admission and Part A payment are appropriate. CMS notes the exception is not intended to apply to anticipated intubations related to minor surgical procedures or other treatment. CHA continues to seek input from the membership to share with CMS any additional categories of patients that should be added to the exceptions list. CMS urges suggestions to be emailed to IPPSAdmissions@cms.hhs.gov with “Suggested Exceptions to the 2 Midnight Benchmark” as the subject line.
Last week the National Uniform Billing Committee redefined a code in its billing data set to allow hospitals to denote inpatient claims meeting the CMS two-midnight benchmark through a combination of outpatient and inpatient services. Effective Dec. 1, hospitals can use Occurrence Code 72 on inpatient bills to denote the date span of contiguous outpatient hospital services that preceded the inpatient admission.
In a recent blog post, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) proposed a new timeline for the implementation of meaningful use for the Medicare and Medicaid electronic health record (EHR) incentive programs. The new timeline would extend stage 2 through 2016 and delay stage 3 until 2017 for providers who have completed at least two years of stage 2.
The delay is intended to give CMS more time to analyze feedback on stage 2 progress and outcomes to better inform stage 3 rulemaking. However, the announcement does not change certification requirements for 2014, and providers are still required to upgrade or adopt technology that meets the 2014 EHR certification standards, regardless of which stage of meaningful use they are in. CMS expects to release proposed rulemaking for stage 3 and corresponding ONC rulemaking for the 2017 edition of the ONC standards and certification criteria in the fall of 2014.
CHA encourages members to participate in the next open door forum being held by the Centers for Medicare & Medicaid Services (CMS) regarding the new inpatient admission and medical review criteria, commonly referred to as the two-midnight rule. The call is scheduled for Thursday, Dec. 19 from 10 a.m. – 11 a.m. (PT) and will give providers another opportunity to ask CMS questions and provide feedback on the finalized policy. To participate, call (866) 501-5502 and enter conference ID # 16505942. For additional information and resources regarding the policy, visit www.calhospital.org/resource/inpatient-admission-and-medical-review-resources.
The Department of Health and Human Services (HHS) published the attached notice in the Federal Register on Nov. 19, proposing a quality rating system (QRS) for qualified health plans (QHPs) offered through health insurance exchanges. The Affordable Care Act requires HHS to create a system enabling consumers to compare QHPs based on relative quality, price and enrollee satisfaction. The notice outlines a proposed methodology for selecting QRS measures, organizing such measures into broad categories meaningful to consumers (e.g., care coordination, preventive services, patient safety, etc.), and calculating statistically valid global ratings for each QHP (as is now done under the Medicare Advantage 5-star rating system).
CHA President/CEO C. Duane Dauner was joined by 10 representatives of CHA member hospitals in Washington, D.C., Dec. 3 for the CHA and American Hospital Association hospital advocacy day. The group met with about half of the California Congressional delegation, including House Minority Leader Nancy Pelosi, House Majority Whip Kevin McCarthy, and Sens. Boxer and Feinstein.
The Centers for Medicare & Medicaid Services (CMS) has released the attached list of measures under consideration for adoption in future Medicare rulemaking, as required by the Affordable Care Act (ACA). The Measures Application Partnership (MAP), convened by the National Quality Forum (NQF), will review the list and provide recommendations to CMS through a process that allows multiple stakeholders the opportunity to weigh in on measure selection before rules are finalized. For the first time in three years, the MAP will allow the public to comment prior to the beginning of its workgroups and coordinating committee meetings. The early public comment period ends on Dec. 9. In addition, as in previous years the public will have an opportunity to comment on the MAP’s recommendations to CMS, to be issued in January.
Under current law, physicians and non-physician practitioners (NPP) will see across-the-board reductions in payment rates based on a formula – the sustainable growth rate (SGR) methodology – that was adopted in the Balanced Budget Act of 1997. Without Congressional action, required by the end of the year, physicians will see payments cut in excess of 20 percent for services in 2014.
The Centers for Medicare & Medicaid Services (CMS) has finalized its CY 2014 conversion factor at $27.2006, reflecting a smaller reduction in the conversion factor than the 24.4 percent cut CMS projected in March.
CHA reminds hospitals participating in the Medicare electronic health record (EHR) incentive program to attest to demonstrating meaningful use by 8:59 p.m. (PT) on Saturday, Nov. 30, in order to receive a 2013 incentive payment. CHA urges hospitals not to wait until the last minute to attest. The Centers for Medicare & Medicaid Services (CMS) website is often flooded with requests at this time each year, causing delays.
Hospitals must attest to demonstrating meaningful use every year to receive an incentive and avoid payment adjustments that are scheduled to begin Oct. 1, 2014. Hospitals that begin participation in the EHR incentive programs in 2014 or later will receive a reduced EHR incentive payment. For federal fiscal year (FFY) 2014, the reporting period will be three months, regardless of the stage of meaningful use, to allow hospitals more time to upgrade to 2014-certified EHR technology. Further, in order to avoid the FFY 2015 payment penalty, hospitals must attest no later than July 1, 2014, which means they must begin their 90-day EHR reporting period no later than April 1, 2014. CHA continues to work with AHA to extend the period of time in which hospitals can remain at each stage to three years, instead of two. For more information regarding the program, visit the CMS EHR incentive program web page.
Home health (HH) agencies paid under Medicare’s prospective payment system (PPS) will see a 1.05 percent decrease in payments in calendar year (CY) 2014 as compared to CY 2013 under a final rule released by the Centers for Medicare & Medicaid Service (CMS). The decrease reflects the combined effects of an increase in the home health market basket update percentage of 2.3 percent, offset by a rebasing adjustment of negative 2.7 percent as required by the Affordable Care Act (ACA), and a .62 percent decrease due to a refinement of the HH PPS Grouper. The ACA requires CMS to begin phasing in rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates and the non-routine supply conversion factor to reflect changes since the inception of the HH PPS. For hospital-based facilities, CMS estimates the reduction will be smaller, negative .58 percent, for CY 2014.
Hospital-based dialysis facilities paid under the end-stage renal disease (ESRD) prospective payment system (PPS) will see an estimated 0.8 percent increase in payments for calendar year (CY) 2014 compared to CY 2013, according to a final rule issued by the Centers for Medicare & Medicaid Services (CMS). CMS estimates that independent ESRD facilities will see no increase in payments in CY 2014 as compared to CY 2013. The update reflects the effect of a 3.2 percent ESRD bundled market basket update; the Affordable Care Act-required productivity adjustment of 0.4 percent; the American Taxpayer Relief Act (ATRA)-required drug utilization adjustment of negative 3.3 percent; a 0.4 percent overall estimated increase in outlier payment from the updates to the fixed-dollar loss threshold and Medicare Allowable Payment amounts; and a 0.2 percent overall estimated increase in payments from the change in the blend of payments.
California Senators Barbara Boxer and Dianne Feinstein sent a letter last week to the Senate Finance Committee urging the committee to adopt a long-term approach to updating Medicare’s Metropolitan Statistical Areas to better reflect current geographic and demographic cost differences. Medicare has not updated its payment regions in more than 16 years, and during that time many areas in California and across the nation that were once rural have become high-cost urban regions. The Senators’ letter urges the Senate Finance Committee to take up a solution included in the House physician payment reform bill, H.R. 2810 (Burgess, R-TX), and identifies a California funding source in Medicaid administrative savings. CHA sent a letter in May to the House Energy and Commerce Committee supporting this fix. The Senators’ letter is attached.
The Centers for Medicare & Medicaid Services (CMS) will hold its third special open door forum (ODF) regarding the new inpatient admission and medical review criteria commonly referred to as the two-midnight rule Tuesday, Nov. 12 from 10 a.m. – 11 a.m. (PT). This call will give hospitals an important opportunity to ask CMS questions about the finalized policy and recently released subregulatory guidance from Nov. 5. To participate, call (866) 501-5502 and enter Conference ID # 98515298.
CHA urges Critical Access Hospitals to also participate in CMS’ special ODF on Wednesday, Nov. 13 from 11 a.m. – noon (PT). Special attention will be paid to clarifying the condition of payment related to the 96-hour rule as well as the related condition of participation. To participate, call (800) 837-1935 and use conference ID # 70964241.
The U.S. Department of Health and Human Services (HHS) has released the attached final rule implementing mental health parity as required by the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA requires large group health plans and health insurance issuers to ensure that financial requirements (e.g., co-pays, deductibles) and treatment limitations (e.g., visit limits) applicable to mental health or substance use disorder benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.
The final rule applies to group health plans and health insurance issuers for plan years (or, in the individual market, policy years) beginning on or after July 1, 2014. Until the final rules become applicable, plans and issuers must continue to comply with the mental health parity provisions of the interim final regulations released in 2010. CHA is analyzing the final rule and will provide members with a summary in the coming weeks. A fact sheet regarding the policy is available on the Center for Medicare & Medicaid Services website.
The Centers for Medicare & Medicaid Services (CMS) has posted the attached transcript from its Sept. 26 special open door forum (ODF) regarding the new inpatient admission and medical review criteria commonly referred to as the two-midnight rule. On the call, CMS read frequently asked questions and attempted to clarify a number of questions unaddressed in recent guidance, including the 96-hour rule for critical access hospitals (CAH). CMS has announced a rural health ODF for Wednesday, Nov. 13 from 11 a.m. – noon (PT) that will further clarify guidance on the CAH 96-hour rule. The ODF agenda also includes discussion on rural health clinic contracting policies proposed in the federally qualified health center prospective payment system proposed rule. To participate, dial (800) 837-1935 and reference conference ID 70964241.
The Centers for Medicare & Medicaid Services (CMS) has released additional guidance regarding the two-midnight inpatient hospital medical review and admission criteria. CMS indicates that it will not conduct post-payment patient status reviews for claims with dates of admission Oct. 1, 2013, through March 31, 2014, three months longer than previously announced. In addition, CMS posted the attached documents setting forth more details on the “probe and educate” audits that will be conducted by Medicare Administrative Contractors. However, the guidance leaves a number of questions unaddressed, and certain areas appear to be inconsistent with guidance previously issued by the agency. For example, the new guidance states that critical access hospitals (CAHs) will be included in the probe audits, although previous guidance specifically excluded CAHs from the audits. CHA will continue to seek clarity from both CMS and Noridian and will provide members with additional information as it becomes available. For additional resources on the policy, visit www.calhospital.org/resource/inpatient-admission-and-medical-review-resources.
The Government Accountability Office released a report yesterday analyzing the progress of the Medicare electronic health records (EHR) incentive programs for payments made in 2011 and 2012. The report found that 48 percent of eligible hospitals received payment in 2012, up from 16 percent in 2011. The report also notes that inpatient prospective payment system hospitals were nearly twice as likely as critical access hospitals to receive a 2012 payment, and that hospitals in urban areas were 1.2 times more likely to have been awarded a payment compared to hospitals in rural areas. The full report is available at www.gao.gov/products/GAO-14-21R.