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 comment letter on the Centers for Medicare & Medicaid Services proposed rule that would establish new criteria for identifying protected classes of drugs, make revisions to promote competition in Part D plans, and provide changes to the regulatory definition of negotiated prices. CHA analyzed the changes and determined the proposal, if fully implemented, would reduce the number of protected classes by half. Neither the antidepressant nor the antipsychotic drug classes would meet the proposed criteria for special formulary protection, and CHA expressed concerns that the proposal would exacerbate compliance issues and place additional burden on the already overcrowded emergency rooms and inadequate behavioral health system in California.
The California Department of Public Health (CDPH) has released the attached All Facilities Letter on proposed fiscal year (FY) 2014-15 health care facility licensing fees. These fees and nursing home administrator program fees are set to go into effect July 1, when the FY 2014-15 state budget is enacted. For the proposed fee schedule, see the annual fee report on the CDPH Licensing and Certification Program website.
Rural hospital leaders from California joined their colleagues from around the nation today in Washington, D.C., to meet with congressional representatives, urging them to support policies important to rural hospitals — including those related to the two-midnight policy, recovery audit contractors, the 96-hour rule for critical access hospitals and the direct supervision policy for outpatient therapies. Since rural hospitals and the patients they serve would be especially vulnerable to any further cuts, the group urged lawmakers not to cut hospital payments in order to fund a repeal of the sustainable growth rate.
The President has released his federal fiscal year 2015 budget for the federal government. The $3.9 trillion budget is viewed largely as a political document because Congress and the administration agreed to spending limits as part of December’s Bipartisan Budget Act. Nonetheless, it does offer a list of potential savings that Congress may turn to as it looks for funds to offset additional spending for policy priorities, such as fixing or repealing the sustainable growth rate formula for Medicare physician payments.
Of significant concern to hospitals are cuts in Medicare payments to providers totaling $354 billion dollars over the next 10 years. The plan also cuts Medicaid spending by $7.3 billion. Many of the proposed cuts have been suggested before and/or recommended by MedPAC. Fortunately, few other areas have additional spending proposed. Of note, the proposed budget also eliminates sequestration by finding other savings. A brief summary, including the 10-year nationwide savings (in red) or spending figure, follows. CHA is working with AHA and others to analyze the budget request and will share additional information soon.
Bad Debt – reduce Medicare coverage of bad debts from 65 percent to 25 percent over three years; $30.8 billion
Graduate Medical Education – $14 billion
New Health Care Provider Training – 13,000 new residents, including support for pediatric specialties in children’s hospitals; $5.23 billion
Children’s Graduate Medical Education – eliminates the program; $265 million
Critical Access Hospitals – reduce payments from 101 percent of reasonable costs to 100 percent; $1.7 billion
Critical Access Hospitals – limit the CAH designation to those facilities more than 10 miles apart; $720 million
Hospital Preparedness Program – unlike previous years, no cuts proposed
Mental Health Programs – train 5,000 new professionals; $164 million
Value-Based Purchasing – implement payment reforms for home health agencies, ambulatory surgical centers and hospital outpatient departments; budget neutral
Post-Acute Care – reduce payment updates; $97.8 billion
Inpatient Rehabilitation Facilities/Skilled Nursing Facilities – implement site-neutral payment for certain conditions; $1.6 billion
Inpatient Rehabilitation Facilities – re-establish the 75 percent compliance threshold for patient conditions; $2.4 billion
Skilled Nursing Facilities – implement payment reduction for readmissions beginning in 2018; $1.9 billion
Home Health – implement beneficiary co-payments; $0.8 billion
Bundled Payment – implement bundled payment for post-acute care beginning in 2019; $8.6 billion
PACE – create pilot to expand age eligibility; budget neutral
Dually Eligible – establish integrated appeals process for Medicare-Medicaid enrollees; budget neutral.
Clinical Laboratory Services – cut payments by 1.75 percent each year from 2016 – 2023; $7.9 billion
Medicaid Disproportionate Share – extend current payment reductions into 2024; $3.26 billion
Medicaid Primary Care – extend enhanced payments for one year; $5.4 billion
Qualified Entity (QE) – expand current activities to allow for use of data for fraud prevention activities and value-added analysis for physicians, and release of raw claims to providers for care coordination and practice pattern improvement; and allow CMS to charge the QE for the cost of providing the data; budget neutral
CHA members visited Washington, D.C., today to meet with their congressional representatives and staff from both California senators’ offices regarding the consequences of Medicare disproportionate share hospital cuts. CHA members also expressed opposition to any further cuts to hospitals as part of a deal to repeal the sustainable growth rate. CHA urges members to continue contacting their representatives in opposition to any further cuts to hospital payments.
The Centers for Medicare & Medicaid Services (CMS) has posted the attached notice announcing preliminary federal disproportionate share hospital (DSH) allotments for fiscal year (FY) 2014. The notice also announces the preliminary federal share FY 2014 limits on aggregate DSH payments that states may make to institutions for mental diseases (IMDs) and other mental health facilities. CMS estimates California’s DSH allotment at $1.169 billion and the state’s IMD DSH limit at $777,960. The DSH allotment notice was delayed by legislation that repealed Medicaid DSH cuts under the Affordable Care Act for FYs 2014 and 2015. Since the final rule implementing the cuts applied only to 2014 and 2015 and the legislation pushes both the 2014 and 2015 cuts into 2016, the final rule is effectively moot. CHA believes CMS must go through a new round of rulemaking, as it had planned for implementing the 2016 cuts, and that may not occur until 2015. CHA continues to monitor the situation closely and will keep the members informed.
On Feb. 24, the Centers for Medicare & Medicaid Services (CMS) posted a number of updated documents providing additional guidance regarding its two-midnight policy and related Probe & Educate audits. The updates, attached, include frequently asked questions about patient status review and guidance related to the review and selection of hospital claims for patient status reviews.
The Centers for Medicare & Medicaid Services (CMS) has posted two public use files containing data that will be used to develop a proposed hospital wage index for fiscal year 2015. The files include wage and occupational mix data for all hospitals in the CMS database through Feb. 19, and a preliminary comparison of average hourly wages by area for fiscal years 2014 and 2015. Medicare Administrative Contractors (MACs) will accept data correction requests through March 3 for errors related to CMS or MAC handling of the wage index data, or MAC handling of the desk review adjustments. Correction requests must include the appropriate documentation. CMS will publish its proposed FY 2015 hospital wage index in the Federal Register this spring. To view the CMS public use files, click here.
The Centers for Medicare & Medicaid Services (CMS) has announced a pause in operations for the Recovery Audit Contractor (RAC) program until the end of the current procurement process for the next round of RAC contracts. RACs may not send a post-payment additional document request (ADR) after Feb. 21. CMS has also announced a number of improvements to the RAC program in response to industry feedback. The changes, attached, include revised ADR limits that will be diversified across claim types; ADR limits adjusted in accordance with a provider’s denial rate; and contingency fees not paid to RACs until the second level of appeal has been exhausted. In addition, providers will no longer have to choose between initiating a discussion and an appeal, and RACs must confirm receipt of a discussion request within three days. CHA is pleased with the direction of CMS’ changes but urges that more be done to relieve the burden on hospitals. CHA continues to support the Medicare Audit Improvement Act of 2013 (H.R. 1250/S.1012) in the House and Senate.
A bill that extends sequestration for mandatory spending – including Medicare spending – through 2024 passed the U.S. House of Representatives late yesterday and the U.S. Senate today. The House passed the bill by a vote of 326-90, while the Senate voted 95-3. The California delegation voted as follows: Reps. Bera, Capps, Chu, Cook, Costa, Denham, Ehsoo, Farr, Garamendi, Hunter, Issa, LaMalfa, Lofgren, Lowenthal, McCarthy, McClintock, McKeon, Gary Miller, Nunes, Peters, Rohrabacher, Royce, Schiff, Sherman, Swalwell, Takano, Valadao, and Vargas voted yes; Reps. Bass, Becerra, Davis, Hahn, Honda, Lee, Matsui, McNerney, George Miller, Napolitano, Negrete-McLeod, Pelosi, Roybal-Allard, Linda Sanchez, Speier, Thompson, Waters, and Waxman voted no. Rep. Loretta Sanchez voted present, and Reps. Campbell and Cardenas did not vote. Both Sens. Boxer and Feinstein voted yes. The President has indicated he will sign the bill into law.
CHA extends its appreciation to members who responded to yesterday’s advocacy alert, urging hospital executives to contact their congressional representatives about this bill. CHA strongly opposes using Medicare reductions to pay for non-Medicare related spending. Medicare is intended to assure seniors access to necessary medical care, not as a piggy bank for other programs. It is poor policy to further extend Medicare sequester cuts that could undermine care for seniors.
On Feb. 6, the U.S. Department of Health and Human Services published a final rule that gives patients the right to obtain their lab test results directly from any lab subject to the Health Insurance Portability and Accountability Act of 1996 Privacy Rule (HIPAA), and to require the labs to send their test results to any designated person or organization. The rule, attached, also amends the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations to permit (but not require) CLIA-certified labs that are not subject to HIPAA to provide test results directly to patients. While patients can continue to get their lab test reports from their doctors, these changes give patients a new option to obtain their test reports directly from the lab. The rule is intended to provide patients greater access to their health information, empowering them to take a more active role in managing their health and health care. The final rule is effective April 7, but HIPAA covered entities must comply with the applicable requirements by Oct. 6.
The Centers for Medicare & Medicaid Services (CMS) announced today it will extend the deadline for eligible professionals to attest to meaningful use for the Medicare EHR Incentive Program 2013 reporting year from 8:59 p.m. (PT) on Feb. 28 to 8:59 p.m. (PT) March 31. In addition, CMS is offering assistance to eligible hospitals that may have experienced difficulty attesting by allowing them to submit their attestation retroactively and avoid the 2015 payment adjustment. Eligible hospitals should contact CMS at EH2013Extension@Provider-Resources.com for assistance submitting attestation retroactively. Hospitals must contact CMS by 8:59 p.m. (PT) on March 15 to participate for the 2013 program year. Hospitals should type “EH 2013 Extension” in the subject line of their email to CMS and include the following information: CCN, hospital name, contact name, contact email, and contact phone number. Each hospital must be identified in a separate email.
The Centers for Medicare & Medicaid Services (CMS) has announced it has delayed the deadlines for reporting certain quality data for the inpatient and outpatient quality reporting programs from Feb. 1 to Feb. 8 due to recent extreme weather in parts of the U.S. Extensions apply to all hospitals and include, for the inpatient quality reporting (IQR) program, the population and sampling data for chart-abstracted quality measures for the third quarter (discharges from July 1 through Sept. 30, 2013). For the outpatient quality reporting (OQR) program, the data for chart-abstracted measures, as well as population and sampling data for the third quarter (encounters between July 1 and Sept. 30, 2013), is also now due Feb. 8.
The deadlines for other IQR and OQR measure data remain unchanged. Hospitals should contact their quality improvement organization with questions about the new deadlines. Other questions about the IQR and OQR programs can be directed to the QualityNet help desk at (866) 288-8912.
The Centers for Medicare & Medicaid Services (CMS) has decided to extend the inpatient hospital prepayment “probe and educate” review process for an additional six months, through Sept. 30. Medicare Administrative Contractors (MACs) will continue to select claims for review with dates of admission between March 31, 2014, and Sept. 30, 2014, and will continue to review and deny claims found not in compliance with the two-midnight rule.
The Centers for Medicare & Medicaid Services (CMS) has released a recording and written transcript of its Jan. 14 national provider call regarding the two-midnight benchmark for inpatient hospital admissions. The call provided a summary of the policy, including unforeseen circumstances and exceptions for cases that may be appropriate for inpatient admission despite a stay of less than two midnights. CMS also offered a number of case scenarios intended to demonstrate the policy for educational purposes. The recording, written transcript and presentation slides are available on the CMS website.
The Medicare Payment Advisory Commission (MedPAC) yesterday approved final recommendations for Medicare payment updates for 2015. The recommendations will be closely watched by Congress as it looks for savings to fund a long-term repeal of the Medicare sustainable growth rate for physician payments. A complete list of specific MedPAC recommendations follows.
The Measure Application Partnership (MAP) has released its draft pre-rulemaking recommendations on performance measures under consideration for federal quality reporting and payment programs. MAP reviewed 234 measures submitted by the U.S. Department of Health and Human Services (HHS) for 20 federal programs that reimburse providers, including clinicians, hospitals and post-acute care facilities. The attached draft report includes tables that summarize MAP’s recommendations for each federal program. CHA participated in the MAP process and will prepare formal written comments reflecting member discussions held in December and submit the comments by Jan. 27. The comment period is open to the public, but comments can only be submitted by registered users of the National Quality Forum’s (NQF) website. As required by the Affordable Care Act, MAP must release its final report to HHS by Feb. 1.
CHA and the California Hospital Patient Safety Organization (CHPSO) have sent a joint comment letter to the Centers for Medicare & Medicaid Services (CMS) regarding a proposed rule that would require certain patient safety and quality improvement activities in order to contract with a qualified health plan (QHP) through the new health insurance exchanges. In the letter, CHA and CHPSO generally agree with CMS’s proposal for implementing the requirements through a delayed two-phased approach. CHA/CHPSO support CMS’s understanding that additional time is needed for hospitals to implement robust patient safety evaluation systems. However, CHA/CHPSO disagree with the assertion that there is a lack of capacity for all hospitals subject to the provision to contract with a PSO at this time. The comment letter points out that CHPSO, in particular, and nationwide PSOs, in general, currently offer adequate capacity to meet the mandate.
The Centers for Medicare & Medicaid Services has released the attached proposed rule establishing emergency preparedness requirements for hospitals, critical access hospitals and 15 other suppliers and providers participating in the Medicare and Medicaid programs. The proposed rule would require participating providers and suppliers to meet four standards, including developing an emergency plan based on a risk assessment; developing and implementing policies and procedures based on the plan; developing and maintaining a communication plan; and a testing and training program based on the plans. The proposed rule would also require hospitals, critical access hospitals and long-term care facilities to implement emergency and standby power systems based on their emergency plan. CHA is currently reviewing the proposed rule and welcomes member input for comments being developed. Comments on the proposed rule are due Feb 25.
Last night, by a 64-36 vote, the U.S. Senate passed the Bipartisan Budget Act of 2013, sending it to the President for his signature and funding the federal government through fiscal year 2015. The budget deal includes a three-month patch to avert a 21 percent payment cut to physicians under the sustainable growth rate (SGR) formula. CHA prepared a summary of the legislation, containing both good and bad news for hospitals, last week. Both California senators voted yes.