According to the Office of the Actuary for the Centers for Medicare & Medicaid Services (CMS), Medicare reimbursement to California hospitals amounted to almost $58 billion in 2004, comprising more than one-third of all Medicare spending in the state for that year. In addition to the volume and monetary value of its reimbursement, CMS through the California Department of Health Services, and through its deeming organizations, remains an extremely important regulator of hospitals.
Because of the influence that Medicare and CMS have on California’s hospitals, CHA is consistently engaged with CMS and with Congress to ensure the adequacy of Medicare reimbursement, and to provide the federal government with California hospitals’ perspectives on policy and payment changes.
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 Department of Health Care Services (DHCS) has begun publishing a weekly newsletter featuring updates on the ongoing implementation of the Coordinated Care Initiative and Cal MediConnect. The email newsletter includes the latest information on provider outreach, as well as events and activities in each of the counties where the program is being implemented. In addition, DHCS has revamped the Cal MediConnect website to include designated sections for providers and beneficiaries, with related informational materials. To access the website and subscribe to the weekly newsletter, visit www.calduals.org.
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.
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) Medicare-Medicaid Coordination Office is facilitating a series of webinars for interested providers, health care professionals and others regarding the Disability-Competent Care (DCC) model. The DCC model is designed to enhance capacity to integrate care for adults with disabilities. Webinars will be tailored by audience and topic, for a total of eight webinars presented live on a weekly basis.
Initial topics will include the dignity of risk and strategies to stimulate and support participant engagement. The first webinar will take place Feb.4 from 11 a.m. – noon (PT). To register for the webinars, visit www.event.on24.com. Additional information and recordings of previous webinars are available at www.ResourcesForIntegratedCare.com.
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 California Department of Aging (CDA) has posted to its website several documents for beneficiaries regarding Cal MediConnect and the Coordinated Care Initiative (CCI), which will be implemented later this year in seven designated counties.
The new resources include beneficiary notification documents in several languages and a frequently asked questions document developed by the Health Insurance Counseling and Advocacy Program (HICAP). A “where to call” document also provides county-by-county contact information for beneficiary support and information, including HICAP, Health Care Options, and the Cal MediConnect Ombudsman. For more information, visit the site at www.aging.ca.gov/Resources/CalMediConnect.
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.
Noridian has announced that it will hold a public Part A Open Door Coverage meeting on Jan. 14 from 11 a.m. – 12:30 p.m. (PT) in San Francisco. The meeting will be conducted both in person — at the University of California, San Francisco Medical Sciences Building, Cole Hall, 513 Parnassus Avenue – and by conference call. Dr. Bernice Hecker, Noridian’s executive medical director, will discuss topics related to local coverage determinations, as well as inpatient medical necessity and review; critical care; research; and CERT errors and findings.
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.
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 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.
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.
The Centers for Medicare & Medicaid Services (CMS) has updated its frequently asked questions (FAQs) document regarding therapy services functional reporting. The document, attached, provides information about CMS coverage for physical therapy, occupational therapy, and speech/language pathology services.
The Centers for Medicare & Medicaid Services (CMS) has notified hospitals regarding possible delays in the release of final rules for calendar year (CY) 2014 Medicare fee-for-service payment regulations as a result of the federal government shutdown. The affected regulations were expected to be released by Nov.1. However, CMS now expects them to be released by Nov. 27 to be effective Jan. 1, 2014. Affected regulations include the CY 2014 outpatient prospective payment system (PPS), CY 2014 end-stage renal disease PPS, CY 2014 home health PPS and CY 2014 physician fee schedule.