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 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 finalized the 2018 Report on
Legislation, summarizing important state health care
legislation enacted during the second year of the
2017-18 legislative session. Developed to help hospitals
understand the implications of the year’s significant bills, the
report also serves as a reference tool for the broad range of
legislative activity that occurred this session.
The U.S. Department of Health and Human Services’ (HHS) Assistant
Secretary for Planning and Evaluation is assessing the effect of
an individual’s socioeconomic status on quality and resource use
measures under the Medicare program. This evaluation is required
by the Improving Medicare Post-Acute Care Transformation (IMPACT)
Act of 2014.
The Centers for Medicare & Medicaid Services (CMS) has issued the
attached advance notice of proposed rulemaking seeking input on a
potential mandatory model to test payment changes for certain
separately payable Part B drugs and biologicals. CMS is
considering issuing a proposed rule in spring 2019 on the
potential model — called the International Pricing Index (IPI)
Model — which would start in spring 2020 and operate for five
The Centers for Medicare & Medicaid Services (CMS) has announced
the Maternal Opioid Misuse (MOM) model, intended to better align
and coordinate care of pregnant and postpartum Medicaid
beneficiaries with opioid use disorder. Under the model, state
Medicaid agencies will be required to design a comprehensive set
of services that includes care management and coordination,
health promotion, individual and family support, and referral to
community and social services.
CHA has submitted the attached comment letter to the Centers for
Medicare & Medicaid Services (CMS) on its
proposed rule that would make changes to the Medicare Shared
Savings Program. CHA thanks members for their feedback, which
helped inform these comments.
In the letter, CHA outlines a number of principles that members
believe are critically important in new alternative payment model
designs. CHA appreciates CMS’ continued stakeholder engagement on
its new direction for the Center for Medicare & Medicaid
Innovation and the development of new alternative payment models,
and urges CMS to reconsider a number of provisions.
The Centers for Medicare & Medicaid Services (CMS) has revised
local coverage determinations (LCD) process for medical
technologies outlined in the Medicare Program Integrity Manual,
as required by the 21st Century Cures Act. The
revisions contain instructions, policies and procedures for
Medicare administrative contractors (MACs) to determine which
items and services are covered, as well as guidance for
The Centers for Medicare & Medicaid Services (CMS) has issued the
attached proposed rule that would revise certain requirements for
Medicare Parts A, B and D claims appeals. The proposed rule
is intended to reduce regulatory burden and improve clarity and
consistency in the appeals process. Among the provisions, CMS
proposes to eliminate the requirement that appellants sign appeal
requests, and change the time frame for vacating dismissals from
six months (which can vary from 181 to 184 days) to 180 calendar
Yesterday, the Senate passed
H.R. 6, the Substance Use-Disorder Prevention that Promotes
Opioid Recovery and Treatment (SUPPORT) for Patients and
Communities Act, by a vote of 98-1. The SUPPORT for Patients and
Communities Act is a bipartisan bill addressing the opioid crisis
and includes several Medicaid and Medicare reforms to help combat
The final bill now moves to the president’s desk, where it is
expected that he will sign it into law.
The Centers for Medicare & Medicaid Services (CMS) has published
electronic clinical quality measure (eCQM) flows for eligible
hospitals and critical access hospitals (CAHs) for the 2019
reporting period. This new resource was created in response to
The eCQM flows are designed to assist in interpreting the eCQM
logic and calculation methodology for reporting rates. They
provide an overview of each of the population criteria
components and associated data elements that lead to the
inclusion in or exclusion from the eCQM’s quality action
The Centers for Medicare & Medicaid Services (CMS) has published
updates to the electronic clinical quality measure (eCQM) value
sets for the 2019 reporting and performance periods. The updates
affect reporting for the Quality Payment Program, including
the Merit-based Incentive Payment System and advanced alternative
payment models; Comprehensive Primary Care Plus Program;
Inpatient Quality Reporting Program; and Medicare and Medicaid
Promoting Interoperability programs.
With these changes — which only affect the value sets for eCQMs —
CMS deleted expired codes and added relevant replacement codes
and newly available codes. All changes to the eCQM value sets are
available through the National Library of Medicine’s Value Set
Authority Center download tab.
On Sept. 18, President Trump signed into law the Dr. Benjy
Frances Brooks Children’s Hospital Graduate Medical Education
Support Reauthorization Act of 2018 (H.R. 5385), extending
payments to the Children’s Hospital Graduate Medical Education
Program through federal fiscal year 2023. Supported by CHA,
the program provides funding to qualifying children’s
hospitals for training pediatric physicians.
The legislation received bipartisan support, including the
following members of the California delegation:
On Sept. 22, the U.S. Department of Homeland Security (DHS)
proposed rule that would change “public charge”
policies. Under long-standing policy, the federal government
can deny individuals U.S. entry or any adjustment to their legal
permanent resident status (e.g., green card) if they are
determined likely to become public charges. The proposed rule —
which is narrower than the drafts that were leaked to the media
this spring — expands the list of programs that may be considered
to include not only cash assistance and long-term care but also
certain health care, nutrition and housing programs.
If the rule is finalized in its proposed form, the benefits
considered would be greatly expanded to include:
Non-emergency Medicaid — Medi-Cal, in California — with
limited exceptions for Medicaid benefits for treating an
“emergency medical condition,” certain disability services
related to education and benefits received by children of U.S.
citizens who will be automatically eligible to become citizens
Supplemental Nutrition Assistance Program, referred to
as CalFresh in California
Low-income subsidies for prescription drug costs under
Medicare Part D
Section 8 Housing Choice Voucher Program, Section 8
Project-Based Rental Assistance and public housing
The Centers for Medicare & Medicaid Services (CMS) has released
the attached proposed rule intended to reduce regulatory burden
for hospitals, critical access hospitals (CAHs) and other
providers. CMS proposes changes to its conditions of
participation (CoPs) — including its emergency preparedness CoPs
— and conditions for coverage.
With respect to its emergency preparedness policies, CMS proposes
Give facilities the flexibility to review their emergency
program every two years rather than annually, or more often at
Eliminate a duplicative requirement that the emergency
plan include documentation of efforts to contact local, tribal,
regional, state and federal emergency preparedness officials, as
well as participation in collaborative and cooperative planning
Give facilities greater flexibility in revising training
requirements to allow training to occur annually, or more often
at their discretion.
Increase flexibility for the inpatient provider testing
requirement so that one of the two testing exercises required
annually may be an exercise of the facility’s choice.
Reduce the number of testing exercises outpatient providers
are required to conduct annually from two to one.
Earlier this week, hospital representatives — including the
American Hospital Association, the Association of American
Medical Colleges, America’s Essential Hospitals and three
hospital plaintiffs — refiled a lawsuit seeking relief from
Medicare payment cuts to hospitals participating in the 340B Drug
Pricing Program. The cuts reduced Medicare payments by nearly 30
percent, or $1.6 billion, to certain hospitals for outpatient
drugs purchased under the 340B program.
Late last year, a federal district court
granted the government’s motion to dismiss an earlier lawsuit
that sought to prevent these payment cuts, which consequently
became effective Jan. 1, 2018. At the time, the judge who ruled
on the case did not address the case’s merits, instead holding
that plaintiffs must first present a concrete claim for
reimbursement to the Department of Health and Human Services. In
July, an appeals court further delayed ruling on the case because
no claims had been filed when the lawsuit to prevent the
cuts was initially filed.
The CHA member forum to discuss the Centers for Medicare &
Medicaid Services’ (CMS) outpatient prospective payment system
rule for calendar year (CY) 2019 has been
rescheduled for Sept. 14 at 10 a.m. (PT). The
proposed rule also includes payment updates for ambulatory
Members who have already registered will automatically
receive meeting materials and the dial-in number the morning of
During the forum, CHA will provide an overview of the proposed
rule and seek member input for its comments, which are due to the
agency Sept. 24.
Of note, CMS proposes to reduce the payment rate for hospital
outpatient clinic visits provided at all off-campus hospital
outpatient provider-based departments (HOPDs) to 40 percent of
the OPPS rate. This includes excepted and non-excepted off-campus
provider-based HOPDs. CMS also proposes to modify its policy
related to excepted off-campus provider-based HOPDs that expand
the families of services they offer.
The Center for Medicare & Medicaid Innovation has
announced the Integrated Care for Kids Model, a child-focused
model to “increase behavioral health access, respond to the
opioid epidemic and positively impact the health of the next
generation.” The new model aims to reduce expenses and
improve quality of care for children eligible for Medicaid and
the Children’s Health Insurance Program – through
prevention, early identification, and treatment of priority
health concerns such as behavioral health challenges and physical
health needs. The Centers for Medicare & Medicaid Services will
select up to eight participants for the model; participants
will be either a state Medicaid agency or a local entity called a
“lead organization.” More information is
CHA has prepared the attached summary detailing the Centers for
Medicare & Medicaid Services’ (CMS) proposed rule addressing rate
updates and policy changes to the Medicare outpatient prospective
payment system (OPPS) system for calendar year (CY) 2019.
The October 2018 outpatient Hospital Compare preview
reports for hospitals participating in the Hospital Inpatient
Quality Reporting, Hospital Outpatient Quality Reporting, and
Prospective Payment System-Exempt Cancer Hospital Quality
Reporting programs are available through Aug. 25.
The House Ways & Means Committee yesterday released the attached
report on reducing regulatory burden as part of the committee’s
Medicare Red Tape Relief Project, an initiative to modernize and
improve the Medicare program. The report provides an overview of
the committee’s efforts since the initiative’s inception in July
2017 and potential next steps to deliver regulatory relief.
As part of the Medicare Red Tape Relief Project, the committee
has held meetings, hearings and bipartisan roundtable
discussions. In addition, it has requested comments from doctors,
hospitals, post-acute care providers and other health care
professionals on how to advance innovation, improve the patient
experience and enhance the quality of care for Medicare
beneficiaries. Last year, CHA submitted
comments to the committee on reducing legislative and
regulatory burdens on Medicare providers.
The committee found that the need for improved flexibility to
provide telehealth services, challenges with the Stark Law, and
document and reporting burdens were three issues that cut across
all provider groups.
The Centers for Medicare & Medicaid Services (CMS) will provide
confidential, hospital-specific reports on two disparity methods
that assess hospital performance for patients with social risk
factors in the Hospital 30-day, All-Cause, Risk-Standardized
Readmission Rate Following Pneumonia Hospitalization (NQF #0506)
The reports will be available by Aug. 24 and available for
preview through Sept. 24.
CMS will host a national provider call on Sept. 12 from 1-2 p.m.
(PT) to review the disparity methods and answer questions. Once
available, registration details will be provided in CHA