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.
The Centers for Medicare & Medicaid Services (CMS) has issued the
attached final rule on the federal fiscal year (FFY) 2019
skilled-nursing facility (SNF) prospective payment system (PPS).
For FFY 2019, CMS estimates that aggregate payments to SNFs will
increase by $820 million, based on an update of 2.4 percent
mandated by the Bipartisan Budget Act of 2018. In addition to
payment and policy updates for FFY 2019, CMS finalized
significant changes to the current SNF PPS case-mix
Despite objections from CHA and other stakeholders, CMS finalized
the SNF Patient-Driven Payment Model (PDPM), effective Oct. 1,
2019. The PDPM focuses on clinically relevant factors — rather
than volume-based service — in Medicare payment determinations,
adjusts payments based on each aspect of the patient’s care and
further adjusts the SNF per-diem rate to reflect varying costs
throughout the patient’s stay.
CMS also finalized changes to the SNF Value-Based Purchasing
Program, including implementation of the program’s readmission
measure, establishment of performance and baseline periods
for the FFY 2021 program year, an adjustment to the scoring
methodology and an extraordinary circumstances exception
policy. CHA will release a detailed summary in the coming weeks.
Additional information is available in CMS’
fact sheet for the final rule.
Yesterday, the Centers for Medicare & Medicaid Services (CMS)
released the outpatient prospective payment system (OPPS)
proposed rule for calendar year (CY) 2019, which also includes
payment updates for ambulatory surgical centers (ASCs).
Today, the Centers for Medicare & Medicaid Services (CMS) issued
its proposed rule on the calendar year 2019 outpatient
prospective payment system (OPPS). A press release and CMS fact
sheet are attached. Most notably, CMS proposes to significantly
expand site-neutral payments across the OPPS, physician fee
schedule and ambulatory surgery center setting, following
previous recommendations from the Medicare Payment Advisory
Commission. In addition, CMS proposes to expand the 340B payment
policy of average sales price minus 22 percent to all
non-excepted, provider-based, off-campus hospital outpatient
CHA is currently reviewing the proposed rule and will share
additional information in tomorrow’s CHA News. A
detailed summary and DataSuite analysis will be distributed to
members in the coming weeks.
As reported in yesterday’s
Advocacy Alert, a new
bipartisan letter circulated by Reps. Jason Smith (R-MO) and
Terri Sewell (D-AL) urges the Centers for Medicare & Medicaid
Services (CMS) to provide additional information about proposed
changes to reimbursement for patients receiving care in inpatient
rehabilitation facilities (IRFs) and units. CHA encourages
members to contact their
congressional representative and urge them to sign on to the
changes proposed by CMS are significant, and CHA is concerned
that — absent additional analysis, review and training — they
will jeopardize patient access to medically necessary
rehabilitation care. CHA encourages members of Congress to sign
the bipartisan letter, which advances several questions and
requests attention to these concerns.
As a reminder, the Centers for Medicare & Medicaid Services (CMS)
will host a special open door forum on post-acute care quality
reporting programs July 25 at 11 a.m. (PT). During the forum, CMS
staff will provide information and solicit feedback about the
standardized patient assessment data elements (SPADE), including
an update on the progress of national field test data collection,
feedback from providers participating in the beta test and
upcoming stakeholder engagement activities. Development and
implementation of the SPADE comply with the requirements of the
Improving Medicare Post-Acute Care Transformation Act of 2014
Note that the dial-in previously provided by CMS has changed to
(800) 857-1738, passcode 7785347.
Yesterday, the House Ways and Means Committee, Subcommittee on
held a hearing on the Stark Law. The hearing examined the
need to modernize the physician self-referral law, as well as
possible solutions that would facilitate the Medicare program’s
successful transition to value-based care. Witnesses urged
Congress to amend the existing law to reflect modern care
Last month, the Centers for Medicare & Medicaid Services (CMS)
request for information on how the Stark Law impedes
care coordination and recommendations on how to address its
burdens. CHA is soliciting input from members about the request
for information; comments are due to CMS by 2 p.m. (PT) on Aug.
Health and Human Services (HHS) Secretary Alex Azar has
announced that Adam Boehler, current director of the Center
for Medicare & Medicaid Innovation, will also serve as senior
advisor for value-based transformation and innovation.
This marks the fourth senior adviser appointed to oversee
Secretary Azar’s four key priorities in his transformation
agenda: combating the opioid crisis, lowering the high cost of
prescription drugs, addressing the cost and availability of
health insurance, and transforming the health care system to a
The other three departmental priorities will be led by Jim
Parker, senior advisor to the secretary for health reform and
director of the Office of Health Reform; Dan Best, senior advisor
for drug pricing reform; and Brett Giroir, MD, senior advisor for
opioid and mental health policy.
CHA looks forward to its continued work with HHS staff on
legislative and regulatory priorities.
The guide highlights the differences between preliminary
performance feedback and final performance feedback. It also
provides step-by-step instructions for accessing the feedback. A
2017 performance feedback
fact sheet is also available.
For more information, contact the Quality Payment Program at
QPP@cms.hhs.gov or (866)
The Centers for Medicare & Medicaid Services has announced in a
communication to applicants that it will allow participants in
the Bundled Payments for Care Improvement (BPCI) Advanced model
to retroactively withdraw all or some episode initiators and
clinical episodes from the model in March 2019. Questions should
be directed to BPCIAdvanced@cms.hhs.gov.
Last week CMS
extended the deadline for BPCI Advanced model participation.
The Centers for Medicare & Medicaid Services has released
the attached proposed rule on the calendar year (CY) 2019
physician fee schedule. The proposed rule also includes
provisions related to the physician quality payment program for
CY 2019. CHA is reviewing the proposed rule and will provide
members with more details in the coming week.
Fact sheets on the proposed rule and Quality Payment Program are
In the letter, CHA argues that the administration’s focus on the
340B drug discount program as part of a plan to lower drug prices
is misplaced. CHA describes the importance of the 340B
program in providing essential medications and access to health
care for California’s most vulnerable populations.
To highlight the program’s importance, CHA offers specific
examples of how California’s hospitals have used the savings from
the program to fund vital patient care services — including
mobile health clinics, chemotherapy infusion centers, Hepatitis C
treatment and inner-city primary care centers.
CHA encourages members to use the letter as a template to submit
their own comments. Comments are due Monday, July 16 by 2 p.m.
(PT) and may be submitted online.
The House Energy and Commerce Committee, Subcommittee on Health
today heard more than a dozen bills and discussion drafts related
to the 340B drug discount program and a recent
Government Accountability Office report raising questions
about 340B contract pharmacies.
A variety of bills were introduced before the hearing, including:
H.R. 4392, which would void recent outpatient prospective
payment system payment changes for certain drugs and biologicals
purchased under the 340 program
H.R. 4710, which would establish a moratorium on the
registration of certain new 340B hospitals and associated sites
H.R. 5598, which would require certain disproportionate share
hospitals under the 340B program to submit reports on low-income
use of outpatient hospital services
H.R. 6071, which would clarify the intent of the program and
enhance program integrity
H.R. 6240, which would provide for user fees under the
H.R. 6273, which would ensure appropriate care by 340B
entities for victims of sexual assault
The discussion drafts would raise the minimum disproportionate
share adjustment percentage to qualify for the program to 18
percent for certain hospitals; provide for a 340B program
administrator; define “patient” for program purposes; require the
Department of Health and Human Services (HHS) to implement the
Government Accountability Office’s recommendations related to
340B contract pharmacies; require covered entities to report
certain information on savings from discounted prices under the
program and the relationship between those savings and charity
care expenditures; require HHS to conduct program audits in
accordance with generally accepted government auditing standards;
establish certain 340B fee amounts for certain low-income
patients; and allow HHS to prescribe regulations to carry out the
The Centers for Medicare & Medicaid Services (CMS) announced
last week that it will exercise enforcement discretion until
Jan. 2, 2019, for its new laboratory date of service exception
policy for advanced diagnostic laboratory tests (ADLTs) and
molecular pathology tests. The exception to the date of service
rule for tests subject to this policy requires the laboratory
performing the test to bill Medicare directly and prohibits the
hospital from billing for these tests. While the rule was
effective Jan. 1, CMS did not instruct the Medicare
administrative contractors (MACs) to implement the new policy
until July 2. On or after July 2, MACs are required to
implement the new policy and may make payment adjustments for
claims with dates of service on or after Jan. 1, and before July
2, that were not processed and paid consistent with the new
During the six-month period of enforcement discretion, hospitals
may continue to bill for ADLTs and molecular pathology tests that
would otherwise be subject to the new laboratory
exception. Clinical laboratories performing the test may
also bill during that period, but may not duplicate billing by
the hospital. Additional information — including a list of
molecular pathology tests and ADLTs subject to the new policy and
a frequently asked questions document – is available on
The Centers for Medicare & Medicaid Services (CMS) has extended
the deadline for submitting signed participation agreements and
selecting clinical episodes for the Bundled Payments for Care
Improvement (BPCI) Advanced model to August 8. The due date for
deliverables to CMS is now Sept. 14.
Last week, CHA sent a
letter to CMS outlining concerns about the current timeline
for participant agreements. CHA also urged CMS to offer two
additional start dates in 2019 to maximize the number of
participants in the model.
The Centers for Medicare & Medicaid Services (CMS) last week
issued the attached notice announcing plans to consider a
Medicare Advantage Qualifying Payment Arrangement Incentive
(MAQI) Demonstration. Under the demonstration, CMS would use
waiver authority to exempt clinicians who participate in certain
payment arrangements with Medicare Advantage organizations from
the Merit-based Incentive Payment System’s reporting
requirements and payment adjustment. If the MAQI Demonstration
moves forward, CMS would need to collect information from
participants on payment arrangements with Medicare Advantage
organizations, as well as Medicare Advantage payments and patient
counts. Because the information is not available through
other sources, CMS would require a new collection process.
CMS seeks comments on the estimated burden associated with
information collection for the demonstration until Sept. 4. CHA
will track the demonstration’s development and will notify
members if it is formally proposed.
The Centers for Medicare & Medicaid Services (CMS) has issued the
attached proposed rule outlining proposed calendar year 2019
Medicare payment updates and proposed quality reporting changes
for home health agencies. CHA is currently reviewing the proposed
rule and will provide additional information later this week in
CHA News. A CMS fact sheet and press release are
Last week CHA sent the attached letter to the Center for Medicare
& Medicaid Innovation (CMMI), urging the agency to consider two
additional start dates for the Bundled Payments for Care
Improvement Advanced model. Under the model’s current timeline,
hospitals are expected to select clinical episodes they will be
held accountable for and sign participation agreements by Aug. 1
for an Oct. 1 start date. However, a number of hospitals did not
receive data from CMS until late June, and have had limited time
to conduct the complex analyses required to decide whether to
participate in the model. In its letter, CHA urges CMMI to
offer two additional, optional performance year 1 start dates of
Jan. 1 and April 1, 2019, to maximize the number of participants
in the model.
The Centers for Medicare & Medicaid Services (CMS) has identified
an error in the quality calculation of the performance year (PY)
1 final and PY 2 initial Comprehensive Care for Joint Replacement
(CJR) reconciliation processes. The CJR data portal now displays
corrected versions of the reconciliation report and data files.
As a result of the error, CMS will restart the 45 calendar-day
appeals submission period. Appeals may be submitted through Aug.
12 by 8:59 p.m. (PT). Questions about the change or other issues
can be emailed to the CJR team at CJRSupport@cms.hhs.gov.
The Centers for Medicare & Medicaid Services (CMS) has announced
new and enhanced initiatives on Medicaid program integrity aimed
at creating greater transparency and accountability.
The initiatives include stronger audit functions, enhanced
oversight of state contracts with private insurance companies,
increased beneficiary eligibility oversight and stricter
enforcement of state compliance with federal rules.
CMS will begin targeted audits of select states based on the
amount spent on clinical services and quality improvement
compared to administration and profit. The medical loss ratio
audits will also include a review of states’ managed care rate
CHA has submitted the attached comments on the Centers for
Medicare & Medicaid Services’ (CMS) federal fiscal year 2019
skilled-nursing facility (SNF) prospective payment system
In its letter, CHA urges CMS not to finalize the proposed Patient
Driven Payment Model — which would replace the current
Resource Utilization Group-IV case-mix methodology — and to
instead proceed with additional evaluation, development and
collaboration with key stakeholders and providers.
CHA expresses support for CMS’ proposal to change base rate
components, including the addition of a specific non-therapy
ancillary component, as well as proposed changes to the therapy
case-mix and nursing components. CHA strongly supports the
transition to a case-mix system that relies on patient
characteristics rather than the volume of therapy services
Additionally, CHA requests that CMS make standardized patient
assessment data elements publicly available on an ongoing basis.