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.
sent a letter to the California congressional delegation
urging support of two bills that would address the opioid crisis
and ensure patients have access to the treatments they need.
H.R. 5797 — known as the Individuals in
Medicaid Deserve Care that is Appropriate and Responsible in its
Delivery Act — would allow states to provide Medicaid
services to individuals in institutions for mental diseases
(IMDs) who have opioid use disorders. Under current law, states
are prohibited from receiving federal matching funds for Medicaid
patients aged 21 through 64 who receive inpatient treatment in
facilities qualified as IMDs, unless the IMD has fewer than 16
inpatient beds. This bill would authorize federal Medicaid
matching funds for IMDs to provide eligible recipients up to 30
days of inpatient opioid abuse treatment over a 12-month period,
The Centers for Medicare & Medicaid Services (CMS) has updated
the Merit-based Incentive Payment System (MIPS) Participation
Lookup Tool. It has been renamed the Quality Payment
Program (QPP) Participation Lookup Tool and now includes
predictive qualifying alternative payment model participant
Clinicians will now be able to check their participation status
in the QPP through one tool. Eligible clinicians in advanced
alternative payment models who meet certain criteria are
considered qualifying participants and are excluded from MIPS.
More information about the program is available on the
The Centers for Medicare & Medicaid Services (CMS) will not
update the Overall Hospital Quality Star Ratings on Hospital
Compare, previously scheduled for July. CMS is postponing
the July star ratings update to further analyze the impact of
changes to some star ratings measures and to address stakeholder
concerns. Star ratings released in December 2017 will remain on
Hospital Compare until the next update. No date has been
set for the release of the next round of star ratings. CMS will
gather feedback from a multidisciplinary technical expert panel
and a work group of provider leaders, and will then set a
public comment period. A frequently asked questions document is
attached; additional questions should be submitted to
The Centers for Medicare & Medicaid Services (CMS) finalized,
without changes, its “extreme and uncontrollable” circumstances
policy for hospitals participating in the Comprehensive Care for
Joint Replacement (CJR) Payment Model, previously set forth in an
interim final rule.
The attached final rule provides flexibility in determining
episode spending for CJR hospitals located in areas impacted by a
major disaster declaration for performance years three through
five. The policy will become effective July 9.
CMS determined at least 22 CJR hospitals were located in areas
affected by the Northern California wildfires, which include
Butte, Lake, Mendocino, Napa, Nevada, Orange, Sonoma and Yuba
counties. The extreme and uncontrollable policy will apply to CJR
participant hospitals whose CMS certification number has a
primary address located within an area that has been issued a
waiver in accordance with section 1135(g) of the Social Security
Act and is in a county, parish or tribal government with a major
disaster declaration under the Stafford Act.
Today, Rep. Doris Matsui (D-Sacramento) introduced House
Resolution 6071, known as the Stretching Entity Resources for
Vulnerable (SERV) Communities Act, which clarifies the intent of
the 340B Drug Pricing Program and provides for enhanced program
integrity. The bill text, a one-page summary, a
section-by-section summary and CHA’s support letter, which was
submitted yesterday, are attached. CHA also issued a
news release today in support of the legislation.
The bill would improve the program’s integrity and transparency
by requiring the Secretary of Health and Human Services to audit
both providers and drug manufacturers. Manufacturers would also
be required to disclose critical pricing information.
Federal Communications Commission (FCC) Chairman Ajit Pai has
circulated a draft order that would increase the annual funding
cap for the Rural Health Care Program from the current $400
million to $571 million. The current cap was established in 1997;
the increase represents what the funding level would be today if
an inflation adjustment had been originally included.
The order would apply the increased cap to the current funding
year to immediately address a critical funding crisis and enable
rural health care providers to continue offering telemedicine
services. It would also adjust the cap annually for inflation and
allow unused funds from prior years to be carried forward to
CHA applauds Chairman Pai’s proposal. In May, CHA
urged the FCC to adjust the program’s funding cap.
Earlier this week, Sen. Dianne Feinstein sent the attached letter
to Chairman Lamar Alexander (R-TN) and Ranking Member Patty
Murray (D-WA) of the Senate Committee on Health, Education, Labor
and Pensions, expressing her strong support for the 340B Drug Pricing Program and asking for protection
of the program as the committee examines it.
In the letter, Sen. Feinstein describes the role safety-net
providers serve in California’s health care system, providing
crucial services to the uninsured and low-income patients in
To highlight the 340B program’s importance, Sen. Feinstein shared
specific examples of how California hospitals have used 340B
savings to offer services needed by their communities.
The Centers for Medicare & Medicaid Services (CMS) regularly
provides important updates for post-acute care quality reporting
programs, including training opportunities, public reporting
details and reminders of data submission and review deadlines.
The latest updates for inpatient rehabilitation facilities,
skilled-nursing facilities, long-term care hospitals, home health
and hospice providers are below.
Inpatient Rehabilitation Facilities Provider Preview Reports
Inpatient rehabilitation facility (IRF) provider preview reports
have been updated and are now available. Providers have until
June 30 to review their performance data on quality measures
based on data from the fourth quarter of 2016 to the third
quarter of 2017, prior to their posting to the IRF Compare
website in September. Corrections to the underlying data will not
be permitted during this time. However, providers can request a
CMS review if they believe their data scores are
This update of the provider reports includes two additional
assessment-based measures and four new claims-based measures, as
well as removal of the All-Cause Unplanned Readmission Measure
for 30 Days Post-Discharge from Inpatient Rehabilitation Facility
During CHA’s Congressional Action Program in Washington, D.C.
earlier this month, Sen. Dianne Feinstein expressed a deep
concern over the continuing intravenous opioid shortage as well
as a strong interest in finding a quick solution.
To illustrate the issue, CHA developed an online survey that
allowed hospitals to describe the direct effect of the shortage.
CHA thanks the 194 hospitals that responded to the survey, as
their insight has been key in demonstrating the shortage’s impact
on patients and communities.
Sen. Feinstein’s staff has continued to be actively engaged with
the Drug Enforcement Administration (DEA) on this issue and
facilitated a call between the DEA and CHA to hear directly from
California hospitals. During the call, the survey results were
reviewed and hospital leaders shared firsthand how the shortage
continues to impact clinical care.
By a vote of 92-5, the Senate today passed bipartisan
legislation to streamline and modernize the Veterans
Administration (VA) health system. California Sens. Feinstein and
Harris voted yes. The VA
Maintaining Internal Systems and Strengthening Integrated Outside
Networks (MISSION) Act of 2018 provides an additional $5.2
billion to fund the VA Choice Program for the remainder of the
year. The measure also eliminates the 40-mile or 30-day wait
periods for access to community care; establishes Medicare
payment rates for community care, with exceptions for rural areas
and value-based payment models; and requires the VA to establish
a prompt payment process. It also creates a VA residency
program and loan repayment program for those training for
specialties that are in short supply. The House passed the
measure last week; President Trump is expected to sign it
President Trump last week released a
blueprint that identifies immediate actions and further
opportunities within federal payment programs to lower drug
prices. In releasing the blueprint, officials from the Department
of Health and Human Services identified four major goals:
Addressing the increase in list prices of drugs
Maximizing the potential of government programs and private
payers to leverage negotiating power
Tackling high out-of-pocket costs
Ensuring the practices of foreign markets are not
disadvantaging American innovation
The Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs
calls for greater transparency of drug prices, better informing
consumers about prescription drugs, promoting the use of generic
drugs and experimenting with value-based payment through the
Center for Medicare & Medicaid Innovation. CHA is reviewing the
blueprint’s policy proposals and anticipates additional
rulemaking and subregulatory guidance to be released over the
coming weeks. Today, the department released a request for
information seeking stakeholder feedback to “to help shape
future policy development and agency action.” Future member
engagement on these important policy issues is likely.
The Centers for Medicare & Medicaid Services (CMS) has issued the
attached interim final rule, which would increase payments for
certain durable medical equipment and enteral nutrition items in
rural areas that are not subject to the Durable Medical
Equipment, Prosthetics, Orthotics, and Supplies Competitive
CMS previously attempted to transition payments from traditional
fee schedule amounts to competitive bid rates. In 2016 and 2017,
the agency used information from the Competitive Bidding Program
to adjust Medicare payments for certain durable medical equipment
and enteral nutrition items in areas that were not part of the
program. In 2016, blended rates — 50 percent of the
amount based on the competitive bid rates and 50 percent of
the traditional fee schedule amounts — were implemented for a
transitional year. Beginning Jan. 1, 2017, the fully adjusted fee
schedule rates took effect. However, CMS notes that stakeholders
have raised concerns about the significant financial challenges
posed by the current adjusted fee schedule rates and that the
number of suppliers in certain areas continues to decline.
To protect access to needed durable medical equipment in rural
and non-contiguous non-bid areas, CMS’ interim final rule resumes
the blended rates from June 1, 2018, to December 31, 2018.
Comments on the interim final rule are due July 9.
reported in CHA News, the Department of Health and
Human Services recently announced improvements to the Medicare
claims appeal process. The Office of Medicare Hearings and
Appeals has begun implementing changes to the program, including
expanding its Settlement Conference Facilitation Program. The
agency will host a
special open door forum on May 22 at 10:30 a.m. (PT) to share
the logistics of the process and program eligibility criteria.
Questions should be submitted in advance to OMHA.SCF@hhs.gov including “SCF May
22 Call” in the subject line. Questions received in advance may
be addressed during the call or referenced in materials following
the call. A frequently asked questions document is
On Jan. 17, Centers for Medicare & Medicaid Services
Administrator Seema Verma joined a public webcast hosted by
the American Hospital Association to preview administration
efforts to reduce regulatory burden on hospitals.
of the webcast is available. If you had previously registered,
hit “Click here to login” at the bottom of the page. Enter your
email address and click “Submit.” You will then be taken to the
If you did not register, fill out the required fields at the top
of the page. Once you click “Submit” you will be redirected to
CHA has compiled a list of quality measures required for public
reporting and performance-based programs for hospitals and other
post-acute care providers. The attached file includes a table
showing measures that are duplicated across federal reporting
programs, as well as a tab for each individual federal program,
including inpatient quality reporting, outpatient quality
reporting, value-based purchasing, readmissions reduction,
hospital acquired condition penalty, meaningful use, inpatient
psychiatric facility quality reporting, prospective payment
system-exempt cancer hospital quality reporting, ambulatory
surgical center quality reporting, and accountable care
organizations. The Excel workbook also includes post-acute care
quality reporting programs, including inpatient rehabilitation
facility quality reporting, long-term care quality reporting,
home health quality reporting and skilled-nursing facility
quality reporting programs.
The information in the document comes from various sources,
including Centers for Medicare & Medicaid final regulations and
the National Quality Forum, and will be updated as new measures
are added through the federal rulemaking process.
On Feb. 17, the House and Senate approved the payroll tax
conference report, which includes payment relief for physicians
using hospital payment cuts to offset the cost. The House vote
was 293-132, with 91 Republicans and 41 Democrats voting against
the measure. The California delegation supported
the bill with a vote of 41-10. Soon after the House
vote, the Senate passed the bill, 60-36. President Obama has
indicated he will sign the legislation today.
President Obama released his federal fiscal year (FY) 2013 budget
proposal, setting forth a plan for spending $3.8 trillion next
year. The proposal would reduce Medicare spending by $267 billion
and Medicaid spending by $50 billion over the next 10 years. The
President’s FY 2013 budget includes many proposals from his
February, April and September 2011 budget plans that would reduce
federal payments for hospital and post-acute-care services to
Medicare beneficiaries, including cuts to payments for bad debt,
rural hospitals and graduate medical education (GME).