CHA News

CHA Issues Summary of CY 2019 OPPS Final Rule

CHA has issued a summary of the Centers for Medicare & Medicaid Services’ final rule addressing rate updates and policy changes to the Medicare outpatient prospective payment system (OPPS) and ambulatory surgical center payment system for calendar year (CY) 2019.

FFY 2019 Uncompensated Care Payments to Come From 2014, 2015 Worksheet S-10 Data

In the federal fiscal year (FFY) 2019 inpatient prospective payment system final rule, the Centers for Medicare & Medicaid Services (CMS) finalized its second year of a three-year transition to use Worksheet S-10 data for distributing Medicare disproportionate share hospital (DSH) uncompensated care payments. CMS will use two years (FFYs 2014 and 2015) of Worksheet S-10 cost report data and one year of proxy data to distribute the uncompensated care payments for FFY 2019.

In response to comments from CHA, CMS noted in the final rule that it planned audits of the data in fall 2018. In late August, CMS began audits of selected hospitals’ FFY 2015 cost reports. A number of hospitals in California have received this data request, and must respond by Sept. 28.  

Because CMS has given the Medicare administrative contractors (MACs) only until the end of January to complete the audits, providers have a short timeline to complete this work with their MACs. Though CHA acknowledges that this presents a challenge from both technical and resource perspectives, CHA highly encourages hospitals that have received a request to respond as quickly as possible. Early communication with Noridian (or its subcontractor, Figliozzi & Company) is critical under this short timeline. A copy of the letter Noridian sent to select providers requesting documentation is attached; these letters are consistent across all MACs.

CHA Comments on CY 2019 Outpatient PPS Proposed Rule

CHA has submitted the attached comment letter on the calendar year (CY) 2019 outpatient prospective payment system (OPPS) proposed rule. In reviewing the policy and payment proposals outlined in the proposed rule, CHA is concerned that the agency has taken steps that are not only unlawful, but threaten the financial stability of the hospital OPPS and, in turn, access to care for Medicare beneficiaries. In particular, CHA strongly opposes CMS’ proposals to expand site-neutral payment policies for off-campus provider-based departments (PBDs) and to expand payment cuts for non-excepted PBDs participating in the 340B Drug Pricing Program. In addition, CHA provides comments on a number of other proposed payment and policy provisions. Specifically, CHA:

Urges CMS to withdraw all three of its proposals to expand site-neutral payment policies in off-campus PBDs
Opposes CMS’ proposal to reduce payments for separately payable Part B drugs from wholesale acquisition cost (WAC) plus 6 percent to WAC plus 3 percent

CHA Issues Summary of Physician Fee Schedule Proposed Rule

CHA has released the attached summary of the calendar year 2019 physician fee schedule (PFS) proposed rule, which also outlines proposed provisions implementing the third year of the Quality Payment Program (QPP) for physician payment.

The summary provides detailed information on a number of proposed policies, including payment for non-excepted off-campus provider departments, reduced administration burden for evaluation and management services, a reduction of payment for new Part B drugs and the implementation of Bipartisan Budget Act of 2018 provisions related to therapy and telehealth services.

The summary also details proposed updates to the Merit-based Incentive Payment System (MIPS) under the QPP, including an expanded definition of MIPS-eligible clinicians, a reduction of the MIPS measure set and proposed testing of the Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration.

Comments on the proposed rule are due Sept. 10 by 2 p.m. (PT).

CHA will host a member forum on Aug. 30 at 10:30 a.m. (PT) in anticipation of submitting comments.

Federal Administration Issues Short-Term, Limited Duration Health Plan Final Rule

Today, the U.S. Departments of Treasury, Labor, and Health and Human Services issued the short-term, limited duration insurance final rule, which finalizes many of the changes in the proposed rule and modifies proposals in other areas. While the three departments finalized the less than 12-month length of the policy as proposed, they changed the total length of the policy to no longer than 36 months in total, taking into account renewals or extensions, based on comments received.

The final rule also retains the requirement that issuers of short-term, limited-duration insurance display prominently in consumer materials one of two versions of a consumer notice explaining the policy that they are purchasing. The departments also strengthened the language required in the notice and included language deferring to state authority. Finally, the departments revised the estimates of the impact of short-term, limited-duration coverage on the individual health insurance market. The final rule is effective and applicable 60 days after publication in the Federal Register. In California, legislation has been introduced — Senate Bill 910  (Hernandez, D-West Covina) — that would prohibit short-term, limited duration health plans from being sold in California.  

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