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.
The California Hospital Association, the California Association of Public Hospitals and Health Systems, Private Essential Access Community Hospitals, Inc., the California Children’s Hospital Association and the District Hospital Leadership Forum have submitted the attached joint letter on the Centers for Medicare & Medicaid Services (CMS) proposed rule on fee-for-service access to care monitoring requirements within the Medicaid program. The proposed rule would amend the process by which states document whether Medicaid payments in fee-for-service (FFS) systems are sufficient to enlist providers to assure beneficiary access to covered care and services consistent with existing statute.
In the letter, the organizations oppose an exemption from the FFS access standards, regardless of the managed care penetration rate, as it eliminates safeguards that promote a more transparent data-driven process. The letter also outlines concerns with proposals related to an exemption for states with high managed care enrollment, exemptions for nominal rate reductions, relief from public notice of rate reductions and the need for greater CMS oversight of state Medicaid programs.
Comments on the proposed rule are due by 2 p.m. (PT) on May 22.
Special resource toolkit developed by CHA’s EMS/Trauma Committee and the Center for Behavioral Health. Designed to help staff provide support to patients in the ED with psychosis and/or substance abuse disorders, this toolkit provides access to articles, policies, management techniques, assessment tools and more. Click the topic tabs below to access resources and information.
The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule that would provide states with greater flexibility in how they meet access to care requirements within the Medicaid program.
The proposed rule addresses concerns associated with the 2015 final rule — which CHA commented on — that requires states proposing to reduce or restructure Medicaid fee-for-service payment rates to collect data through an Access Monitoring Review Plan and solicit input on the potential impact on beneficiaries’ access to care.
CMS proposes to exempt states with an overall Medicaid managed care penetration rate of 85 percent or greater from most fee-for-service access monitoring requirements; California’s current Medi-Cal managed care penetration rate is 80 percent.
CHA DataSuite has issued the fourth quarter 2017 update of the Medicare cost report model, which provides hospitals with commonly sought after data elements from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System database. The model highlights hospital utilization data, inpatient and outpatient data, overall hospital statistics and uncompensated care data.
S-3 Part I – utilization data
S-10 – uncompensated care data
G-3 – overall revenue and expense data
E Part A – hospital inpatient data
E Part B – hospital outpatient data
E-3 Part V – critical access hospital inpatient services data
E-4 – hospital direct graduate medical education and end stage renal disease outpatient direct medical education data
As reported in CHA News last week, the Department of Health Care Services (DHCS) recently sent hospitals invoices covering the first six fee-for-service cycles of the 2017-19 Hospital Fee Program. The attached draft model incorporates those invoiced amounts, as well as the supplemental fee-for-service payment amounts approved last month by the Centers for Medicare & Medicaid (CMS) services. Notably, the “Gain.Contribute” tab in the model includes a summary, by state fiscal year, of the estimated fee and payment amounts for the 30-month program period. CHA is in the process of creating hospital-specific fee and payment schedules, which will be distributed within the next week.
It is important to note that the managed care components of the program have not been approved by CMS and, therefore, the payment amounts in the draft model are very preliminary. Furthermore, the supplemental Medi-Cal managed care payments made through the new directed payment mechanism have been estimated using inpatient utilization data publicly reported to the Office of Statewide Planning and Development for fiscal years ending in 2015. However, in actuality, the directed payments will be made for inpatient and outpatient services provided to in-network patients during the current state fiscal year.
Last week, the Department of Health Care Services Disproportionate Share Hospital Unit emailed a survey to private hospitals that participate in the hospital fee program. The Calendar Year 2016 Quality Assurance Fee Survey seeks information related to hospital fees and payments during calendar year 2016 of the hospital fee program; results will be used to calculate Medi-Cal disproportionate share hospital payments for state fiscal year 2018-19. If a hospital fails to respond to the survey by Feb. 9, the department will use internal data to estimate the fees and payments from the hospital fee program, which may impact eligibility or payment amounts.
As reported in CHA News last month, the Centers for Medicare & Medicaid Services approved the supplemental fee-for-service payments and overall tax structure of the 2017-19 hospital fee program. CHA is working with the Department of Health Care Services (DHCS) to update the draft model so hospital-specific implementation schedules can be distributed by the end of this month. DHCS expects the first round of invoices will be sent to hospitals within the next month, with a due date in late February. As soon as the exact timing is finalized, CHA will notify members via CHA News.
Now that the fee-for-service component of the program has been approved, DHCS has turned its attention to the managed care components of the program. As previously reported in CHA News, the new federal Medicaid managed care rules require significant changes to how supplemental Medi-Cal managed care payments are made through the hospital fee program. Effective July 1, 2017, roughly half of the supplemental Medi-Cal managed care payments must be transitioned to a directed payment methodology. Under the directed payment method, supplemental payments can be made only to network providers based on utilization in the encounter data file from the current rate year.
In response to several questions submitted by CHA and others, as well as questions asked during a recent open door forum, the Centers for Medicare & Medicaid Services has released the attached document clarifying its recently revised instructions for Worksheet S-10 of the Medicare cost report. CHA reminds hospitals that the deadline to submit amended cost reports for federal fiscal years 2014 and 2015 is Jan. 2. Worksheets received by Dec. 2 will be reflected in the cost report data file used to develop federal fiscal year proposed rules. Hospital data submitted after Dec. 2 but by Jan. 2 will be reflected in the cost report data file that is typically used to develop the federal fiscal year final rules. Additional resources for Worksheet S-10 are available on CHA’s website.
The House narrowly passed the Senate’s fiscal year 2018 budget resolution, House Concurrent Resolution 71, by a vote of 216-212 with 20 Republicans voting “no.” The budget resolution allows Congress to use the reconciliation process, which only requires a majority vote, to move forward on a tax reform bill that could increase the deficit by $1.5 trillion. CHA will continue to monitor tax reform legislation, expected to be unveiled in the coming weeks.