CHA News

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.  

CHA Submits Joint Letter on Medicaid Access to Care Monitoring Requirements

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.

Emergency Department Toolkit

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.

CMS Proposes Regulation to Alleviate State Burden

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 Releases Medicare Cost Report Model Update

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.

Worksheets include:

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

CHA Releases Draft Model of 2017-19 Hospital Fee Program

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.

Hospitals Must Respond to Hospital Fee Program Survey by Feb. 9

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.