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.
The Centers for Medicare & Medicaid Services (CMS) has updated its instructions for Worksheet S-10. The update, attached, clarifies definitions and instructions for uncompensated care, non-Medicare bad debt, non-reimbursed Medicare bad debt and charity care to include uninsured discounts. It also modifies the calculation relative to uncompensated care costs. The changes are effective for cost reporting years from Oct. 1, 2013, onward. CHA is currently reviewing the revisions and will provide members with more detail in the coming weeks.
In addition, CMS has extended the deadline for hospitals to revise and submit amended cost reports for federal fiscal years (FFY) 2014 and 2015 from Sept. 30 to Oct. 31. CHA urges members to review Worksheet S-10 of their FFY 2014 and 2015 cost reports and submit amendments to their respective Medicare administrative contractors before the Oct. 31 deadline. More information is available in the attached MLN Matters article.
Yesterday, CHA met with representatives from the Centers for Medicare & Medicaid Services (CMS) at its headquarters in Baltimore to discuss the Medicaid managed care rules finalized in May 2016 and January 2017 and, specifically, their impact on the Quality Assurance Fee (QAF) program.
As part of the House budget resolution process, the Energy and Commerce Committee announced earlier today the Common Sense Savings Act of 2016 (H.R. 4725), legislation introduced by Health Subcommittee Chairman Joe Pitts (R-PA) to reduce the federal deficit by almost $25 billion through cuts to Medicaid, the Children’s Health Insurance Program (CHIP) and the Prevention and Public Health Fund. The legislation, opposed by CHA, would:
Eliminate the enhanced federal Medicaid matching funds available for the coverage of prisoners as a result of the Affordable Care Act’s Medicaid expansion. States would continue to be allowed to receive federal funds for Medicaid coverage for prisoner inpatient services, but at the traditional federal matching rate.
Reduce the amount of the non-federal share that can come from providers by gradually reducing the Medicaid provider tax threshold from its current 6 percent of the net patient service revenues to 5.5 percent (the amount that was in place until Oct. 1, 2011).
Eliminate the 23 percentage point increase in the CHIP matching rate implemented in the Affordable Care Act.
Repeal the Prevention and Public Health Fund, which amounts to more than $14 billion over the next 10 years.
Close a loophole in a current statute that has allowed lottery winners to retain taxpayer-financed Medicaid coverage.
The budget trailer bill adopted as part of the state’s final 2015-16 budget amends Section 1220 of the Business and Professions Code pertaining to clinical laboratories. Specifically, the budget trailer bill allows clinical laboratories to establish an alternative quality control program that meets federal regulations under the Clinical Laboratory Improvement Act and that may include the use of alternative quality control testing procedures already recognized by the Centers for Medicare & Medicaid Services (CMS). Until now, the California Department of Public Health has interpreted regulations in a way that did not recognize federally approved alternative quality control methods, requiring labs to perform frequent quality control tests, which are substantially more expensive than the current federally recognized equivalent quality control (EQC) procedures and the impending individualized quality control plans (IQCPs).
Last night the House of Representatives passed the Bipartisan Budget Act of 2013. The Senate is expected to do so today, and the President has indicated he will sign the measure. The vote in the House was 332-62; nine Californians voted against passage. The legislation contains both good news and bad news for California’s hospitals.
Also this week, the House Ways and Means and Senate Finance Committees reported bipartisan legislation to repeal the sustainable growth rate (SGR) for physician Medicare payments. They will continue to work toward a permanent solution during the first quarter of 2014. The financing mechanisms for offsetting the cost of repeal have not been released. Payments to hospitals continue to be vulnerable as the committees look for as much at $150 billion over the next 10 years to pay for the SGR repeal.
CHA has provided the attached summary of the Bipartisan Budget Act of 2013 with additional information about the hospital-related provisions.
CHA President/CEO C. Duane Dauner was joined by 10 representatives of CHA member hospitals in Washington, D.C., Dec. 3 for the CHA and American Hospital Association hospital advocacy day. The group met with about half of the California Congressional delegation, including House Minority Leader Nancy Pelosi, House Majority Whip Kevin McCarthy, and Sens. Boxer and Feinstein.