CHA News

CHA Members Take Hospital Message to Capitol Hill

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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.

US Supreme Court Same Sex Marriage Rulings Have Major Impact for Employers

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On June 26, 2013, the US Supreme Court’s decision in United States v. Windsor struck down Section 3 of the federal law known as the Defense of Marriage Act (DOMA). Under DOMA and for purposes of federal law, the term “spouse” was limited to individuals of the opposite sex.

OIG Revises Self-Disclosure Protocol

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The U.S. Office of Inspector General (OIG) today issued a revised guidance to its provider Self-Disclosure Protocol (SDP). The guidance addresses a range of issues for providers who wish to voluntarily disclose self-discovered evidence of potential fraud, including conduct eligible (and ineligible) for the SDP, disclosure requirements, calculating damages and reporting potential anti-kickback statute violations. The new protocol also suspends a 60-day overpayment rule (see CHA’s comments) proposed by the Centers for Medicare & Medicaid Services (CMS). The OIG said it would provide further SDP guidance once CMS releases its final rule on the 60-day overpayment issue. The revised SDP is available at http://oig.hhs.gov/compliance/self-disclosure-info/files/Provider-Self-Disclosure-Protocol.pdf.

CMS and ONC Seek Input on Advancing Interoperability, HIE

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The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have issued the attached request for information (RFI). Seeking input on potential policy and program changes to accelerate electronic health information exchange (HIE) across providers, the RFI specifically addresses the extent to which current CMS payment policies encourage or impede electronic information exchange across health care provider organizations, as well as which current programs are having the greatest impact on encouraging electronic HIE. CMS also asks providers to suggest how CMS and states can use existing authorities to better support electronic and interoperable HIE among Medicare and Medicaid providers — including post-acute, long-term care and behavioral health providers — and how policies could be developed to maximize the impact on care coordination and quality improvement. Comments on the RFI are due April 22.

CHA Comments on Hospital Readiness to Use EHRs for Quality Reporting

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CHA has submitted the attached comments to the Centers for Medicare & Medicaid Services (CMS) on hospital and vendor readiness to report certain clinical quality measures under the Hospital Inpatient Quality Reporting program using certified electronic health record (EHR) technology. Submitted in response to a CMS request for information, CHA’s letter raises concerns about the ability of hospitals to collect and report measures through an EHR when the vast majority of California’s hospitals have not met stage 1 “meaningful use” requirements and the accelerated timeline for implementing and revising measure specifications. CHA also urges CMS to use the Measures Application Partnership to bring the Office of the National Coordinator for Health Information Technology’s quality reporting efforts into better alignment with the Hospital Inpatient Quality Reporting Program.

CHA Comments on ACA’s Medicare DSH Provisions Prior to Formal Rulemaking

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CHA has submitted comments on the Medicare disproportionate-share hospital (DSH) provisions in Section 3133 of the Affordable Care Act (ACA) to the Centers for Medicare & Medicaid Services (CMS). The comments were provided in response to the agency’s request for input following a Jan. 8 National Provider Call on the same topic. In its comment letter, CHA recommends CMS consider, for formal rulemaking, adopting a definition of “uninsured” that includes undocumented individuals; adopting a definition of “uncompensated care” that includes the unreimbursed costs of Medicaid, the Children’s Health Insurance Program and other state and local government indigent care programs; and including graduate medical education costs in calculating cost-to-charge ratios. In addition, CHA urges greater clarity regarding definitions for lines 17 and 18 of Worksheet S-10, and requests excluding revenue streams created in California’s most recent Section 1115 waiver from uncompensated care calculations. For more information, see attached comments. CHA expects CMS to propose policies for implementing both the Medicare and Medicaid DSH provisions in the fiscal year 2014 inpatient prospective payment system proposed rule to be released in April. CHA will convene members to discuss these important provisions during the comment period.

Duals Demo Timeline Changes Included in Proposed State Budget

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Gov. Jerry Brown’s 2013-14 state budget proposal, released Jan. 10, includes a delay in implementing the Coordinated Care Initiative (CCI), which will transition individuals eligible for both Medicare and Medi-Cal —dual-eligibles — into managed care. It will also integrate long-term care services and supports into managed Medi-Cal. CCI implementation is now scheduled for September 2013, rather than June 2013 as originally planned. Under the revised timeline, beneficiaries will receive notice of changes no sooner than June 2013. Beneficiary enrollment schedules have also been modified and will vary among the designated counties: in Los Angeles County, enrollment will be phased in over 18 months; in the County of San Mateo, beneficiaries will be enrolled at once; and in Orange County, County of San Diego, County of San Bernardino, County of Riverside, Alameda County, and the County of Santa Clara, enrollment will be phased in over 12 months.

CMS Issues Request for Information on Health Plan Quality for Exchanges

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The Centers for Medicare & Medicaid Services (CMS) has published a request for information (RFI), seeking comments on health plan quality management in insurance exchanges. The Affordable Care Act requires qualified health plans (QHPs) that participate in insurance exchanges to implement quality improvement strategies, enhance patient safety through specific contracting requirements and publicly report quality data. CMS seeks comments on the current landscape of quality improvement strategies and how applicable these strategies are to the health insurance exchange marketplace. The RFI also provides the opportunity for stakeholders to recommend the most effective ways to enhance and align quality reporting and display requirements for QHPs beginning in 2016. Comments on the RFI are due Dec. 27 and can be submitted at www.regulations.gov. For more information, see attached RFI.

House Subcommittee Passes Labor-HHS Appropriations Bill

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The House Appropriations Subcommittee on Labor, Health and Human Services (HHS), Education, and Related Agencies held a mark-up of its fiscal year 2013 appropriations bill today, reducing the HHS discretionary budget by $1.3 billion below current levels. If signed into law, the bill would restrict use of any HHS funds to implement the Affordable Care Act and would rescind funds authorized for the Consumer Operated and Oriented Plan (CO-OP) Program, Center for Medicare & Medicaid Innovation, Prevention and Public Health Fund and Patient-Centered Outcomes Research Trust Fund. The legislation also would eliminate the Agency for Healthcare Research and Quality effective Oct. 1, 2012. Members of the California congressional delegation on the subcommittee voted along party lines, with Rep. Jerry Lewis (R) joining the majority to pass the bill, and Reps. Lucille Roybal-Allard (D) and Barbara Lee (D) opposing the bill. While the legislation will likely pass the full appropriations committee, it will not pass the Senate. CHA expects a final budget to be resolved in a conference committee.

OIG Seeks Input on Physician Self-Disclosure Protocol

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The Office of Inspector General (OIG) is seeking comments, recommendations and other suggestions on how to revise the Provider Self-Disclosure Protocol. The OIG plans to revise the protocol to conform to current industry requirements, and to provide useful guidance to the health care industry. The OIG will use lessons learned from processing more than 800 disclosures and recovering more than $280 million over the past 14 years. The comment period closes Aug. 17. Attached is the Federal Register notice.