The newsroom includes access to CHA News, which provides timely information to members every Monday and Thursday and is at the core of CHA benefits. In addition, it is also home to resources such as toolkits and talking points designed to help member hospitals and health systems communicate with internal and external audiences on a range of current health care-related issues. Links to CHA media statements and press releases can also be found here.
New resources are available from the Substance Abuse and Mental Health Services Administration to help providers who care for children with serious emotional disturbances, including those caused by disasters. The resources define “serious emotional disturbance,” address emotional disturbances during disasters, highlight disasters’ emotional impact on children and teens, clarify complex trauma and how it can impact children, and explain causes of post-traumatic stress disorder in children and teens.
On Jan. 16, CHA submitted a comment letter to the California Department of Tax and Fee Administration (CDTFA) on its proposed amendments that would clarify how sales and use tax is applied to medical items furnished by hospitals.
In the letter, CHA urges CDTFA not to change its current policy that treats hospitals as retailers and to convene a small workgroup to fully understand the ramifications of the proposed changes. CHA also identifies complexities that would result from the proposal as currently written, including that it would require auditors to use confidential patient medical records to determine taxability.
CDTFA has acknowledged it will not apply the proposed rule to hospital claims for services rendered prior to Jan. 1, and will resume processing all claims that have been on hold. Should CDTFA finalize these changes, CHA also urges CDTFA to replace the proposal’s effective date of Jan. 1, 2019, with a prospective date so that hospitals have time to prepare.
Last week, the Department of Health Care Services (DHCS) issued its final All Plan Letter (APL) 19-001, specifying contractual requirements that must exist between Medi-Cal managed care plans (MCPs) and hospitals for a hospital to be considered a network provider.
This definition of a network provider will take effect in state fiscal year 2019-20 (July 1, 2019-June 30, 2020). As previously noted in CHA News and discussed on a previous CHA Hospital Fee Program webinar, hospitals and MCPs must comply with the requirements to be eligible to receive Hospital Fee Program managed care payments under the Private Hospital Directed Payment Program. To be eligible for directed payments, hospitals and MCPs must:
- Have an executed written Network Provider Agreement with the MCP, or its subcontractor, that meets all the requirements set forth in Attachment A of APL 19-001.
- Be enrolled in accordance with the APL 17-019, the Medi-Cal Managed Care Provider Enrollment FAQ document, or any subsequent APL or FAQ.
- Be reported on the MCP’s 274 file submitted to DHCS in accordance with APL 16-019 or any subsequent APL on the topic and the most recent DHCS 274 Companion Guide.
- Be included on all network adequacy filings that occur within the effective dates on the written Network Provider Agreement, in accordance with APL 18-005 or any subsequent APL following the agreement’s execution.
Even though the definition of a network provider will change in state fiscal year 2019-20 as result of APL 19-001, DHCS intends to continue the current process of hospitals and MCPs working together to populate the Contract Status (“network provider”) fields for each encounter.
To help members understand how this APL impacts the Hospital Fee Program, CHA will host a webinar on Feb. 21; registration is available online.
A new report from the Department of Managed Health Care examines the degree to which providers were able to offer timely appointments in response to patients’ requests, based on provider-reported data from measurement year 2017.
The report measures how frequently providers had appointments available within wait time standards. For non-urgent appointments, availability within the wait time standards ranged from a high of 99 percent of the time to a low of 70 percent. For urgent appointments, that percentage ranged from a high of 99 percent to a low of 52 percent.
In All Facilities Letter 19-03, the California Department of Public Health outlines requirements for a federal grant available to skilled-nursing and nursing facilities.
The grant funding will come from federal civil monetary penalties issued when a facility is out of compliance with one or more Medicare or Medicaid participation requirements. Through the grant process, the funds are reinvested to support activities that benefit patients’ quality of life.
Requirements for billing outpatient physical therapy (PT), occupational therapy (OT) and speech language pathology (SLP) services have changed as of Jan. 1.
Providers of outpatient (Part B) PT, OT and SLP services are no longer required to include functional status reporting (G-codes) for services provided on or after Jan. 1. While providing the G-codes is no longer required for payment, CMS is retaining the set of 42 non-payable HCPCS G-codes until calendar year (CY) 2020. This is intended to allow time for therapy providers and other private insurers who currently use the codes for functional reporting to update their billing systems and policies, and to ensure claims that inadvertently contain any of these G-codes during 2019 are not unnecessarily returned or rejected.
Elimination of Therapy Caps: Use of “KX” modifier
The Balanced Budget Act (BBA) of 2018 repealed the Medicare annual per beneficiary caps on PT, OT and SLP. Previously, therapy providers were required to use the “KX” modifier when annual per beneficiary expenditures exceed $2,010 for PT and SLP services combined, and $2,010 for OT services. However, while the caps have been eliminated, the new law requires that providers continue to include a modifier on the Medicare claim once the prior therapy cap amounts have been reached. Therapists must continue to track total claim amounts for Medicare beneficiaries and apply the “KX” modifier to claims that exceed the $2,100 threshold, as confirmation that the services are medically necessary as documented in the medical record.
Payment for Outpatient PT and OT Services Furnished by Therapy Assistants
The BBA of 2018 also included a provision reducing payment to therapy services furnished in whole or part by a PT or OT assistant to 85 percent of the physician fee schedule (PFS) amount beginning on Jan. 1, 2022. CMS finalized two modifiers, one to identify services furnished in whole or in part by PT assistants and the other to identify services furnished in whole or in part by OT assistants. CMS anticipates addressing therapy assistant modifiers and the 10 percent standard, including their application in different scenarios and types of services, more specifically in CY 2020 rulemaking.
CHA has submitted comments to the Centers for Medicare & Medicaid Services (CMS) on its release of preliminary findings from the national beta test of standardized patient assessment data elements (SPADEs).
Late last year, CHA participated in a meeting hosted by CMS and the RAND Corporation, where an overview of the findings was presented. CHA is still reviewing the information and intends to provide additional comment. In this initial comment letter, CHA urges CMS to release the beta test data set so that other stakeholders can conduct analysis for the agency’s consideration. In addition, CHA raises concerns about the patients for whom data was not collected, particularly those with cognitive impairments or whose primary language is not English. CHA will continue to engage with CMS and members on these and other important issues.
The beta test was conducted in 143 post-acute care (PAC) facilities, across 14 markets, from November 2017 to September 2018. CMS is currently working to develop, implement and maintain standardized PAC patient assessment data. This test was intended to determine the reliability, validity and ease of use of data elements in four PAC settings: home health agencies, skilled-nursing facilities, inpatient rehabilitation facilities and long-term care hospitals. The data collected by SPADEs, if found to be reliable and valid, will enable CMS to compare patients’ clinical characteristics across PAC settings, beyond existing claims and patient assessment data. It would also be used to inform future payment reforms, such as a unified PAC prospective payment system.
CHA appreciates CMS’ efforts to make available early findings for review and discussion, and urges continued dialogue with stakeholders in the implementation of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act.
Earlier this month, the Department of Health Care Services (DHCS) sent hospitals invoices covering fee-for-service cycle 8 of the 2017-19 Hospital Fee Program. The cycle eight invoice covers Oct. 1, 2018-Dec. 31, 2018, and was due Jan. 2. DHCS collected enough fees to pay nearly 100 percent of the modeled cycle eight Medi-Cal fee-for-service payments, and will issue payments to providers on Jan. 21.
In preparation for an upcoming meeting to solicit stakeholder feedback on possible changes to Title 22 infection control and physical plant regulations for general acute care hospitals, the California Department of Public Health has released a series of questions. More details are available in All Facilities Letter 18-56.1.
Nonprofit organizations and counties that participate in the County Medical Services Program (CMSP) are encouraged to apply for funding through the Health Systems Development Grant Program.
Grants of up to $300,000 are available to support programs that strengthen the overall health care delivery system, increase access to care and coordinate care within CMSP counties. More information and an application, due March 1, are available online.