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.
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.
In addition, every state that cuts Medicaid fee-for-service rates by up to 4 percent in one state fiscal year or up to 6 percent in two consecutive years would no longer be required to conduct analysis to determine if access to care would be harmed by the reductions. When reducing Medicaid payment rates, states would rely on baseline information about access under current payment rates, rather than be required to predict the effects of rate reductions on access to care.
The proposed rule does not change statutory responsibilities for states to ensure Medicaid members have access to services, but aims to provide regulatory relief to states. CHA is currently analyzing the impact of this proposed rule and will submit comments, which are due by 2 p.m. (PT) on May 22.
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 CMS issued changes to instructions for the Medicare Cost Report Worksheet S-10 late last year for cost-reporting years beginning with Oct.1, 2013, hospitals that revised and submitted amended cost reports for federal fiscal years 2014 and 2015 should review this update.
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.Read more
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.
CHA and a small group of hospital representatives recently met with DHCS to educate the state on the various contractual relationships that exist between hospitals, health plans and delegated entities, such as medical groups. The goal of the meeting was to define the types of arrangements that will be considered to meet the network provider requirement. DHCS confirmed that if a hospital has a contract with a delegated entity — including another hospital, medical group or health plan — admissions at that hospital will be considered in-network and eligible to receive the supplemental directed payment. In addition, if a hospital has a limited scope contract for a specific service line — emergency, transplant, orthopedic, etc. — those services will be considered in-network. However, patient-specific contracts and letters of agreement are not considered in-network and will not be eligible for supplemental payments. Similarly, admissions of non-contracted, out-of-network patients who present through the hospital’s emergency room will not be eligible to receive supplemental directed payments.
Although half of the managed care payments must be transitioned to the new directed payment method, the other half will continue to be made through the historic pass-through method, which does not require a contract and is based on 2013 utilization. CHA will continue to meet regularly with DHCS to refine the definition of a network provider and tackle other areas of concern related to the accuracy of the encounter data file. Updates will be provided through CHA News.
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. CHA was represented by Senior Vice President of Health Policy and Innovation Anne McLeod; Vice President of Federal Regulatory Affairs Alyssa Keefe; and Vice President of Finance Amber Ott.
CMS was responsive to questions and concerns raised by CHA, and provided helpful clarifying information that CHA believes supports the QAF program’s current direction and compliance with these new federal requirements CHA will continue discussions with CMS and the Department of Health Care Services over the next several months as the state plan amendment, tax waiver and managed care rates are submitted to CMS for review and approval.