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The Centers for Medicare & Medicaid Services (CMS) has issued the attached interim final rule with comment period delaying, by three months, implementation of its new mandatory episode-based payment model (EPM) for cardiac care and expansion of the current Comprehensive Care for Joint Replacement (CJR) model to include surgical treatments for hip and femur fractures beyond hip replacement. The interim final rule, which was issued to give the Trump Administration additional time to review the original final rule consistent with the administration’s regulatory freeze, delays the implementation date of these models from July 1 to Oct. 1. It also further delays certain provisions for a second time, from March 21 to May 20. In addition, CMS seeks comments on the appropriateness of the delay, and whether implementation of the new models should be delayed further until Jan. 1, 2018.

CHA anticipates that CMS will make fairly significant modifications to these programs through separate rulemaking in the very near future, and will respond during this 30-day comment period. As providers await more details from CMS, CHA is interested in learning from members about the programs’ opportunities and challenges and changes that are needed. Contact Alyssa Keefe, CHA vice president, federal regulatory affairs, at akeefe@calhospital.org or (202) 488-4688 with feedback.    

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CHA reminds hospitals participating in the Comprehensive Care for Joint Replacement (CJR) Model to provide the Centers for Medicare & Medicaid Services (CMS) with a list of previous and current CJR collaborators as of Feb. 28. Participating hospitals are required to provide CMS with “evidence sufficient to enable the audit, evaluation, inspection, or investigation of the individual’s or entity’s compliance with CJR requirements, the quality of services furnished, the obligation to repay any reconciliation payments owed to CMS, or the calculation, distribution, receipt, or recoupment of gainsharing payments, alignment payments, or distribution payments.” CJR participant hospitals should complete the attached Excel form and submit to CJRsupport@cms.hhs.gov by 5 p.m. (PT) on March 21.

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CHA has submitted the attached comment letter on the Centers for Medicare & Medicaid Services (CMS) proposed rule specifying necessary qualifications practitioners must meet to furnish and fabricate prosthetics and custom-fabricated orthotics. Noting that the proposed rule would impose additional burden on hospitals, and is inconsistent with the Trump Administration’s commitment to reducing regulatory burden, CHA urges CMS to withdraw rather than finalize the proposed rule. If CMS moves forward in finalizing the rule, CHA urges CMS to make changes to its proposed policies. Specifically, CHA urges CMS to exempt occupational and physical therapists from certain certification requirements and to make changes to its fabrication facility requirements. Comments on the proposed rule are due March 13 by 5 p.m. (PT).

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CHA seeks member input on a Centers for Medicare & Medicaid Services (CMS) proposed rule specifying necessary qualifications practitioners must meet to furnish and fabricate prosthetics and custom-fabricated orthotics. The rule would also address the qualifications and accreditation requirements suppliers must meet in order to fabricate and bill for the same devices. In addition, the rule sets forth a time frame by which qualified practitioners and suppliers must meet the rule’s requirements. CHA is developing its comment letter and seeks input from members on how the provisions in this proposed rule would impact their operations. Comments and questions should be directed to Megan Howard, CHA senior policy analyst, at mhoward@calhospital.org.

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On Jan. 20, the Trump Administration issued a memo to the heads of all executive departments and agencies freezing new and pending federal regulatory activity until the President’s appointees or designees have had the opportunity to review any new, recently finalized or pending regulations. The memo, which is common for an incoming administration, addresses regulations that have been sent to the Office of the Federal Register but not yet published, as well as regulations that have been published in the Federal Register but were not yet effective on Jan. 20.

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The Centers for Medicare & Medicaid Services has published the attached Medicare Learning Network Matters article about the waiver of the three-day qualifying stay for post-hospital care provided in a skilled-nursing facility (SNF) under the Comprehensive Care for Joint Replacement model. The article addresses policies related to the waiver and how services should be billed, and describes conditions that must be met for coverage of the SNF stay.

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The Centers for Medicare & Medicaid Services (CMS) has issued the attached final rule implementing the Physician Quality Payment program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In response to comments from CHA and other stakeholders, CMS has finalized a number of changes that increase flexibility for the Merit-based Incentive Payment System (MIPS) and for qualifying for incentive payments through participation in advanced alternative payment models (APMs).

Among the changes finalized, CMS has codified its previous announcement that physicians will be able to pick their own pace under MIPS for the 2017 transition year. Specifically, CMS will allow MIPS-eligible clinicians to avoid a negative payment adjustment by submitting a minimum amount of data (for example, one quality measure or one improvement measure). CMS has also finalized an option of a continuous 90-day MIPS reporting period that would allow clinicians to receive a neutral or modest payment increase, depending on performance. Clinicians who choose to report for more than 90 days up to a full year would be eligible for moderate positive payment adjustments.

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CHA has developed a seminar to help participating hospitals and their staff understand the clinical and financial risks associated with the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Care for Joint Replacement (CJR) program. Implementing CJR —Strategies for Success will be held on Oct. 25 from 8:30 a.m. – 4 p.m. in Los Angeles.

The nationwide mandatory episode payment model, which took effect April 1, impacts 135 California hospitals in three metropolitan service areas. The Implementing CJR—Strategies for Success seminar will provide participants with the knowledge needed to manage patient care, foster physician alignment and develop effective partnerships with post-acute care providers. The program features state and national faculty, each with an area of expertise in episode care payment models. Session topics include: CJR program overview; using data to identify opportunities and risks; creating or strengthening your post-acute care strategy; legal considerations including collaborator agreements, gainsharing and program waivers; and planning for CJR implementation in your facility.