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Alternative Payment Models

Below are a number of resources to help member hospitals understand the regulatory framework as they move toward development and implementation of one or more alternative payment models (APMs). The information includes:

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Clarification Issued on Revised Worksheet S-10 Instructions

This post has been archived and contains information that may be out of date.

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. 

House Passes Budget Resolution

This post has been archived and contains information that may be out of date.

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.

CMS Extends Deadline for Revised Worksheet S-10 Data to Jan. 2

This post has been archived and contains information that may be out of date.

The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for hospitals to submit amended cost reports for federal fiscal years (FFY) 2014 and 2015 to account for recently issued changes to the instructions for Worksheet S-10. CMS has instructed Medicare administrative contractors to accept revised cost reports until Jan. 2, 2018. Previously, CMS required hospitals to submit this information by Oct. 31. Worksheets received by Dec. 2 will be reflected in the cost report data file that would typically be used to develop FFY proposed rules. However, if a hospital submits data after Dec. 2 but by Jan. 2, 2018, the data will be reflected in the cost report data file that is typically used to develop the FFY final rules.

CHA recently held an executive briefing, featuring faculty from Toyon Associates, to explain the revised instructions to Worksheet S-10 and provide hospitals with the information needed to make decisions on how best to position themselves to improve performance under the revised instructions. A recording of the executive briefing and additional resources on Worksheet S-10 are available on CHA’s website.

Carmela Coyle

Carmela Coyle began her tenure as President & CEO of the California Hospital Association, the statewide leader representing the interests of more than 400 hospitals and health systems in California, in October 2017.

Previously, Coyle led the Maryland Hospital Association for nine years, where she played a leading role in reframing the hospital payment system in Maryland and moving to a value-based methodology. Maryland is now considered a national leader in health care policy and innovation.

Prior to 2008, Coyle spent 20 years in senior policy positions with the American Hospital Association (AHA), including 11 years as the senior vice president of policy, where she served as a national media spokesperson and led AHA’s policy development and strategy planning activities. Earlier in her career, she worked for the Congressional Budget Office in Washington, D.C., advising members of Congress and their staff on the economic and budgetary implications of legislative policy.

IMPACT Act Resources

Background

On October 6, 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) was signed into law. The Act requires post-acute care (PAC) providers — including long-term care hospitals (LTCHs), skilled-nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs) and home health agencies (HHAs) — to submit standardized data using specific reporting tools.

CMS Issues Revised Instructions for S-10 Worksheet

This post has been archived and contains information that may be out of date.

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. 

CHA DataSuite Releases Analysis of IPPS FFY 2018 Final Rule

This post has been archived and contains information that may be out of date.

CHA DataSuite has provided member hospitals and health systems with a hospital-specific analysis showing how Medicare inpatient fee-for-service payments will change from federal fiscal year (FFY) 2017 to FFY 2018 based on the policies in the Centers for Medicare & Medicaid Services’ (CMS) FFY 2018 inpatient prospective payment system (IPPS) final rule. The analysis compares the year-over-year changes in operating, capital and uncompensated care IPPS payments. It also includes breakout sections with detailed insight into specific policies that influence IPPS payment changes, including:

Potential penalties under the Inpatient Quality Reporting and Electronic Health Record Incentive programs
Expiration of the Medicare Dependent Hospital and expanded Low-Volume Hospital Adjustment programs
Quality-based payment adjustments
Disproportionate share hospital (DSH) uncompensated care (UCC) payments
CMS’ transition to the Medicare Cost Report Worksheet S-10 for UCC payments for FFY 2018