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:
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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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 Centers for Medicare & Medicaid Services (CMS) has published data collection protocols for the current beta test of standardized patient assessment data, as required by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). The data — which will be collected at admission and discharge in long-term care hospitals, inpatient rehabilitation facilities, skilled-nursing facilities and home health agencies — will be tested for potential inclusion in the four currently administered post-acute care instruments.
The Centers for Medicare & Medicaid Services (CMS) will host a one-hour webinar on Dec. 13 addressing the recently published final rule that cancelled the episode payment models and revised the Comprehensive Care for Joint Replacement (CJR) model. The presentation will begin at 11 a.m. (PT); registration is available online.
The webinar will provide an overview of the final rule and clarify which hospitals are eligible for voluntary participation in the CJR model and how they may elect to participate. CMS has provided a list of participating hospitals and their status under the final rule. A template letter for hospitals eligible to elect voluntary participation in the CJR model is also available; the deadline for submission is Jan. 31.
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) issued the attached proposed rule updating Medicare Advantage and the Part D prescription drug program for contract year 2019. Among the proposed changes, CMS would codify the current Quality Star Rating System for Medicare Advantage and Part D plans, eliminate the “meaningfully different” standard that Medicare Advantage organizations must meet if they offer multiple plans in the same county and change the open enrollment period to Jan. 1 through March 31.
CMS also solicits comments on how Part D plan sponsors — through their pharmacy benefit managers — negotiate drug price concessions from drug manufacturers, network pharmacies and other entities. Specifically, CMS is interested in learning if Part D plans and their pharmacy benefit managers are lowering premiums and cost-sharing for beneficiaries because of the savings generated from price concessions.
The Centers for Medicare & Medicaid Services (CMS) has posted quality reporting program quick reference guides for several post-acute care settings, including long-term care hospitals, inpatient rehabilitation facilities, home health agencies and hospice. The guides include frequently asked questions, information on help desks and links to additional resources.
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 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.
The Centers for Medicare & Medicaid Services (CMS) has notified hospitals participating in the Comprehensive Care for Joint Replacement (CJR) Model that they must make selections to participate in either Track 1 or Track 2 of the model by Oct. 24 at 5 p.m. (PT). Track 1 of the CJR model is considered an Advanced Alternative Payment Model (APM) under requirements of the Medicare Access and CHIP Reauthorization Act (MACRA). Participation in Track 1 requires hospitals to attest to the use of Certified Electronic Health Record Technology, as defined in 42 CFR Section 414.1305, to document and communicate clinical care to their patients or other health care providers, and to submit a financial arrangement list of CJR collaborators. CJR collaborators of the Track 1 participant hospitals and the practice collaboration agents of CJR collaborators are eligible to earn a 5 percent APM incentive payment under the Quality Payment Program, provided they achieve threshold levels of participation in Advanced APMs to attain qualifying APM participant (QP) status for a year.
CMS also notes that hospitals that previously selected Track 2 participation may revise their election to Track 1. Track selection can be made by filling out the attached Excel spreadsheet and sending it to CJRSupport@cms.hhs.gov. A document providing additional instructions is attached.