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CMS Expands Site-Neutral Payment Policy in CY 2019 OPPS Final Rule

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Today, the Centers for Medicare & Medicaid Services (CMS) issued its final rule updating the outpatient prospective payment system (OPPS) for calendar year (CY) 2019, which also includes payment updates for ambulatory surgical centers. Despite strong opposition from CHA and the hospital field, CMS finalized an expansion of its site-neutral payment policies.

CMS Issues CY 2019 Physician Fee Schedule Final Rule

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The Centers for Medicare & Medicaid Services (CMS) yesterday released its final rule updating the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies for calendar year (CY) 2019. The final rule includes a number of significant proposals that will impact hospitals and clinicians. Included in the PFS final rule is an interim final rule that implements provisions of the recently signed Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act.

CMS Finalizes Physician Fee Schedule Rule

This post has been archived and contains information that may be out of date.

Today, the Centers for Medicare & Medicaid Services (CMS) issued the physician fee schedule (PFS) final rule for calendar year 2019. A fact sheet and press release are available.

In addition, CMS released the end-stage renal disease prospective payment system final rule, which includes provisions related to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program. A fact sheet and press release are available.

CMS Provides Updates for IRF, LTCH 2019 Policy Changes

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The Centers for Medicare & Medicaid Services (CMS) has issued the attached MLN Matters article about federal fiscal year 2019 policy changes to the inpatient rehabilitation facility (IRF) and long-term care hospital (LTCH) prospective payment systems. Included are MS-DRG grouper changes, wage index changes, and updates to quality reporting and value-based purchasing programs. 

CHA Submits Letter on Anti-Kickback Statute Request for Information

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CHA has submitted the attached comment letter in response to the Office of Inspector General’s (OIG) recent request for information (RFI) seeking public input on safe harbors to the Anti-Kickback Statute (AKS). The RFI also seeks comments on exceptions to the beneficiary inducements civil monetary penalty definition of “remuneration,” as related to care coordination.

CHA Submits Comments on Medicare Shared Savings Program Proposed Rule

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CHA has submitted the attached comment letter to the Centers for Medicare & Medicaid Services (CMS) on its proposed rule that would make changes to the Medicare Shared Savings Program. CHA thanks members for their feedback, which helped inform these comments.

In the letter, CHA outlines a number of principles that members believe are critically important in new alternative payment model designs. CHA appreciates CMS’ continued stakeholder engagement on its new direction for the Center for Medicare & Medicaid Innovation and the development of new alternative payment models, and urges CMS to reconsider a number of provisions.

CMS Provides Updates for Post-Acute Care Quality Reporting

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The Centers for Medicare & Medicaid Services (CMS) regularly provides important updates for post-acute care (PAC) quality reporting programs (QRP), including training opportunities, public reporting details and reminders of data submission and review deadlines. 

Inpatient Rehabilitation Facilities

Provider Preview Reports
Inpatient rehabilitation facility (IRF) provider preview reports are now available with first through fourth quarter 2017 data. IRFs are reminded to review performance data on quality measures by Oct. 8, prior to public display on IRF Compare in December 2018. While corrections to the underlying data are not permitted during this time, providers may request a CMS review if they believe that the data are incorrect.

FFY 2019 Uncompensated Care Payments to Come From 2014, 2015 Worksheet S-10 Data

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In the federal fiscal year (FFY) 2019 inpatient prospective payment system final rule, the Centers for Medicare & Medicaid Services (CMS) finalized its second year of a three-year transition to use Worksheet S-10 data for distributing Medicare disproportionate share hospital (DSH) uncompensated care payments. CMS will use two years (FFYs 2014 and 2015) of Worksheet S-10 cost report data and one year of proxy data to distribute the uncompensated care payments for FFY 2019.

In response to comments from CHA, CMS noted in the final rule that it planned audits of the data in fall 2018. In late August, CMS began audits of selected hospitals’ FFY 2015 cost reports. A number of hospitals in California have received this data request, and must respond by Sept. 28.  

Because CMS has given the Medicare administrative contractors (MACs) only until the end of January to complete the audits, providers have a short timeline to complete this work with their MACs. Though CHA acknowledges that this presents a challenge from both technical and resource perspectives, CHA highly encourages hospitals that have received a request to respond as quickly as possible. Early communication with Noridian (or its subcontractor, Figliozzi & Company) is critical under this short timeline. A copy of the letter Noridian sent to select providers requesting documentation is attached; these letters are consistent across all MACs.

CHA Comments on CY 2019 Outpatient PPS Proposed Rule

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CHA has submitted the attached comment letter on the calendar year (CY) 2019 outpatient prospective payment system (OPPS) proposed rule. In reviewing the policy and payment proposals outlined in the proposed rule, CHA is concerned that the agency has taken steps that are not only unlawful, but threaten the financial stability of the hospital OPPS and, in turn, access to care for Medicare beneficiaries. In particular, CHA strongly opposes CMS’ proposals to expand site-neutral payment policies for off-campus provider-based departments (PBDs) and to expand payment cuts for non-excepted PBDs participating in the 340B Drug Pricing Program. In addition, CHA provides comments on a number of other proposed payment and policy provisions. Specifically, CHA:

Urges CMS to withdraw all three of its proposals to expand site-neutral payment policies in off-campus PBDs
Opposes CMS’ proposal to reduce payments for separately payable Part B drugs from wholesale acquisition cost (WAC) plus 6 percent to WAC plus 3 percent

CHA Submits Comments to DEA on Controlled Substances Quotas

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CHA has submitted the attached comments on the Drug Enforcement Administration’s (DEA) notice of proposed rulemaking on aggregate production quotas for Schedule I and II controlled substances.

The DEA’s proposed aggregate production quotas would reduce manufacturing quotas for six frequently used opioids by an average of 10 percent. In the letter, CHA requests that the DEA reconsider this reduction to mitigate the ongoing drug shortages in California’s hospitals. Further, CHA urges the agency to reconsider its proposal to reduce manufacturing quotas specific to injectable medications used in hospitals rather than other dosage forms or opioid products.

While setting production quotas for opioid medications can be an effective step in preventing these controlled substances from accumulating in amounts that exceed legitimate need, CHA raises concerns that the limited information the DEA considered when developing these quotas does not reflect hospital patients’ legitimate need for essential medication.

CHA will continue to work with stakeholders, as California continues to be in a critical shortage situation.