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CMS Issues Final Rule With Comment Period on Access to Covered Medicaid Services

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The Centers for Medicare & Medicaid Services (CMS) has issued a final rule with comment period that aims to allow states and CMS to make better informed, data-driven decisions when considering whether proposed changes to Medicaid fee-for-service payment rates are sufficient to ensure that Medicaid beneficiaries have access to covered Medicaid services. The final rule also intends to strengthen CMS’ ability to review Medicaid payment rates to ensure they are consistent with efficiency, economy and quality of care, as well as ensure sufficient beneficiary access to care under the Medicaid program. CMS also issued a Request for Information (RFI) to gather input into additional approaches that it and states may consider to better ensure compliance with Medicaid access requirements. The RFI asks for comments on the potential development of standardized core set measures of access, access measures for long-term care and home and community-based services, national access to care thresholds, and resolution processes that beneficiaries could use when they have problems accessing essential health care services.

CMS Seeks Comments on Physician Payment Provisions of MACRA

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The Centers for Medicare & Medicaid Services (CMS) issued the attached request for information (RFI) yesterday seeking public comment on implementation of some of the payment provisions for physicians and professionals in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Those provisions include the merit-based incentive payment system, incentive payments for participation in certain alternative payment models, and physician-focused payment models. CMS also made available a frequently asked questions document on the MACRA provisions. Responses to the RFI will be due 30 days after publication in the Federal Register, which is scheduled for Oct. 1.

CHA Issues Summary of 340B Omnibus Guidance

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CHA has released the attached summary, prepared by Health Policy Alternatives, Inc., detailing the 340B omnibus guidance released Aug. 28 by the Health Resources and Services Administration (HRSA). The notice with comment period provides guidance for covered entities enrolled in the 340B program and drug manufacturers required by section 340B of the Public Health Service Act to make their drugs available to covered entities under the 340B program.

CHA Submits Comments on CCJR Payment Model Proposed Rule

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CHA has submitted the attached comment letter on the Centers for Medicare & Medicaid Services (CMS) Comprehensive Care for Joint Replacement Payment Model proposed rule.

In the letter, CHA urges CMS to consider several important changes to the proposed rule so that hospitals, physicians and post-acute care providers can collectively continue to provide the highest quality care to Medicare beneficiaries while fulfilling the shared goals of the triple aim. Specifically, CHA urges CMS to delay the start date of the program; narrow the 90-day episode definition to only elective joint replacement procedures; further refine the risk adjustment model; and exclude the Hospital Consumer Assessment of Healthcare Providers and Systems survey from the program.

HRSA Issues Proposed Guidance for 340B Drug Pricing Program

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The Health Resources and Services Administration (HRSA) has released “mega guidance” for its proposed 340B Drug Pricing Program. The guidance is included in a notice with a 60-day comment period. In the guidance, HRSA provides clarification on the areas of covered entity eligibility, patient definition, group purchasing organization prohibition, contract pharmacy, duplicate discounts and covered entity audits. It also includes enhanced program integrity requirements for pharmaceutical manufacturers participating in the program. CHA is reviewing the proposed guidance and will seek member input on the anticipated hospital impact. Comments are due Oct. 26.

Registration for Call on CCJR Bundled Payment Model Closes Tomorrow

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CHA reminds members to register by noon tomorrow, Aug. 13, for a member call on the proposed rule for the Comprehensive Care for Joint Replacement (CCJR) bundled payment model. Scheduled for Aug. 14 from 11 a.m. – noon (PT), the call will provide an overview of the proposed rule and solicit member input for CHA’s comments, which are due Sept. 8. CHA encourages all hospitals currently providing lower extremity joint replacement services to participate. While CMS is currently proposing this mandatory model in randomly selected metropolitan statistical areas (MSAs) across the country — including three in California — the MSAs have the potential to change between now and release of the final rule. The policy’s effective date is currently scheduled for Jan. 1, 2016.

To register for the call, visit www.surveymonkey.com/r/ccjrproposed. Members are encouraged to send questions in advance. A dial-in number and materials will be sent to registered attendees on Aug. 13 and posted to the CHA website. Additional information about the proposed rule is available at www.calhospital.org/cha-news-article/cha-issues-summary-ccjr-payment-model-proposed-rule. 

CHA DataSuite Releases Analysis of CCJR Payment Model

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CHA DataSuite has released a report analyzing the 2015 Comprehensive Care for Joint Replacement (CCJR) model, a new Medicare Part A and B payment model. The proposed rule implementing CCJR would require acute care hospitals in certain selected geographic areas, including three in California, to participate in the model and receive bundled payments for episodes of care where the diagnosis at discharge included lower extremity joint replacement or attachment of a lower extremity that was furnished by the hospital. The DataSuite analysis provides hospitals with a first look at Medicare spending for episodes of care specific to their own patients. The report uses only 2013 data and is not an estimate of the program’s impact, although an impact analysis will be produced when 2014 data becomes available from the Centers for Medicare & Medicaid Services.

CHA Issues Summary of CCJR Payment Model Proposed Rule

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CHA has released the attached summary, prepared by Health Policy Alternatives, Inc., detailing the Centers for Medicare & Medicaid Services (CMS) proposed rule implementing the Comprehensive Care for Joint Replacement (CCJR) model, a new Medicare Part A and B payment model. The proposed rule would require acute care hospitals in certain selected geographic areas, including three in California, to participate in the CCJR model and receive bundled payments for episodes of care where the diagnoses at discharge included lower extremity joint replacement or attachment of a lower extremity that was furnished by the hospital. The summary details provisions of the proposed rule, including the definition of the episode initiator; methodology for setting episode prices and payment for model participants; and the use of quality measures and data sharing.

CMS to Host Webinars on its New Joint Replacement Model

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As reported in CHA News last week, the Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that creates a new model in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for hip and knee replacements beginning Jan. 1, 2016. This week, the CMS Innovation Center will host two webinars for providers to discuss the new model: July 15 from 10 – 11 a.m. (PT) and July 16 from 11 a.m. – noon.