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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.

President Signs Opioid Legislation

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President Trump on Wednesday signed bipartisan legislation to address the opioid crisis. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (H.R. 6) includes a number of provisions intended to reduce opioid use and improve treatment and recovery programs for substance use disorders (SUD). CHA has summarized the key provisions for hospitals, and has attached a detailed legislative summary prepared by Health Policy Alternatives.

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.

CMS Provides Updates for Post-Acute Care Quality Reporting

This post has been archived and contains information that may be out of date.

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

Inpatient Rehabilitation Facilities 
Provider Preview Reports
Updated inpatient rehabilitation facility (IRF) provider preview reports are now available. Providers have until Oct. 8 to review their 2017 quality measure performance data prior to their posting to the IRF Compare website in December. Corrections to the underlying data will not be permitted during this time. However, providers can request CMS review if they believe the data scores displayed are inaccurate. 

Four new quality measures will be reported on IRF Compare: 

Assessment-based measures:

Application of Percent of Long-Term Care Hospital Patients With an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)
Application of Percent of Residents Experiencing One or More Falls with Major Injury (NQF #0674)

Claims-based measures: 

Medicare Spending Per Beneficiary
Discharge to Community

CHA Comments on CY 2019 Physician Fee Schedule Proposed Rule

This post has been archived and contains information that may be out of date.

CHA has submitted the attached letter on the calendar year (CY) 2019 physician fee schedule (PFS) and quality payment program (QPP) proposed rule, providing comments on many of the provisions that are significant to hospitals and the physicians who provide care in hospitals. This includes CMS’ proposal to maintain a payment rate of 40 percent of outpatient prospective payment system (OPPS) rates for items and services furnished at certain off-campus hospital outpatient provider based clinics, as required by Section 603 of the Bipartisan Budget Act of 2015. CHA is disappointed that the agency continues to ignore the significant differences in regulatory requirements and responsibilities of the hospital outpatient department in providing health care services to Medicare beneficiaries, and urges the agency to refine its methodology for determining the rate. CHA believes a more robust analysis would support a payment rate of 65 percent of the OPPS rates.

CHA also comments on CMS’ proposal to reduce documentation requirements for evaluation and management (E/M) visits while collapsing payments for Level 2 through Level 5 E/M visits into a single blended payment rate. While supporting a number of the proposals that would reduce documentation burden, CHA urges the agency to withdraw its payment proposal and engage stakeholders to address the outdated coding system and improve payment accuracy in the future.