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HHS Proposes Quality Rating System for Qualified Health Plans

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The Department of Health and Human Services (HHS) published the attached notice in the Federal Register on Nov. 19, proposing a quality rating system (QRS) for qualified health plans (QHPs) offered through health insurance exchanges. The Affordable Care Act requires HHS to create a system enabling consumers to compare QHPs based on relative quality, price and enrollee satisfaction. The notice outlines a proposed methodology for selecting QRS measures, organizing such measures into broad categories meaningful to consumers (e.g., care coordination, preventive services, patient safety, etc.), and calculating statistically valid global ratings for each QHP (as is now done under the Medicare Advantage 5-star rating system).

CHA Members Take Hospital Message to Capitol Hill

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CHA President/CEO C. Duane Dauner was joined by 10 representatives of CHA member hospitals in Washington, D.C., Dec. 3 for the CHA and American Hospital Association hospital advocacy day. The group met with about half of the California Congressional delegation, including House Minority Leader Nancy Pelosi, House Majority Whip Kevin McCarthy, and Sens. Boxer and Feinstein.

US Supreme Court Same Sex Marriage Rulings Have Major Impact for Employers

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On June 26, 2013, the US Supreme Court’s decision in United States v. Windsor struck down Section 3 of the federal law known as the Defense of Marriage Act (DOMA). Under DOMA and for purposes of federal law, the term “spouse” was limited to individuals of the opposite sex.

OIG Revises Self-Disclosure Protocol

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The U.S. Office of Inspector General (OIG) today issued a revised guidance to its provider Self-Disclosure Protocol (SDP). The guidance addresses a range of issues for providers who wish to voluntarily disclose self-discovered evidence of potential fraud, including conduct eligible (and ineligible) for the SDP, disclosure requirements, calculating damages and reporting potential anti-kickback statute violations. The new protocol also suspends a 60-day overpayment rule (see CHA’s comments) proposed by the Centers for Medicare & Medicaid Services (CMS). The OIG said it would provide further SDP guidance once CMS releases its final rule on the 60-day overpayment issue. The revised SDP is available at http://oig.hhs.gov/compliance/self-disclosure-info/files/Provider-Self-Disclosure-Protocol.pdf.

CMS and ONC Seek Input on Advancing Interoperability, HIE

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The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have issued the attached request for information (RFI). Seeking input on potential policy and program changes to accelerate electronic health information exchange (HIE) across providers, the RFI specifically addresses the extent to which current CMS payment policies encourage or impede electronic information exchange across health care provider organizations, as well as which current programs are having the greatest impact on encouraging electronic HIE. CMS also asks providers to suggest how CMS and states can use existing authorities to better support electronic and interoperable HIE among Medicare and Medicaid providers — including post-acute, long-term care and behavioral health providers — and how policies could be developed to maximize the impact on care coordination and quality improvement. Comments on the RFI are due April 22.

CHA Comments on Hospital Readiness to Use EHRs for Quality Reporting

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CHA has submitted the attached comments to the Centers for Medicare & Medicaid Services (CMS) on hospital and vendor readiness to report certain clinical quality measures under the Hospital Inpatient Quality Reporting program using certified electronic health record (EHR) technology. Submitted in response to a CMS request for information, CHA’s letter raises concerns about the ability of hospitals to collect and report measures through an EHR when the vast majority of California’s hospitals have not met stage 1 “meaningful use” requirements and the accelerated timeline for implementing and revising measure specifications. CHA also urges CMS to use the Measures Application Partnership to bring the Office of the National Coordinator for Health Information Technology’s quality reporting efforts into better alignment with the Hospital Inpatient Quality Reporting Program.

CHA Comments on ACA’s Medicare DSH Provisions Prior to Formal Rulemaking

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CHA has submitted comments on the Medicare disproportionate-share hospital (DSH) provisions in Section 3133 of the Affordable Care Act (ACA) to the Centers for Medicare & Medicaid Services (CMS). The comments were provided in response to the agency’s request for input following a Jan. 8 National Provider Call on the same topic. In its comment letter, CHA recommends CMS consider, for formal rulemaking, adopting a definition of “uninsured” that includes undocumented individuals; adopting a definition of “uncompensated care” that includes the unreimbursed costs of Medicaid, the Children’s Health Insurance Program and other state and local government indigent care programs; and including graduate medical education costs in calculating cost-to-charge ratios. In addition, CHA urges greater clarity regarding definitions for lines 17 and 18 of Worksheet S-10, and requests excluding revenue streams created in California’s most recent Section 1115 waiver from uncompensated care calculations. For more information, see attached comments. CHA expects CMS to propose policies for implementing both the Medicare and Medicaid DSH provisions in the fiscal year 2014 inpatient prospective payment system proposed rule to be released in April. CHA will convene members to discuss these important provisions during the comment period.

Duals Demo Timeline Changes Included in Proposed State Budget

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Gov. Jerry Brown’s 2013-14 state budget proposal, released Jan. 10, includes a delay in implementing the Coordinated Care Initiative (CCI), which will transition individuals eligible for both Medicare and Medi-Cal —dual-eligibles — into managed care. It will also integrate long-term care services and supports into managed Medi-Cal. CCI implementation is now scheduled for September 2013, rather than June 2013 as originally planned. Under the revised timeline, beneficiaries will receive notice of changes no sooner than June 2013. Beneficiary enrollment schedules have also been modified and will vary among the designated counties: in Los Angeles County, enrollment will be phased in over 18 months; in the County of San Mateo, beneficiaries will be enrolled at once; and in Orange County, County of San Diego, County of San Bernardino, County of Riverside, Alameda County, and the County of Santa Clara, enrollment will be phased in over 12 months.

CMS Issues RFI on Hospital Readiness to Electronically Report Quality Measures

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The Centers for Medicare & Medicaid Services (CMS) has issued a request for information (RFI) on hospital and vendor readiness to report certain clinical quality measures under the hospital inpatient quality reporting program using certified electronic health record (EHR) technology required by the Medicare EHR Incentive Program. In the RFI, CMS asks hospitals to answer a number of questions, including if they plan to adopt EHR certified technology during or before calendar year (CY) 2014; if they are aware of payment adjustments beginning in fiscal year 2015 for failing to demonstrate meaningful use requirements under the EHR Incentive Program; what operational challenges exist to electronically report data, and what tools and methodologies they and their vendors use to validate data. For the full list of CMS questions, see attached RFI. CHA is interested in hearing from hospitals about their experiences implementing clinical quality measures using certified EHRs to inform our response to CMS. Comments can be submitted electronically to CMS at www.regulations.gov and are due Jan. 22 by 2 p.m. (PT).

CHA Submits Comments on Quality Measurement in Insurance Exchanges

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CHA has submitted comments to the U.S. Department of Health and Human Services (HHS) in response to a request for information on health plan quality management in health insurance exchanges under the Affordable Care Act. In its comment letter, CHA notes California hospitals’ extensive experience in quality reporting programs at both the state and federal level. CHA also offers HHS several guiding principles to consider as the agency begins the rulemaking process to measure quality in the exchanges.