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Yesterday, CHA met with representatives from the Centers for Medicare & Medicaid Services (CMS) at its headquarters in Baltimore to discuss the Medicaid managed care rules finalized in May 2016 and January 2017 and, specifically, their impact on the Quality Assurance Fee (QAF) program.
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The Centers for Medicare & Medicaid Services (CMS) has issued the attached proposed rule updating the physician fee schedule (PFS) for calendar year (CY) 2018. The proposed rule includes a number of provisions that will impact hospitals, including a proposal to reduce payments to non-excepted, off-campus provider-based departments to 25 percent, rather than 50 percent, of the outpatient prospective payment system (OPPS) rates. That provision is described in more detail in CHA’s overview of the CY 2018 OPPS proposed rule. Under the PFS, CMS proposes a total increase in payment rates of 0.31 percent for CY 2018, which includes a 0.5 percent update as required by the Medicare Access and CHIP Reauthorization Act 2015, adjusted for a misvalued code as required under the Achieving a Better Life Experience Act of 2014.
Other provisions that will impact hospitals are:
Telehealth Services: CMS proposes to add a number of codes to the list of Medicare-payable telehealth services, including psychotherapy for crisis, health risk assessments, care planning for chronic care management, interactive complexity and counseling visits to determine low dose computed tomography eligibility.
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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.
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CHA has prepared the attached first-glance summary of the Centers for Medicare & Medicaid Services (CMS) final rule implementing the Comprehensive Care for Joint Replacement (CJR) payment model. As noted when the rule was issued, CMS has finalized the start date for this program to April 1, 2016, a slight delay from the proposed start date of Jan. 1, 2016. The model will require participation from inpatient prospective payment system hospitals in three California metropolitan statistical areas, as proposed.
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CHA joined 25 members of the Alliance for Patient Care, a coalition of health care providers, health plans and patient advocates, for several meetings in Washington, D.C., this week to urge the Centers for Medicare & Medicaid Services (CMS) to reject California’s proposed cuts to Medi-Cal. CHA President/CEO C. Duane Dauner and Marcia Hall, CEO of Sharp Coronado Hospital and Healthcare Center, met with CMS Administrator Donald Berwick, MD, and CMS Deputy Administrator Cindy Mann for more than an hour.