Senate bill would extend two-midnight partial enforcement delay   03/06/2014
Sens. Robert Menendez (D-NJ) and Deb Fischer (R-NE) yesterday introduced the Two-Midnight Rule Coordination and Improvement Act (S. 2082). The AHA-supported legislation would require CMS to implement a new payment methodology for short inpatient stays in FY 2015. The bill would also extend the partial delay in enforcement of the Centers for Medicare & Medicaid Services’ two-midnight policy to the earlier of Oct. 1, 2015 or when the agency develops criteria defining short inpatient stays. “The AHA strongly supports this important legislation,” said Rick Pollack, AHA executive vice president. “The current CMS policy is bad news for seniors because it undermines the medical judgment of physicians. The bill also rightly calls on the agency to develop an acceptable long-term payment solution.” CMS recently delayed enforcement of the two-midnight policy, under which hospital admissions spanning less than two midnights will generally be considered outpatient cases, regardless of clinical severity, until Oct. 1, 2014. However, the agency continues to allow contractors to deny limited numbers of inpatient claims based on prepayment audits under the policy.
Rural hospital leaders seek support for key issues from Capitol Hill   03/06/2014
Rural hospital leaders gathered today on Capitol Hill to urge lawmakers to extend Medicare provisions for rural hospitals, remove the 96-hour rule for critical access hospitals, and provide relief from the direct supervision policy for critical access and rural prospective payment system hospitals with 100 or fewer beds. As Congress prepares to address a physician payment fix and Medicare provisions for rural hospitals that expire at the end of March, lawmakers will make decisions that have profound effects on rural hospitals, AHA President and CEO Rich Umbdenstock told participants in the association’s rural Advocacy Day. “If they don’t hear from you, they will not consider those effects when they get ready to vote.” Before visiting lawmakers’ offices, participants were briefed by AHA staff on the latest rural health care developments in Washington.
Senators urge CMS to clarify meaningful use hardship exception flexibility   03/06/2014
Sens. Lamar Alexander (R-TN), John Thune (R-SD), Richard Burr (R-NC), Tom Coburn (R-OK), Mike Enzi (R-WY) and Pat Roberts (R-KS) today urged the Centers for Medicare & Medicaid Services to provide details on its plan to grant health care providers hardship exemptions from the 2014 meaningful use requirements for electronic health records, instead of granting additional time as AHA and other provider groups have requested. “We were disappointed to hear this announcement, even more so because of the lack of clarity about how the exceptions will be administered,” the senators said in a letter to CMS Administrator Marilyn Tavenner. “Thus, we are writing to ask that you immediately clarify how the hardship exceptions will be granted…Given the importance of this issue to hundreds of thousands of providers participating in the electronic health records program, we urge CMS to respond to our request for clarification as soon as possible.”
Hospitals urged to respond to AHA survey on Probe & Educate audits   03/06/2014
AHA is asking all members to complete by March 14 a short survey on the Center for Medicare & Medicaid Services’ two-midnight policy and related Probe & Educate audit process. Emailed to members today, the survey will help determine whether Medicare Administrative Contractors are conducting the Probe & Educate audits consistent with the standards set forth by CMS, and whether the audits will be completed by Sept. 30. Responses will help AHA in its general advocacy efforts on the two-midnight policy and allow the association to address any issues or concerns regarding the Probe & Educate audits with CMS.
AHA comments on proposed Medicare Advantage payment and policy updates   03/06/2014
The AHA today expressed support for Centers for Medicare & Medicaid Services proposals to increase Medicare Advantage beneficiary awareness of their cost-sharing responsibilities by requiring clearer, plain language descriptions in plan comparison information, but called on the agency to adopt additional guidance regarding substantial mid-year changes to provider networks. “The AHA believes it is important to ensure that MA enrollees have access to a selection of high-quality providers in or near to their communities, while not inhibiting care coordination and the growth of integrated care systems,” said Linda Fishman, AHA senior vice president for policy analysis and development, commenting on CMS’s draft payment and policy updates for Medicare Advantage for 2015. “The AHA also believes that Medicare beneficiaries should be able to rely on the information available about an MA plan when they select that plan.”
CMS extends transitional policy for small group, individual coverage   03/06/2014
The Centers for Medicare & Medicaid Services yesterday extended to October 2016 a transitional policy allowing health insurers in the individual and small group markets to extend expiring policies that do not meet certain market reforms, such as essential health benefits standards, under the Patient Protection and Affordable Care Act. “At the option of the states, health insurance issuers that have issued or will issue a policy under the transitional policy anytime in 2014 may renew such policies at any time through Oct. 1, 2016, and affected individuals and small businesses may choose to re-enroll in such coverage through Oct. 1, 2016,” wrote Gary Cohen, director of the agency’s Center for Consumer Information and Insurance Oversight. Health insurance issuers that renew coverage under the policy extension must notify affected individuals and small businesses each policy year as specified, informing them of their options and new consumer protections that are available in other plans. Cohen said CMS “will consider the impact of the two-year extension of the transitional policy in assessing whether an additional one-year extension is appropriate.”
HHS extends comment period for administrative simplification certification rule   03/06/2014
The Department of Health and Human Services yesterday extended the comment period for its proposed rule requiring health plans that control their own business activities to demonstrate compliance with certain standards and operating rules for administrative simplification, as required by the Affordable Care Act. The new deadline for comments is April 3. The agency said it specifically seeks additional comments from third-party administrators and self-insured plans, which may not been affected by previous administrative simplification requirements. AHA submitted comments on the proposed rule last week.