AHA comments on Medicaid DSH proposed rule   07/02/2013
The AHA today commented on Centers for Medicare & Medicaid Services’ approach to implementing the Patient Protection and Affordable Care Act aggregate reductions to state Medicaid Disproportionate Share Hospital allotments. “The proposed rule would not discourage Medicaid expansion, nor would it cause undue harm to hospitals in states that have decided not to expand or in states that have yet to decide to expand their Medicaid programs,” wrote AHA Executive Vice President Rick Pollack. In addition, AHA said the agency’s two-year time frame for the application of the proposed DSH reduction methodology was a “responsible approach,” and expressed general support for its weighting factors and data sources. AHA also urged CMS to engage providers in future changes to its methodology prior to formal rulemaking and be “as transparent as possible on the issues regarding data refinement and methodology improvements.” In the letter, AHA also expressed strong support for the DSH Reduction Relief Act of 2013 (H.R. 1920), which would delay for two years cuts to the Medicare and Medicaid DSH programs to allow more time for health coverage expansions under the ACA to be more fully realized.
Ways and Means leader urges IRS to update tax-exempt bond 'safe harbors'   07/02/2013
Rep. Jim McDermott (D-WA), ranking member of the House Ways and Means Health Subcommittee, yesterday urged the Internal Revenue Service to quickly update “safe harbor” provisions that protect the tax-exempt status of certain bonds issued by health care facilities to recognize new payment models between hospitals and physicians to promote care coordination and efficiency. “Because of the limited nature of the safe harbors, some of the newly emerging innovative methods by which a hospital may want to compensate a physician do not fit squarely within the existing safe harbors,” McDermott said in a letter to the agency. “…As a result, stakeholders may have some anxiety with entering into new and innovative arrangements encouraged by the Affordable Care Act.” AHA also has urged the agency to update the safe harbor provisions.
Data preview periods for hospital quality reporting programs underway   07/02/2013
Hospitals can preview their hospital-specific reports for the inpatient and outpatient quality reporting programs through July 27 at My QualityNet. Hospitals are encouraged to review their reports and alert the Centers for Medicare & Medicaid Services to any data issues. For measure and program-specific contacts, see the Help guides at QualityNet. Hospital-specific preview reports for the fiscal year 2014 Hospital Readmissions Reduction Program also are available at My QualityNet through July 12. Participants should report any suspected errors in their Excess Readmission Ratio calculations or discharge-level data to CMS_readmissions_reduction@mathematica-mpr.com. The inpatient, outpatient and readmissions data in the preview reports are scheduled to appear on CMS’ Hospital Compare website in October.
CMS proposes 9.3% cut for hospital-based ESRD services in CY 2014   07/02/2013
The Centers for Medicare & Medicaid Services yesterday issued a proposed rule that would reduce overall Medicare payments to end stage renal disease facilities by 9.4% in calendar year 2014, primarily due to a provision in the law that requires an payment adjustment to reflect the decline in per patient utilization of ESRD drugs and biological since 2007. Hospital-based facilities would see a 9.3% payment cut. 2014 is the first year all Medicare ESRD facilities will be paid 100% under the ESRD prospective payment system. The 9.4% reduction reflects a 2.9% ESRD bundled market basket update minus a 12% drug utilization adjustment, 0.4% productivity adjustment and wage index budget-neutrality adjustment as required by law. This results in a 2014 ESRD PPS base rate of $216.95. CMS seeks comment on whether the drug utilization adjustment should be phased in over more than one year. For payment year 2016, the rule also proposes to update requirements for the ESRD Quality Incentive Program, which adjusts payments to dialysis facilities based on their performance on quality measures. The rule also addresses issues related to coverage and payment of durable medical equipment, prosthetics, orthotics, and supplies. The proposed rule will be published in the July 8 Federal Register with comments accepted until Aug. 30.
AHA urges changes to CMS proposed rule on accrediting organizations   07/02/2013
AHA late yesterday urged CMS not to finalize several provisions in the Centers for Medicare & Medicaid Services proposed rule on oversight of national accrediting organizations, noting that several provisions of the rule would “substantially change the nature of the relationship between CMS and AOs from a partnership model to a framework in which CMS is overly prescriptive.” Commenting on the proposed rule, AHA Executive Vice President Rick Pollack wrote that AHA would oppose potential policies such as those that would require AOs to align their standards and survey processes to those of the State Operations Manual.
Supreme Court overturns workforce-related decision   07/02/2013
The Supreme Court last week held that an employee’s claim for retaliation under Title VII of the Civil Rights Act “requires proof that the unlawful retaliation would not have occurred in the absence of the alleged wrongful action or actions of the employer.” Rejecting the court of appeals’ interpretation that it was sufficient to demonstrate retaliation was a motivating factor, the Court concluded that “[t]he text, structure, and history of Title VII demonstrate that a plaintiff making a retaliation claim…must establish that his or her protected activity was a but-for cause of the alleged adverse action by the employer.” Noting the “ever-increasing frequency” of retaliation claims, the decision said the “proper interpretation and implementation” of the statute was of “particular significance.” The AHA joined in a friend-of-the-court brief that urged overturning the court of appeals decision.
HHS awards $32 million to help enroll children in Medicaid, CHIP   07/02/2013
The Department of Health and Human Services today awarded about $32 million in grants for efforts to identify and enroll children eligible for Medicaid and the Children’s Health Insurance Program. State agencies, community health centers, school-based organizations and non-profit groups received the funds to engage schools in outreach, enrollment and retention activities; reach out to children less likely to have health coverage; streamline enrollment for people in public benefit programs; and improve application assistance. “We are drawing from successful children’s health coverage outreach and enrollment efforts help promote enrollment this fall in Medicaid and the new Health Insurance Marketplace,” said Health and Human Services Secretary Kathleen Sebelius. The awards are part of $140 million included in the Patient Protection and Affordable Care Act and Children’s Health Insurance Program Reauthorization Act for enrollment and renewal outreach. For more information, visit www.insurekidsnow.gov.