CMS issues outpatient PPS/ASC and PFS proposed rules   07/08/2013
The Centers for Medicare & Medicaid Services today issued calendar year 2014 proposed rules for the outpatient prospective payment system and ambulatory surgical centers and for the physician fee schedule. The OPPS/ASC rule would increase hospital outpatient payment rates by 1.8%, based on the projected inpatient market basket increase of 2.5% minus a proposed multifactor productivity adjustment of 0.4 percentage point and a 0.3 percentage point adjustment required by the Patient Protection and Affordable Care Act. The rule also proposes to end the direct supervision enforcement delay for critical access hospitals and small rural hospitals on Dec. 31, a proposal strongly opposed by the AHA. In addition, the rule would collapse the current five levels of outpatient visit codes with a single code for each type of outpatient hospital visit, including clinic and Type A and Type B emergency department visits; package seven new categories of supporting items into the payment for the primary service; and create 29 comprehensive ambulatory payment classifications to replace existing device-dependent APCs. Without congressional action, the PFS rule would reduce Medicare physician payments by an estimated 24.4% on Jan. 1. Comments are due to CMS by Sept. 6 and final rules are expected by Nov. 1. The AHA will send members a Special Bulletin with highlights on the rules' key provisions tomorrow followed by detailed Regulatory Advisories in the next several weeks.
CMS issues final rule on Medicaid, CHIP, Marketplace provisions   07/08/2013
The Centers for Medicare & Medicaid Services Friday issued a final rule implementing provisions of the Patient Protection and Affordable Care Act related to eligibility and enrollment for Medicaid, the Children’s Health Insurance Program and health insurance exchange-based premium tax subsidies. With regard to Medicaid, the rule provides guidance to states implementing coverage for the new low-income adult group beginning in 2014. The guidance includes giving states additional time to design their Alternative Benefit Plans (benchmark plans), which include the ACA require “essential health benefit.” In addition, the rule implements the ACA provision requiring that states allow hospitals to make presumptive eligibility determinations for potential Medicaid patients seeking care. The rule also implements a single set of rules for Medicaid premiums and cost sharing, while allowing states to impose higher cost sharing for non-emergency use of hospital emergency departments and non-preferred drugs. The final rule allows individuals applying for exchange-based premium subsidies to self-attest to whether they are offered employer-based health coverage. The final rule does not address all provisions included in the January proposed rule. The agency said it intends to address the remaining provisions, including proposed certification standards for counselors who help people apply for qualified health plans through an exchange or insurance affordability program, in future rulemaking. AHA is reviewing the 606-page rule and will provide more information to members soon in a Special Bulletin.
HHS awards preparedness funding for hospitals, public health   07/08/2013
The Department of Health and Human Services last week awarded states, territories and large cities about $332 million in Hospital Preparedness Program funds to help hospitals and health systems improve surge capacity and prepare for public health emergencies. The funds are distributed by award recipients to health care coalitions and hospitals according to a plan approved by HHS. In addition, the Centers for Disease Control and Prevention awarded more than $584 million in preparedness funds to state and local public health departments. “Recent events underscore the critical role these preparedness programs play in ensuring our health care and public health systems are poised to respond successfully to emergencies and recover quickly from events like Hurricane Sandy, large explosions such the chemical plant in Texas, or terrorist attacks like the Boston Marathon bombings in April,” said Nicole Lurie, M.D., HHS assistant secretary for preparedness and response. Funding for the Hospital Preparedness Program has declined nearly 30% over the past decade.
Study: Population health drives local Medicare costs per beneficiary   07/08/2013
Population health appears to be the major driver of geographic variation in Medicare costs per beneficiary, although treatment patterns likely influence episode costs for specific conditions, according to a new study by the Center for Studying Health System Change published in the journal Health Services Research. “Our results suggest that beneficiaries in geographic areas with higher total cost per beneficiary are sicker and therefore have more episodes of care,” the authors said. “The prevalence of most conditions we examined was significantly greater in high-cost areas, consistent with our finding of higher comorbidity scores in those areas.” The study, funded by National Institute on Aging, examined episode and total annual costs for 10 common conditions in 60 nationally representative communities. Episode treatment costs varied widely across communities, but patterns of geographic cost variation were not consistent across conditions.