DoD issues final TRICARE payment rule for SCHs   08/13/2013
The Department of Defense last week published a final payment rule for sole community hospitals under TRICARE, which covers uniformed service members and their families. Beginning Jan. 1, the rule will transition SCH payments from 100% of billed charges to the greater of the TRICARE diagnosis-related group amount, or an amount equal to billed charges times the hospital’s most recent Medicare Cost-to-Charge Ratio. The change is expected to reduce TRICARE payments to SCHs by an estimated $676 million through fiscal year 2017. During the transition, annual payment reductions will be limited to 10 percentage points for network hospitals and 15 percentage points for non-network hospitals. Under a special provision, the rule will pay 130% of the Medicare CCR for labor/delivery and nursery care after the transition period to reflect the higher cost of these services under TRICARE. For network hospitals that serve a disproportionate share of active duty service members and their dependents, the rule also gives the TRICARE director discretion to apply a year-end temporary payment adjustment for inpatient services in both SCHs and critical access hospitals. TRICARE expects to issue instructions for exercising the discretionary authority within the first half of 2014.
CMS notices, IRS final rule for exchange data sharing released   08/13/2013
The Centers for Medicare & Medicaid Services today announced plans to establish computer matching agreements with the Veterans Health Administration and Internal Revenue Service to govern disclosures of information through the CMS Data Services Hub to determine applicants’ eligibility for advance premium tax credits, cost sharing reductions and health coverage offered through health insurance exchanges. CMS will accept comments on the notices for 30 days after publication in tomorrow’s Federal Register. Also today, the IRS issued a final rule relating to the disclosure of return information to help exchanges perform certain functions for which income verification is required.
CDC issues updated guidance on MERS   08/13/2013
The Centers for Disease Control and Prevention yesterday issued updated guidance to health care providers and public health officials regarding who should be tested for the Middle East Respiratory Syndrome coronavirus. The guidance also highlights changes to CDC’s “probable case” definition, and clarifies what specimens should be obtained when testing for MERS. Eight countries have reported a total of 94 confirmed cases of MERS to the World Health Organization since April 2012, including 46 deaths. No cases have been reported in the U.S. to date.