MHA Today | December 19, 2016

December 19, 2016

MHA Today: News for Healthcare Leaders

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In This Issue
CMS Cancels Medicare Prescription Drug Model Implementation
OIG Reports Vulnerabilities Remain Under Medicare’s Two-Midnight Hospital Policy
HHS States It Cannot Meet Order To Clear Medicare Appeal Backlog
CMS Finalizes Rule To Provide Risk Stabilization For Marketplace
CMS Issues Update To Life Safety Standards

Advocate
state and federal health policy developments


CMS Cancels Medicare Prescription Drug Model Implementation

Staff Contact: Andrew Wheeler

Earlier this year, the Centers for Medicare & Medicaid Services proposed a rule that would focus on testing new models to improve how Medicare pays for prescription drugs. MHA submitted comments voicing concerns of the rule being designed as a “giant payment experiment.” MHA also visited with members of Congress and relayed concerns about CMS using hospitals as “lab rats” and the complexity of the rule. Due to congressional and provider objections to the mandatory model, the Obama administration announced that it would not implement the rule. Experts say that the cancellation of the program does not preclude future proposed rules about outpatient drugs.

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OIG Reports Vulnerabilities Remain Under Medicare’s Two-Midnight Hospital Policy

Staff Contact: Andrew Wheeler

The U.S. Department of Health & Human Services’ Office of Inspector General released a report about the vulnerabilities under Medicare’s two-midnight hospital policy. The OIG analyzed Medicare claims from fiscal years 2013 and 2014, and focused on short-stay discharges and whether the claim met the Centers for Medicare & Medicaid Services’ criteria for payment under the two-midnight policy. The OIG found the following vulnerabilities.

  • hospitals are billing for many short inpatient stays that are potentially inappropriate
  • Medicare pays more for some short inpatient stays than for short outpatient stays
  • hospitals continue to bill for a large number of long outpatient stays
  • an increased number of beneficiaries in outpatient stays pay more and have limited access to skilled nursing facility services than they would have as inpatients
  • hospitals continue to vary in how they use inpatient and outpatient stays

The OIG recommends that CMS address the vulnerabilities by improving oversight of hospital billing, including reviewing short inpatient stays, analyzing potential impacts of counting the time spent as an outpatient toward the three night requirement for SNF services and exploring ways of protecting beneficiaries in outpatient stays from paying more than they would have paid as inpatients.

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HHS States It Cannot Meet Order To Clear Medicare Appeal Backlog

Staff Contact: Andrew Wheeler

On Dec. 5, the U.S. District Court for the District of Columbia imposed a request to resolve the backlog of nearly 658,000 pending Medicare provider appeals by the end of 2020. The U.S. Department of Health & Human Services has since filed a motion for the court to reconsider the ruling and stated it could not hit the targets set forth in the ruling. HHS is blaming lack of resources as the reason, and Assistant Secretary for Financial Resources and Chief Financial Officer, Ellen Murray, stated that, “absent substantial new resources and authorities from Congress, the agency cannot reduce the backlog on the schedule that the court has required.”

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Regulatory News
the latest actions of agencies monitoring health care


CMS Finalizes Rule To Provide Risk Stabilization For Marketplace

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services issued a final rule that focuses on risk stabilization. The rule includes the notice of benefit and payment parameters, and the final annual letter of issuers for 2018. The risk stabilization elements include the following four specific phenomena.

  • account for the number of individuals who had a marketplace plan for less than 12 months
  • better account for the risk of high-cost patients
  • improve compensation for healthier members
  • use prescription drug data as another way to account for sicker members

CMS Acting Administrator Andy Slavitt stated, “The improvements announced today build upon years of work to implement a marketplace that is capable of providing high-quality, affordable coverage to all Americans no matter their health status, their income or where they live. The administration will leave the marketplace on a stable path that, when fully implemented, will ensure quality coverage is available for all Americans well into the future.” Key dates and timelines have been issued.

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CMS Issues Update To Life Safety Standards

Staff Contact: Jim Mikes

The Centers for Medicare & Medicaid Services has issued updated guidance for compliance with fire safety requirements. Facilities using the fire safety evaluation system must use the version found in “NFPA 101A: Guide on Alternative Approaches to Life Safety, 2013 Edition.” A facility that receives a passing score on the evaluation will be considered for certification and recertification with the Medicare and Medicaid programs.

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Consider This ...

In 2015, more than 52,000 people died from a drug overdose, and of those, 33,091 (63.1 percent) involved a prescription or illicit opioid. Since 2000, more than 300,000 Americans have lost their lives to an opioid overdose.

Source: Centers for Disease Control and Prevention