Archive for Medicare regulations

 

Court Halts Medicare Site-Neutral Payment Changes

The Centers for Medicare & Medicaid Services did not have the authority to implement the site-neutral payment system for Medicare-covered outpatient services that it introduced last year, a federal court has concluded.

According to the court, CMS exceeded its authority because it

…was not authorized to ignore the statutory process for setting payment rates in the Outpatient Prospective Payment System and to lower payment rates only for certain services provided by certain providers.

In general, hospitals oppose the movement toward site-neutral payments and independent physician groups support it.

The court did not order CMS to reimburse affected physician practices for lost revenue.  Instead, it directed CMS to develop an appropriate remedy.

CMS is likely to appeal the ruling.

Meanwhile, CMS has proposed continuing its phase-in of the site-neutral payment policy in its proposed 2020 outpatient prospective payment system regulation that will take effect on January 1, 2020.  It is not clear how or if – the court ruling might affect CMS’s decision to move ahead with this proposal.

Learn more about the case, the court decision, and what might happen next in the Healthcare Dive article “Hospitals score victory as judge tosses CMS site neutral rule.”

Stakeholders Respond to CMS “Patients Over Paperwork” RFI

More than 400 stakeholders responded to the federal government’s request for ideas to reduce the administrative burden associated with serving publicly insured patients.

The request was disseminated via a Centers for Medicare & Medicaid Services request for information that was part of the agency’s “Patients over Paperwork” initiative.  Among the groups that responded were the American Hospital Association, The American Association of Colleges of Nursing, the Critical Access Hospital Coalition, the Coalition of Long-Term Acute-Care Hospitals, the National Rural Association of Rural Health Clinics, the American Academy of Ophthalmology, the American Academy of Family Physicians, the American Hospital Association, and others.

Among the suggestions they offered were reconsideration of quality  metrics, changes in the merit-based incentive payment system (MIPS), the inclusion of social determinants of health in quality metrics, changes in star rating systems, greater efficiency in prior authorization processes, changes in interoperability requirements, and others.

Learn more about who submitted comments in response to this RFI and what they proposed in their comments in the Healthcare Dive article “CMS says it wants to cut paperwork. Providers have ideas.”

CMS Chief Criticizes Health Care Proposals

In an address to the Better Medicare Alliance 2019 Medicare Advantage Summit, Centers for Medicare & Medicaid Services Administrator Seema Verma criticized Medicare for All proposals, said Medicare “public option” proposals are no better, and called the Affordable Care Act a failure,.

Verma also insisted that greater reliance on market forces would improve Medicare and Medicaid, said the 340B prescription drug program is harming the health care system, and called for a reduction of federal regulations that limit how and where people can receive care.  She said reduced regulations have spurred hundreds of new plans to participate in the Medicare Advantage program, have led to reduced health care premiums, and have fostered a greater focus on the quality of care providers deliver rather than on the quantity of services they provide.

Learn more by reading Verma’s prepared remarks.

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MedPAC Weighs in on Proposed Medicare Payment Changes

The Medicare Payment Advisory Commission has submitted formal comments to the Centers for Medicare & Medicaid Services in response to the latter’s publication of a proposed regulation that would govern how Medicare will pay for acute-care hospital inpatient services and long-term hospital care in the coming 2020 fiscal year.

The 14-page MedPAC report addresses four aspects of the proposed Medicare payment regulation:

  • inpatient- and outpatient drug- and device related payment proposals
  • proposed changes in the hospital area wage index
  • the reporting of hospitals’ uncompensated care on the Medicare cost report’s S-10 worksheet
  • the long-term hospital prospective payment system

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

See MedPAC’s letter to CMS here.…

CMS Seeks Help With Reducing Administrative and Regulatory Burdens

Reducing administrative and regulatory burdens is the subject of a new request for information issued last week by the Centers for Medicare & Medicaid Services.

In the RFI, CMS explains that it is especially interested in “…innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve”

  • reporting and documentation requirements
  • coding and documentation requirements for Medicare or Medicaid payment
  • prior authorization procedures
  • policies and requirements for rural providers, clinicians, and beneficiaries
  • policies and requirements for dually enrolled (Medicare and Medicaid) beneficiaries
  • beneficiary enrollment and eligibility determination
  • CMS processes for issuing regulations and policies

Comments are due to CMS by August 12.

For further information, see the CMS news release “CMS Seeks Public Input on Patients over Paperwork Initiative to Further Reduce Administrative, Regulatory Burden to Lower Healthcare Costs” or go here to see the RFI itself.…