Tuesday, February 10, :45 AM Mountain

Transcription

1 Tuesday, February 10, :45 AM Mountain

2 Protect Rural Health Care! aha.org/ruraladvocacy #RuralHealth

3 Today s Speakers: Sarah Macchiarola, Senior Associate Director, Federal Relations, American Hospital Association Priya Bathija, Senior Associate Director, Policy, American Hospital Association

4 Overview Political overview Legislative agenda Regulatory overview ACA update

5 Senate Leadership John Cornyn (R-TX) John Thune (R-SD) John Barrasso (R-WY)

6 Senate Committees Finance Orrin Hatch (R-UT) HELP Lamar Alexander (R-TN) Budget Mike Enzi (R-WY) Appropriations Thad Cochran (R-MS)

7 House of Representatives Leadership no changes Committees Ways and Means Paul Ryan (R-WI) Kevin Brady (R-TX) Budget Tom Price (R-GA) Energy and Commerce Fred Upton (R-MI) Joe Pitts (R-PA)

8 Key Political Focus House and Senate Leadership Committee leaders Democrat senators who might compromise 27 of 34 Senators facing re-election in 2016 Few open seats GOP in blue states

9 2015 Legislative Schedule March 31, 2015 Physician payment fix Extenders At-risk for hospital cuts Summer 2015 Debt Ceiling At-risk for hospital cuts Budget Reconciliation 51 votes Entitlement reform Tax reform Deficit reduction ACA repeal

10 At-Risk for Hospital Cuts Prospective coding offsets ($8 billion) Site neutral payment policies E&M code/hopd ($10 billion) 66 additional APCs procedures ($9 billion) 12 procedures performed in ASCs ($6 billion) Hospital bad-debt reductions ($20 billion) (Assistance for low income Medicare beneficiaries) GME reductions ($10 billion) CAH: payment reductions and qualification criteria ($2 billion) Post acute care ($70 billion) IPAB expansion ($4.1+ billion) Medicaid

11 President s FY 2016 Budget Rural hospital cuts 101% to 100% for CAHs 10 miles to 35 House and Senate budget proposals Short-term funding deals

12 Rural Advocacy Agenda Protect vital funding Secure existing programs Relieve regulatory burden

13 Rural Legislative Priorities 96 Hour Rule (S. 258/H.R. 169) Direct Supervision (PARTS) (S. 257) Extenders MDH/LVA (S. 332/H.R. 663) Ambulance Add-On Payments Rural Community Hospital Demo Program (H.R. 672) Meaningful Use Program Flexibility (H.R. 270)

14 96-Hour Rule Two existing statutory conditions for CAHs Condition of Participation CAHs must provide acute inpatient care for a period that does not exceed, on an annual average basis, 96 hours per patient Condition of Payment a physician must certify that a beneficiary may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission

15 96-Hour Rule (S. 258/H.R. 169) Removes condition of payment on physician certification Maintains condition of participation on annual length of stay Sen. Pat Roberts (R-KS) Sen. Jon Tester (D-MT) Rep. Adrian Smith (R-NE)

16 Direct Supervision CMS ended the direct supervision enforcement moratorium for CAHs and small rural hospitals, effective Jan. 1, 2014 Congressional extension through Dec. 31, 2014 CMS will require a minimum of direct supervision for all outpatient therapeutic services furnished in hospitals and CAHs Hospitals that do not comply are at risk for significant enforcement penalties Hospital Outpatient Payment (HOP) Panel 1

17 Direct Supervision (S. 258) Protecting Access to Rural Therapy Services (PARTS) Act Allows a default standard of general supervision for outpatient therapeutic services Jerry Moran (R-KS) John Thune (R-SD) Jon Tester (D-MT)

18 Medicare Extenders Low Volume Payment Adjustment Medicare Dependent Hospital Program Ambulance Add-On Payments All now extended, as part of the Protecting Access to Medicare Act of 2014, until March 31,

19 MDH/LVA (S. 334 /H.R. 663) Permanently extends Medicare Dependent Hospital program and enhanced low-volume adjustment Sen. Charles Grassley(R-IA) Sen. Charles Schumer (D-NY) Rep. Tom Reed (R-NY) Rep. Peter Welch (D-VT)

20 Flex-IT Act (H.R. 270) Flexibility in Health IT Reporting (Flex-IT) Act of 2015 Reduces reporting period in FY 2015 to 90 days Rep. Renee Ellmers (R-NC) Rep. Ron Kind (D-WI)

21 Ambulance Add-On (S. 377/H.R. 745) Permanently extends additional payments for ambulance services in rural areas Sen. Pat Roberts (R-KS) Sen. Charles Schumer (D-NY) Rep. Greg Walden (R-OR) Rep. Peter Welch (D-VT)

22 Rural Community Hospital Demo H.R. 672 Allows hospitals with less than 51 beds to test the feasibility of cost-based reimbursement Extends demonstration for 5 years Budget neutral Rep. Don Young (R-AK)

23 Regulatory Update: Top 5 Trends Medicare payments will continue to be at risk as the transition from volume to value continues; Reforms will be made to the Recovery Audit Contractor (RAC) program; We may see movement on a short-stay payment methodology related to the two-midnight rule; This will be a big year for 340B; and Threats to rural hospital programs will continue.

24 1 Medicare Payments At Risk

25 1 Medicare Payments At-Risk

26 2 RAC Reform

27 2 RAC Reform New policies issued by CMS on Dec. 30 We continue to focus on additional reforms: Prohibit any payment structure that encourages RACs to deny claims Impose a financial penalty on RACs when a denial is overturned on appeal Limit RAC determination based on the medical documentation available at the time of the admission decision Eliminate the one-year timely filing limit to rebilled Part B claims Limit RAC approval for auditing approved issues to a particular defined time period (instead of approving them indefinitely) Litigation and legislation update

28 3 Short Stay Payment Solution Two-midnight rule - CMS will generally consider hospital admissions spanning two midnights as appropriate for inpatient Part A payment. In contrast, hospital stays of less than two midnights will generally be considered outpatient cases, regardless of clinical severity. Regulatory and Legislative Strategies: - Keep certainty that cases spanning at least two midnights are inpatient cases - Partial enforcement delays (not implementation delays) through March 31, Consider payment methodology for short-stay cases with intensive resource use

29 3 Short Stay Payment Solution Short Stay Payment Solution - Provides fair and adequate reimbursement for resource intensive short-stay cases - Paid as inpatient under Medicare Part A - Helps beneficiary cost-sharing problems - AHA guiding principles/process - AHA data analysis to explore various options for implementation - Help inform CMS decision making on methodology - Examination by MedPAC and Committee on Ways & Means

30 4 A Big Year for 340B Mega guidance from HRSA late this spring - Hospital Eligibility - Definition of Patient/Employee Health Programs - Contract Pharmacy Arrangements/ Diversion Congressional hearings on 340B Reports from GAO and OIG expected in the spring/summer Update on the orphan drug litigation

31 4 A Big Year for 340B AHA Key Message to Policy Makers - 340B program works - Huge benefit for communities and safety net hospitals from a small program - Decreasing the 340B program only benefits pharmaceutical manufactures, not people in need of access to more affordable drugs - AHA is not negotiating changes to the program

32 4 A Big Year for 340B

33 4 A Big Year for 340B AHA Message to 340B Hospitals: - Run a Compliant Program - Keep up to date on HRSA Guidance - Prime Vendor Program/Apexus Apexus Answers 340B University - Apexus - Be Ready for HRSA and Manufacturer Audits - Self Audit, Self Audit, Self Audit

34 5 Threats to Rural Hospitals Continue 2011 CBO options document $62B in savings if eliminate CAH, MDH and SCH programs 2014 Omnibus asks CMS for 10 mile list President Obama s FY 2016 Budget Reduce CAHs payment of 101% of costs to 100% ($-1.73B) Prohibit CAH designation for those CAHs that are less than 10 miles from nearest hospital ($-770M) OIG is focused on CAHs and rural health clinics

35 To-Do List Rural Advocacy Action Center Contact Join the Rural Advocacy Alliance Participate in Advocacy Days February 26 th March 19 th

36 Question & Answer

37 Protect Rural Health Care! aha.org/ruraladvocacy #RuralHealth

38 Tuesday, February 10, :45 AM Mountain