Tag: proposed rule

Comments Due Nov. 6 on LTC Nurse Staffing Standards Proposed Rule

Member News

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule Sept. 1 which would establish comprehensive, minimum nurse staffing standards for long-term care (LTC) facilities. There are three core components to this rule:

  1. Sets minimum staff hours per resident per day – 0.55 hours by registered nurses (RNs) and 2.45 hours by nurse aides (no mention of licensed practical nurses).
  2. Requires an RN on site 24/7.
  3. Enhances facility assessment requirements.

The MHA is deeply concerned about the implications of this legislation due to the current challenges securing long-term care placements and expects more beds will come offline or facilities will close to meet the proposed standard. Michigan is currently experiencing a shortage of nurses, and implementing a blanket staffing mandate for healthcare institutions will have a negative impact on access to care.

The MHA encourages members to consider responding to this proposed rule by Nov. 6. Members interested may provide comments to the MHA to be included in a comment letter.

More information can be found in the White House fact sheet or CMS press release. Members with questions or input may contact Kelsey Ostergren at the MHA.

CMS Releases Medicare FFS OPPS Proposed Rule

Member News

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule to update the Medicare fee-for-service (FFS) outpatient prospective payment system (OPPS) effective Jan. 1, 2024. The rule proposes to:

  • Increase the outpatient conversion factor by a net 2.2% from the current $85.585 to $87.488, after the proposed 2.8% market basket is reduced for budget neutrality and other adjustments.
  • Pay average sales price plus 6% for drugs and biologicals acquired under the 340B drug discount program and require use of a single modifier, “TB”, for 340B drugs, effective Jan. 1, 2025. Hospitals would have the option to continue reporting the “JG” modifier or transition to solely using the “TB” modifier during 2024.
  • Implement several provisions of the Consolidated Appropriations Act that will expand access to behavioral health services including:
    • Adopting an additional, untimed code for remote group psychotherapy and making technical refinements to how these codes are recorded that would allow billing for multiple units on the same day.
    • Delaying the requirement for an in-person visit within six months prior to the first remote mental heath service and within 12 months after each remote mental health service until Jan. 1, 2025.
    • Establishing an intensive outpatient program (IOP) benefit beginning Jan. 1, 2024, with regulatory changes to ensure consistency in requirements among rural health clinics, federally qualified health centers and hospitals. The proposed requirements govern:
      • The scope of benefits and definition of IOP services paid on a per-diem basis.
      • Minimum number of hours of IOP services per week (9) and frequency (at least every other month) for IOP coverage eligibility.
      • Payment rates, established as two ambulatory payment classifications for each provider type and number of services per day.
  • Expand the practitioners who may supervise cardiac rehabilitation, intensive cardiac rehabilitation and pulmonary rehabilitation services to include nurse practitioners, physician assistants and clinical nurse specialists. The CMS also proposed to allow for the direct supervision of these services to include virtual presence through audio-video, real-time communications technology (excluding audio-only) through Dec. 31, 2024, and to extend this policy to these nonphysician practitioners, who are eligible to supervise these services in calendar year (CY) 2024.
  • Update the outpatient quality reporting program.
  • Seek comments regarding whether gastric restrictive procedures (CPT codes 43775, 43644, 43645 and 44204) are appropriate for removal from the inpatient only list. Specifically, the CMS requests information on whether these services can be performed safely on the Medicare population in the outpatient setting. The CMS also proposes to add nine services for which codes were newly created.
  • Add 26 dental surgical procedures to the ambulatory surgical center covered procedure list for CY 2024.
  • Adopt four quality measures for required reporting beginning in CY 2024 for rural emergency hospitals:
    • Abdomen CT – Use of Contrast Material.
    • Median Time from ED Arrival to ED Department for Discharged ED Patients.
    • Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy.
    • Risk-Standardized Hospitals Visits Within 7 Day After Hospital Outpatient Surgery.
  • Require hospitals to utilize a standard template to display their standard charge information.

The MHA will provide hospitals with an estimated impact analysis within the next several weeks and encourages hospitals to review the rule and submit comments to the CMS by Sept. 11.

Members with questions should contact Vickie Kunz at the MHA.

MHA Comments on LTCH PPS Proposed Rule

Member News

The MHA recently submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the proposed rule to update the Medicare fee-for-service (FFS) long term care hospital (LTCH) prospective payment system (PPS) for fiscal year 2024. These comments were due to the CMS June 9.

The CMS is expected to release a final rule to update the LTCH PPS in early August (2023) ahead of the Oct. 1 effective date. The MHA will provide members with an updated Medicare FFS impact analysis following the final rule’s release.

Members with questions should contact Vickie Kunz at the MHA.

CMS Seeks Comment on Rural Emergency Hospital Proposed Rule

Member News

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule to obtain comment on potential Conditions of Participation (CoPs) for critical access hospitals (CAHs) and certain rural hospitals seeking to convert from their current status to be designated as a Rural Emergency Hospital (REH). REHs are a new provider type authorized by the Consolidated Appropriations Act passed Dec. 27, 2020, to address concern regarding the closure of rural hospitals across the country. This new designation provides an opportunity for CAHs and rural hospitals with 50 or fewer beds to continue providing essential services in their communities effective Jan. 1, 2023. REHs would be required to:

  • Discontinue providing acute care inpatient services.
  • Provide 24-hour emergency services, observation care and can choose to offer additional outpatient services.
  • Have an annual per patient average stay of 24 hours or less.
  • Have a transfer agreement with a Level I or II trauma center but not precluded from having agreements with Level III or IV trauma centers.

The CMS recently included payment policies related to the new REH in the 2023 Medicare outpatient prospective payment system (OPPS) proposed rule. Medicare outpatient services provided by a REH will be paid 105% of the Medicare OPPS rate with the REH also receiving a monthly facility payment. The CMS proposes a monthly payment of $268,294 for each REH in 2023, with this amount increased annually based on the hospital market basket change.

The CMS proposes that REHs may provide outpatient services that are not paid under the OPPS such as laboratory services paid under the Clinical Lab Fee Schedule (CLFS), which would be paid at the CLFS rate. REHs can also provide distinct part skilled nursing facility (SNF) services which would be paid based on the SNF prospective payment system. Services paid outside of the OPPS such as lab and SNF would not receive the additional 5% payment. The CMS also seeks input on quality measures recommended by the National Advisory Committee on Rural Health and Human Services, and additional suggested measures for the REH quality reporting program. The CMS is seeking additional comments on behavioral and mental health, rural virtual care and maternal health services.

Comments on the proposed CoP rule are due Aug. 29, while comments regarding payment provisions included in the OPPS proposed rule are due Sept. 13. The CMS is expected to release a final OPPS rule around Nov. 1. Members with questions should contact Lauren LaPine at the MHA.

Member Feedback Requested on Rural Emergency Hospital Proposed Rule

Member News

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule June 30 that would establish conditions of participation (CoPs) that Rural Emergency Hospitals (REHs) must meet to participate in the Medicare and Medicaid programs. This proposed rule also includes changes to the Critical Access Hospital CoPs. Proposed payment and enrollment policies, quality measure specifications and quality reporting requirements for REHs will be included in future rulemaking. The CMS also modifies the provider agreement regulations to include REHs. The public comment period will end Aug. 29.

The MHA has been working closely with the Michigan Department of Health and Human Services (MDHHS) and the Michigan Department of Licensing and Regulatory Affairs (LARA) over the past few months to develop the licensure criteria and conversion process for eligible facilities in Michigan to convert to an REH after Jan. 1, 2023. The MHA will develop a comment letter in response to the proposed rule and share a draft with small/rural members prior to submission. To include input from Michigan hospitals eligible to convert to an REH in its comments, the MHA has created a brief survey to collect critical feedback that should be submitted by Aug. 1. Members with questions or concerns are encouraged to contact Lauren LaPine at the MHA.

Long-term Acute-care Hospital Payment System Proposed Rule Released

Member News

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule to update the Medicare fee-for-service long-term care hospital (LTCH) prospective payment system for fiscal year (FY) 2023.  The proposed rule would:

  • Increase the standard federal rate by a net 2.8% for cases that meet LTCH criteria.
  • Continue paying site-neutral cases at the full-site neutral rate, instead of the prior 50/50 blend of LTCH and site-neutral rates.
  • Establish a cost outlier threshold of $44,182 for cases paid based on the LTCH standard rate, up 34% from the current $33,015 threshold, resulting in fewer cases qualifying for an outlier payment. The CMS adjusts this threshold annually to maintain outlier payments at the targeted 8% of aggregate LTCH payments.
  • Cap annual wage index decreases at 5%.
  • Cap annual decreases at 10% for Medicare Severity Long-term Care Diagnosis-related Group relative weights to mitigate negative impacts of significant weight decreases.
  • Seek input on strategies to improve measurement of disparities in health outcomes. Through a Request for Information, the CMS requests input on its framework to collect, stratify and report quality performance across the CMS programs including specific methods that could be used within the LTCH quality reporting program (QRP).
  • Request input on the potential inclusion of an updated healthcare-associated infection measure in the LTCH QRP. The National Healthcare Safety Network Healthcare-associated Clostridioides difficile infection (CDI) Outcome Measure would improve upon the CDI measure currently used in the LTCH QRP by using data from electronic health records.

The MHA is continuing to review the proposed rule and will provide hospitals with an estimated impact analysis soon. The association will also share its draft comments with members when available. The CMS will accept comments on the proposed rule until June 17. Members with questions should contact Vickie Kunz at the MHA.

CMS Releases FY 2023 Proposed Rule to Update Hospital IPPS

Member News

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule to update the Medicare fee-for-service (FFS) hospital inpatient prospective payment system (IPPS) for fiscal year (FY) 2023. When all proposed changes are considered, the rule is expected to result in a net decrease due to proposed cuts to disproportionate share hospital (DSH) and other payments. The MHA considers these cuts to be unacceptable given the extraordinary inflationary environment and extreme labor and supply cost pressures that hospitals continue to experience.  The proposed rule would:

  • Reduce national DSH and uncompensated care (UCC) pool payments by $800 million. The CMS projects a UCC pool of roughly $6.5 billion to be allocated to hospitals based on audited Worksheet S-10 data from FY 2018 and FY 2019 cost reports. The CMS proposes to use a three-year average to calculate payments starting in FY 2024.
  • Eliminate payment enhancements for Medicare-dependent hospitals and low-volume hospitals absent congressional action to extend those payments beyond the Sept. 30, 2022, expiration date.
  • Provide a net 3.2% increase in the federal operating rate for hospitals that successfully participate in the inpatient quality reporting program (QRP) and are meaningful electronic health record users.
  • Increase the standard federal capital rate by 1.6% from $472.60 to $480.29.
  • Establish a cost outlier threshold of $43,214, up 39% from the current $30,988 threshold, resulting in fewer cases qualifying for an outlier payment. The CMS adjusts the threshold annually to ensure that outlier payments do not exceed the established target of 5.1% of aggregate IPPS payments.
  • Cap wage index decreases at 5%, ensuring each hospital’s wage index is at least 95% of its final wage index for the prior fiscal year. This policy would be funded by a national adjustment to the standard federal operating rate. The CMS proposes to continue the current policy that provides a wage index increase for hospitals in the bottom quartile.
  • Modify graduate medical education policy related to full-time-equivalent caps and increase flexibility for rural hospitals that participate in a rural track program.
  • Suppress several measures in the hospital value-based purchasing program and continue the special scoring methodology used for FY 2022 to ensure hospitals are neither penalized nor rewarded due to the COVID-19 public health emergency.
  • Suppress all six measures in the hospital acquired conditions (HAC) reduction program. If finalized as proposed, hospitals will not be given a measure score, a total HAC score, or a payment penalty for FY 2023.
  • Establish a publicly reported hospital designation on the quality and safety of maternity care in efforts to reduce maternal mortality and morbidity, a priority of the Biden-Harris administration. The CMS would award this designation to hospitals that report “Yes” to both questions in the Maternal Morbidity Structural Measure, previously finalized in the Hospital Inpatient QRP.
  • Seek input on ways to advance health equity. The CMS is seeking comment on key considerations to improve data collection to better measure and analyze disparities across CMS programs and policies and approaches for updating the Hospital Readmission Reduction Program to encourage providers to improve performance for socially at-risk populations.
  • Seek input on the appropriateness of a payment adjustment for FY 2023 and beyond to recognize the additional resource costs associated with acquiring surgical N95 respirators that are approved by the National Institute for Occupational Safety and Health and are wholly domestically made.

The MHA is continuing to review the proposed rule and will provide hospitals with an estimated impact analysis soon. The association will also share its draft comments with members when available. The CMS will accept comments on the proposal through June 17. Members with questions should contact Vickie Kunz at the MHA.