CMS is accepting comments on several proposed payment rules.
Legislative update – day 116 of session
Activity at the state capitol continues to slow as a budget agreement has yet to be reached. Despite the slow pace, AzHHA has successfully advanced several legislative priorities including HB2454: TELEHEALTH; HEALTH CARE PROVIDERS; REQUIREMENTS which was signed into law by Governor Doug Ducey on Wednesday, May 5.
See which bills have been signed into law and other bill status updates by visiting azhha.org/azhha_priority_and_key_legislation.
CMS releases proposed payment rules for FY 2022
The Centers for Medicare & Medicaid Services (CMS) released proposed payment rules for Inpatient Prospective Payment System (IPPS), Long-Term Care Hospital Prospective Payment System (LTCH PPS), Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) and Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) for fiscal year 2022. DataGen reports analyzing the impact of the IPF PPS and IRF PPS proposed rules, including facility-specific impact, have been sent to AzHHA members. Reports on the IPPS and LTCH proposed rule are forthcoming. Members may contact Liz Lorenz, AzHHA director of policy, at [email protected] with any questions.
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IPPS and LTCH Proposed Rule - With respect to the IPPS, CMS proposes increasing payments by 2.8%, repealing certain price transparency requirements, launching the "promoting rural hospital GME funding opportunity" and implementing new health equity proposals including a hospital equity score. Regarding the LTCH PPS, CMS proposes decreasing payments by 1.1%, which is largely due to a reduction in payments for site-neutral cases, which account for 25% of all cases. Comments are due June 28, 2021.
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IPF PPS Proposed Rule - CMS proposes increasing payments by 2.3%, updating policies regarding residents displaced by IPF closures, and modifying the IPF Quality Reporting Program by incorporating the rate of COVID-19 vaccinations among healthcare workers and the rate of follow-up visits for discharges with select mental illness or substance use disorders. Comments are due June 7, 2021.
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IRF PPS Proposed Rule - CMS proposes increasing payments by 1.8% and modifying the IRF Quality Reporting Program to take into account COVID-19 reporting exemptions. CMS is also requesting feedback on collecting quality and health equity data. Comments are due June 7, 2021.
AHCCCS proposes policy changes to its Medical Policy Manual
AHCCCS is proposing several changes to the AHCCCS Medical Policy Manual (AMPM) which may be of interest to hospitals and other healthcare facilities. Details of the proposed changes are listed below as well as information on where to submit comments and the deadline to submit.
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Proposed changes to AMPM 320-U regarding Pre-Petition Screening, Court Ordered Evaluation, and Court-Ordered Treatment would add a definition of “voluntary evaluation.” Comments are due May 21, 2021, via the comment portal for AMPM 320-U.
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Proposed changes to AMPM Exhibit 300-2B regarding AHCCCS-Covered Non-Title XIX/XXI Behavioral Health Services specify the circumstances under which primary and secondary screenings/assessments may be covered for non-Title XIX/XXI eligible individuals. Comments are due May 29, 2021, via the comment portal for AMPM Exhibit 300-2B.
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Proposed changes to AMPM 310-BB regarding emergency transportation and non-emergency medical transportation encourage certain providers to offer public transportation options to fee-for-service AHCCCS members. Comments are due May 21, 2021, via the comment portal for AMPM 310-BB.
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Proposed changes to AMPM 420 would impact family planning services including a new definition of “family planning provider.” Comments are due May 24, 2021, via the comment portal for AMPM 420.
Members may contact Liz Lorenz, AzHHA director of policy, at [email protected] with questions related to the proposed changes.
ADHS discourages providers from using antibody testing to assess immunity to SARS-CoV-2 after COVID-19 vaccination
The Arizona Department of Health Services (ADHS) Immunization Program sent a message to providers this week notifying them that antibody testing should not be used to assess immunity to SARS-CoV-2 post-COVID-19 vaccination. According to ADHS the Centers for Disease Control and Prevention (CDC) does not recommend testing for immunity following vaccination.
CDC recommendations on serologic testing after vaccination, when to re-vaccinate or giving additional doses of COVID-19 vaccines may be updated when additional information is available.
CMS begins issuing warning notices for noncompliance with hospital price transparency rule
The hospital price transparency rule took effect January 1, 2021, requiring hospitals and health systems to disclose all standard charges, as defined by the CMS to mean privately negotiated rates with insurers, gross charges and discounted cash prices. Hospitals also are required to provide a patient price estimator tool or negotiated rate information on 300+ “shoppable” services for patients.
CMS is actively conducting audits of hospital websites and reviewing complaints submitted through the CMS Hospital Price Transparency website. The audits began with large acute care hospitals and now expanded to include a random sample of all acute care hospitals. The first set of warning letters were issued the week of April 19. CMS intends to send warning letters on a rolling basis as the agency identifies hospitals that are out of compliance with the requirements.
Upon receiving a noncompliance letter, hospitals will have 90 days to address the identified issue(s) and become compliant. CMS will re-review the hospital for compliance at the end of the 90 days, or sooner if CMS learns the issues have been addressed. Hospitals asked to submit a corrective action plan and do not submit it or do not follow it may be issued a civil monetary penalty of up to $300 per day.
Hospitals are encouraged to review the CMS website to learn more. The website includes resources such as FAQs, steps to take to create the machine-readable files and consumer-friendly displays, and a quick reference checklist.
Social determinants of health, AHCCS DAP milestone due May 14
A milestone for participation in the Social Determinants of Health (SDOH) Closed-Loop Referral Program Differential Adjusted Payment (DAP) initiative for 2022 is due May 14, 2021. This 1% DAP applies to behavioral health outpatient clinics, integrated clinics, community service agencies, independent substance abuse counselors, behavioral health therapeutic homes and rural substance abuse transitional agencies. To participate, the provider must submit a registration form and a SDOH Closed-Loop Referral system spreadsheet to Health Current at [email protected] by May 14, 2021. Templates for these documents are available here. Specific information about the requirements for each milestone may be found in the AHCCCS DAP 2022 Final Public Notice or AzHHA’s summary of the 2022 DAP initiatives. Contact Liz Lorenz, AzHHA director of policy, at [email protected] with any questions.
Long-term effects of COVID-19, Palliative Care Telehealth can help
While many individuals with COVID-19 fully recover, some have symptoms lasting weeks or months after they have tested negative and no longer have COVID-19. Although the CDC and other organizations are actively working to learn more about these effects of long COVID-19, patients are living with mild to more serious post-COVID-19 complications. Those experiencing post-COVID-19 complications or symptoms have a no-cost resource for their care that allows them to receive care services in their own home. Palliative Care Telehealth is a referral service that allows patients to consult with a palliative care specialist for symptom management or goals of care. After the consultation, the palliative care specialist will collaborate with the referring provider on any changes to the plan of care. Patient and provider resources and information are available at azhha.org/telehealth.
Upcoming Events
May 7 - 5th Annual Value-Based Care Conference: Payer & Provider Forum
The Arizona Chapter of the Healthcare Financial Management Association and The Hertel Report will host the 5th Annual Value-Based Care Conference bringing payers and providers together in a unique forum where they will share their perspectives on value-based care. The conference will be held virtually on May 7 from 8:30 a.m. - 3:30 p.m. PT. To register, click here.
May 24 - Developing a Telemedicine Program
This course is ideal for individuals or groups who have some telehealth experience and are interested in expanding their services. It is also a great course for those new to telehealth who are interested in gaining a deeper understanding of the growing industry. The course fee is waived for Arizona, New Mexico, Utah, Colorado and Nevada residents. Register here.
June 22 and 23 - Working together: Forging the future of serious illness care
In collaboration with partners from California and Hawaii, AzHHA will hold a virtual summit, Working Together: Forging the Future of Serious Illness Care, on June 22 and 23. Attendees will hear from inspiring speakers, get the latest information on the state of serious illness care from thought leaders and connect with colleagues and friends in breakouts and group discussions. Registration is now open here.
July 14 - 2021 coding clinic: Quarter 1 updates
AzHHA Affiliated Partner, NJHA Healthcare Business Solutions, is offering member health information managers and coding specialists a series of coding webinars, 2021 Coding Clinic Updates - Everything You Really Need to Know held quarterly. The webinar series provides a concise overview of the current issue of Coding Clinic and allows participants an opportunity for discussion and Q&A. The second quarter session is scheduled July 14. Register here.
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