January 2016

January 2016

Extension of enforcement moratorium of supervision levels for outpatient therapeutic services 

On December 18, 2015, the President signed Senate Bill 1461 into law (PL 114-112).  This law extends the Centers for Medicare & Medicaid Services (CMS) enforcement instruction on supervision requirements for outpatient therapeutic services in CAHs and small rural hospitals through the end of 2015. The enforcement instruction was previously extended through 2014 by PL 113-198. With this law, Medicare contractors will not evaluate or enforce the supervision requirements for outpatient therapeutic services delivered in 2015 by these rural hospitals. As a reminder Medicare requires direct supervision by a qualified practitioner of all hospital outpatient therapeutic services unless CMS makes an assignment of either general or personal supervision for an individual service. This supervision requirement has not been enforced for critical access hospitals (CAHs) or small rural hospitals since 2010 after rural stakeholders expressed concern that the increased staffing required for direct supervision would make some services unavailable in rural hospitals.  

Meeting of the Advisory Panel on Hospital Outpatient Payment (HOP Panel) on March 14-15

The next meeting of the Advisory Panel on Hospital Outpatient Payment will be March 14-15, 2016. The meeting will be conducted only via teleconference and webcast. Comments and presentations are due January 29 to APCPanel@cms.hhs.gov. Registration is not required to participate in this teleconference public meeting.  See the Federal Register Notice of the meeting for full details. The meeting agenda will be published in March. CMS permits hospitals to request supervision level changes for outpatient therapeutic services through the HOP Panel process. In addition to reviewing APC assignments, the Panel may make recommendations to CMS about the appropriate supervision level (Personal, General, Extended Duration, or Direct) for outpatient therapeutic services presented for consideration.

Accountable Health Communities Model

Applications for funding in the Accountable Health Communities (AHC) Model are due March 31. CMS is currently accepting applications for an effort that seeks to address the gap between clinical and social needs for beneficiaries.  Over a five-year period, CMS will implement and test promising service delivery approaches that link beneficiaries to community services in five core areas: housing instability and quality, food insecurity, utility needs, interpersonal violence and transportation needs. Through cooperative agreement awards ranging from $1 million to 4.5 million, up to 44 bridge organizations will partner with state Medicaid agencies, clinical delivery sites and community service providers to test three scalable approaches that link clinical and community services. Rural providers and organizations with knowledge of beneficiaries’ needs and longstanding networks of community care are in a unique position to take part in the model and help determine the impact of social needs on health care quality and cost. There are three tracks within the AHC model, any of which could be a fit for rural community organizations. Rural organizations with an interest in the model to take a close look at Track 3. Interested organizations should consider partnering with a consortium of organizations and clinical delivery sites because the model requires that each consortium screen at least 75,000 beneficiaries per year. Applicants must submit a non-binding letter of intent by February 8. For more information, send an email to AccountableHealthCommunities@cms.hhs.gov.

Request for Information: Certification Frequency and Requirements for the Reporting of Quality Measures Under CMS Programs

On December 31, 2015, CMS and the Office of the National Coordinator for Health Information Technology issued a Request for Information to inform future rulemaking on health information technology (IT) certification. Specifically, they are requesting “feedback on how often to require recertification, the number of clinical quality measures to which a certified Health IT Module should be certified, and ways to improve testing of certified Health IT Module(s).” This is a chance to inform policy for health IT and quality reporting requirements from the unique perspective of rural providers. Comments must be submitted by 5:00 p.m. Eastern Time on February 1. 

CMS Quality Measure Development Plan

On December 18, 2015, CMS released a draft Quality Measure Development Plan to serve as a strategic framework for the future of clinician quality measure development for the transition to new Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs). Beginning 2019, CMS will apply payment adjustments to eligible professional (e.g. physicians, nurse practitioners, physician assistants) based on measures across four categories: quality, resource use, clinical practice improvement activities and meaningful use of certified electronic health record technology. This plan is an opportunity for rural providers and stakeholders to give CMS input on the beginning stages of the measure development process. Comments for the draft plan are due March 1. 

New Rule Expands Access to Care for Eligible Veterans 

The Department of Veterans Affairs (VA) recently published changes to the Veterans Choice Program that expands access to non-VA care. Effective, December 1, 2015, this rule, in part, removes the 60-day limit on an episode of care, modifies the wait-time and 40-mile distance eligibility criteria, and makes it easier for community providers to join the Choice Program. With 5.3 million Veterans residing in rural America, the Choice Program can have a significant impact on how and where Veterans access services. This is an interim final rule that is open for comment so rural community providers can inform the VA of rural considerations in terms of serving rural Veterans through the Choice Program. Comments are due March 30.  

CMS Letter to Health Insurance Issuers 

On December 23 CMS issued the 2017 draft letter to issuers in the Federally Facilitated Marketplaces (FFMs). This letter provides the operational and technical guidance for health plans to participate in the Marketplace in 2017 based on the policies set forth in the proposed rule for 2017. CMS accepted comments about this draft letter until January 17, 2016, and a final letter to issuers, incorporating any changes, will be released after the 2017 Benefit and Payment Notice Rule is finalized.  

The draft letter provides more detail than the proposed rule on what information participating health insurance plans need report; many sections had no substantive changes from last year. In some areas the draft letter provides greater detail than the proposed rule for new initiatives and requirements:

  • The proposed rule specifies that Qualified Health Plans (QHPs) must meet quantifiable network adequacy standards. In states that do not use quantifiable metrics, a Federal default time and distance standard would apply, and the draft letter includes proposed time and distance standards by specialty area and geographic location on Table 2.1
  • CMS intends to develop a label for each QHP that would describe the breadth of the network as compared to other QHPs on HealthCare.gov in the same geographic area. The draft letter outlines the proposed method for determining the labels of Broad, Standard or Basic
  • To assist issuers in identifying ECPs, CMS will publish in winter 2016 an updated list of available ECPs that meet the definition specified in the final rule. CMS will collect more complete provider data through the ECP petition process so that the list more accurately reflects the universe of qualified, available ECPs. The draft letter includes the proposed methodology for determining whether plans satisfied the 30 percent ECP standard requirement as well as the 2017 ECP categories and provider types (Table 2.2).
  • Beginning in 2017, QHP issuers that contract with a hospital with more than 50 beds must verify that the hospital uses a patient safety evaluation system and has implemented a comprehensive person-centered discharge program to improve care coordination and health care quality
  • For 2017, CMS proposes to use standardized criteria to assess whether plans proposed to be offered by issuers are meaningfully different from other plans the issuer requests to offer

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,100,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.