October 2017

October 2017

FORHP’s Policy Team is ready to answer any questions you may have about these updates at RuralPolicy@hrsa.gov

Veterans Administration (VA) Publishes Telehealth Proposed Rule 

The VA published a proposed rule that would allow any VA health care provider to provide telehealth services across state lines. While such policy is currently in place, many VA medical centers have not expanded telehealth services due to conflicting state regulations for licensure, registration, certification or other requirements. If finalized, the proposed rule would preempt state law for telehealth providers working within the scope of their VA employment. The VA views this as an opportunity to expand health care to veterans, especially those living in remote, rural or medically underserved areas. Comments are due by November 1, 2017.  

The Centers for Medicare and Medicaid Services (CMS) Revises Instructions for Medicare Cost Report Worksheet S-10

CMS released a Medicare Learning Network (MLN) article on September 29, 2017, that summarizes revisions and clarifications to the instructions for Worksheet S-10 to ensure hospitals are appropriately reporting their uncompensated care costs.

  • Reported “charity care” can include discounts provided to uninsured patients who meet a hospital’s charity care policy (line 20), as clarified in the Fiscal Year (FY) 2018 Inpatient Prospective Payment System (IPPS)/Long Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule
  • Reported bad debt from all payers (i.e., Medicare and non-Medicare) must be net of recoveries (line 26)
  • Adds Medicare allowable bad debts for the hospital (new line 27.01), which CMS will use to compute non-Medicare bad debt separately from non-reimbursed Medicare bad debt
  • No longer applies hospital cost-to-charge ratio (CCR) to:
    • Non-reimbursed Medicare bad debt or
    • Deductible and coinsurance amounts for insured patients approved for charity care.
  • Applies hospital CCR to:
    • Uninsured patients approved for charity care or a discount
    • Non-Medicare bad debt and
    • Charges for non-covered days exceeding a Medicaid (or other indigent care program) length of stay limit

CMS will begin incorporating uncompensated care data from Worksheet S-10 to distribute Medicare uncompensated care funds, beginning FY 2018 with Worksheet S-10 data from FY 2014 cost reports, as finalized in the FY 2018 IPPS/LTCH PPS final rule. CMS estimates this change will increase Medicare uncompensated care payments to rural hospitals by about 17% in FY 2018.

Note: Critical access hospitals (CAH) are not eligible for Medicare uncompensated care funds or Disproportionate Share Hospital (DSH) payments.

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.