CMS finalizes new Medicare and Medicaid Home Health Care Quality Measurement Program

At the agencies

The Center for Medicare and Medicaid Services (CMS) has again extended its temporary ban on non-emergency ambulance suppliers and home healthcare agencies in six states from enrolling in Medicare and Medicaid for six months. The ban will continue in New Jersey, Pennsylvania and Texas for non-emergency ambulance services and in Florida, Texas, Illinois and Michigan for home health agencies. The notice cites the continued potential for fraud and abuse from these specific supplier types and the agency’s need for additional moratoria to allow for adequate monitoring and recording. The ban began in 2013 after the release of a National Health Care Anti-Fraud Association report that revealed as much as $60 billion were lost through waste and fraud in federal healthcare programs.

CMS has announced a new Quality Measurement Program for Medicare and Medicaid home health agencies. The final rule, released on Jan. 9, 2017, mandates a system to analyze and track how well home health providers are treating their patients and whether facilities are improving.  The new program merges two separate evaluations that home health agencies are required to track. The new rule also requires home health agencies to meet certain communication standards, including creating a system to maintain constant contact between patients’ physicians and the home health agencies providing their care. CMS also intends to mandate that home health agencies maintain more detailed patient assessments and to set new minimum qualifications for some home health workers.

CMS has published a final rule to prevent increases in pass-through payments and new pass-through payments in states that use private managed care to deliver benefits. The action ignores calls by hospitals and Medicaid managed care groups for the rule to be put on hold until the new administration can examine it. The rule enforces parts of the Medicaid managed care rule that were intended to phase-out those payments. The Medicare managed care rule codifies a ban on states paying extra to Medicaid managed care providers when those payments are not associated with a specific benefit or service.

A new proposed rule tightening oversight of prosthetics suppliers and specialists has been released by CMS. The proposed rule would set more specific accreditation requirements and narrows the types of prosthetics claims that can be paid by Medicare. The regulation would require that specialists be state licensed or certified by one of the two national prosthetist/orthotist organizations to qualify for Medicare reimbursements in addition to their national accreditation. There are permitted exceptions if a supplier or specialist has other credentials that are approved by HHS.

CMS is extending its 2016 reporting deadline and will modify 2017’s requirements for reporting electronic Clinical Quality Measure (eCQM) under the inpatient Quality Reporting and Electronic Health Record (EHR) Incentive Programs for hospitals. The extension of submission of eCQM data for 2016 has been pushed to March 13, 2017, to allow hospitals additional time to submit eCQM data. The modifications to 2017’s report program will address stakeholder concerns regarding challenges associated with hospitals transitioning to new EHR systems or products. CMS is also considering future rulemaking to modify the number of eCQMs required to be reported for 2017 as well as to shorten the reporting period.

CMS has announced that participants in its four Alternative Payment Models (APM) are responsible for treating roughly 12.3 million Medicare and Medicaid beneficiaries in all states. CMS has enrolled more than 359,000 clinicians in new payment structures this year as part of the agency’s shift towards paying hospitals and physicians based on new quality measures. The clinician enrollees will take part in one of the four APMs: the Medicare Shared Savings Program, the Next Generation ACO Model, the Comprehensive End-Stage Renal Disease Care Model or the Comprehensive Primary Care Plus Model.

A group of 21 Medicare Advantage insurers have been warned by federal officials to fix errors in their online network directories by Feb. 6, 2017, or face heavy fines. This comes after an audit of the accuracy of Medicare Advantage provider directories, which had been the target of consumer issue complaints for years. The CMS report found almost half of the 5,832 doctors listed had incorrect information. Due to the nature of private Medicare plans, consumers are restricted to choosing doctors whose information is available on these networks’ directories.  CMS expects to complete their investigation of directories by the end of 2018.

On the Hill

Representative Tom Price testified on Jan. 18, 2017, in front of the Senate Committee on Health, Education, Labor & Pensions in a step towards his confirmation as Secretary of Health and Human Services. Among the topics addressed, the repeal and replacement of the Affordable Care Act (ACA), drug pricing, and Medicare expansion received the greatest attention.  Price did not provide any additional information on a timeline for the legislative efforts to repeal and replace the ACA.  He did reaffirm his support for President-elect Trump’s statement that there would be no cuts to Medicare or Medicaid.  He and congressional Republicans have historically been in support of transforming Medicaid into a block grant program.

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