mid-south cah conference rural hospitals federal …...340b orphan drug lawsuit 1. hrsa issues...
TRANSCRIPT
Rural Hospitals
Federal Update
John T Supplitt
Senior Director AHA Section for
Small or Rural Hospitals
Mid-South CAH Conference
Agenda
1 Regulatory Policy
2 Fiscal Flashpoints
3 Advocacy Agenda
4 Legal Resources
Regulatory
Policy
OMB Bulletin No 13-01
Office of Management and Budget Bulletin No 13-01 (Who is Rural)
Revised delineations establish new CBSAs urban counties that
would become rural rural counties that would become urban and
existing CBSAs that would be split apart In summary there are
34 New Micropolitan Statistical Areas
55 Deleted Micropolitan Statistical Areas
27 Micropolitan Statistical Areas now Metropolitan Statistical Areas
3 Metropolitan Statistical Areas now Micropolitan Statistical Areas
Program Efficiency Transparency and
Burden Reduction
Conditions of Participation
Conditions for Coverage bull Removes a regulation requiring that a hospitalrsquos governing
board include a member of the medical staff
bull Allows qualified dieticians to order patient diets
bull Allows CMS-approved accrediting organizations to assess
compliance with ldquoswing bedrdquo requirement (CAH already eligible)
bull Removes a requirement that CAHs consult with a non-staff
member in developing patient care policies
bull Eliminates requirement for CAHs RHCs and FQHCs that a
physician must be on site at least once in every two-week period
bull Allows long-term care facilities to apply for a deadline extension
for automatic sprinkler system installation requirements
DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Centers for Medicare amp
Medicaid Services
42 CFR Parts 411 412 416
419 422 423 and 424
[CMS-1613-P]
RIN 0938-AS15
Medicare and Medicaid
Programs Hospital
Outpatient Prospective
Payment and
Ambulatory Surgical
Center Payment Systems
and Quality Reporting
Programs
OPPS Proposed Rule
Provisions in the proposed rule include bull Outpatient Department fee schedule
increase factor of 21
bull Increasing payments to SCHs by 71 percent
for all services paid under the OPPS
bull Making a single packaged payment for
ancillary services when they support a
primary service
bull Addition of one measure to outpatient
quality reporting requirements and removal
of three others
bull Collecting data on site-of-service for off-
campus provider-based departments
bull Changes to data requirements for rural
physician-owned hospitals
bull Revision of the requirements for physician
certification of hospital inpatient admissions
IPPS Final Rule
FY 2015 INPATIENT HOSPITAL PPS
FINAL RULE
Note This update does not include hospital-specific payment changes due to
readmissions VBP HACs MU etc
IPPS Final Rule CMS will continue working with stakeholders to address
how to improve payment policy for short inpatient
hospital stays
Finalizes change to the physician certification
requirement associated with 96-hour condition of
payment for CAHs CAHs will now have until one day
before the date on which the claim for payment is
submitted to complete all requirements
Clarifies funding of GME for rural hospitals and urban
partners that are now classified as urban in the revised
CBSAs
Finalizes MDHLow Volume Adjustments for the period
Oct 1 2014 through March 31 2015
Price Transparency bull ACA requires each hospital to establish
update and make public a list of its standard
charges for items and services it provides
bull ldquoRemindsrdquo hospitals of this obligation
bull Post publicly or be in response to inquiry
bull Must be updated annually
bull The AHA has developed tools and resources
to assist hospitals in making this information
available to patients
IPPS Final Rule FY15
Direct Supervision of HOTS
CMSrsquo June 5 Statement on HOP Panel
Recommendations
Next Meeting Aug 25-26
Accepted Direct to General
bull G0176 Activity therapy
bull 36593 Declotting by thrombolytic
agent
bull 36600 Arterial puncture withdrawal
of blood for diagnosis
bull 94667 Manipulation chest wall initial
demonstration andor evaluation
bull 94668 Manipulation chest wall
subsequent
Extended Duration to General
bull 96370 Subcutaneous infusion for
therapy or prophylaxi
Direct to Extended Duration
bull 36430 Transfusion blood or blood
components
Remaining Extended Duration
bull 96369 71 Subcutaneous infusion for
therapy or prophylaxis
Not Accepted Direct to General
bull 96401-2 Chemotherapy
administration
bull 96409 11 Chemotherapy
intravenous push techniques
bull 96413 15 16 17 Chemotherapy
intravenous infusion techniques
bull 97597 Debridement open wound
Outpatient Therapy Caps
bull ATRA subjects CAHs to the therapy cap beginning
Jan 1 2014
bull Pathway for SGR Reform Act of 2013
ndash Therapy cap exceptions process extended
ndash Temporary application of the therapy cap to
hospital outpatient departments
1
SUBJECT Applying the Therapy Caps to CAHs
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Agenda
1 Regulatory Policy
2 Fiscal Flashpoints
3 Advocacy Agenda
4 Legal Resources
Regulatory
Policy
OMB Bulletin No 13-01
Office of Management and Budget Bulletin No 13-01 (Who is Rural)
Revised delineations establish new CBSAs urban counties that
would become rural rural counties that would become urban and
existing CBSAs that would be split apart In summary there are
34 New Micropolitan Statistical Areas
55 Deleted Micropolitan Statistical Areas
27 Micropolitan Statistical Areas now Metropolitan Statistical Areas
3 Metropolitan Statistical Areas now Micropolitan Statistical Areas
Program Efficiency Transparency and
Burden Reduction
Conditions of Participation
Conditions for Coverage bull Removes a regulation requiring that a hospitalrsquos governing
board include a member of the medical staff
bull Allows qualified dieticians to order patient diets
bull Allows CMS-approved accrediting organizations to assess
compliance with ldquoswing bedrdquo requirement (CAH already eligible)
bull Removes a requirement that CAHs consult with a non-staff
member in developing patient care policies
bull Eliminates requirement for CAHs RHCs and FQHCs that a
physician must be on site at least once in every two-week period
bull Allows long-term care facilities to apply for a deadline extension
for automatic sprinkler system installation requirements
DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Centers for Medicare amp
Medicaid Services
42 CFR Parts 411 412 416
419 422 423 and 424
[CMS-1613-P]
RIN 0938-AS15
Medicare and Medicaid
Programs Hospital
Outpatient Prospective
Payment and
Ambulatory Surgical
Center Payment Systems
and Quality Reporting
Programs
OPPS Proposed Rule
Provisions in the proposed rule include bull Outpatient Department fee schedule
increase factor of 21
bull Increasing payments to SCHs by 71 percent
for all services paid under the OPPS
bull Making a single packaged payment for
ancillary services when they support a
primary service
bull Addition of one measure to outpatient
quality reporting requirements and removal
of three others
bull Collecting data on site-of-service for off-
campus provider-based departments
bull Changes to data requirements for rural
physician-owned hospitals
bull Revision of the requirements for physician
certification of hospital inpatient admissions
IPPS Final Rule
FY 2015 INPATIENT HOSPITAL PPS
FINAL RULE
Note This update does not include hospital-specific payment changes due to
readmissions VBP HACs MU etc
IPPS Final Rule CMS will continue working with stakeholders to address
how to improve payment policy for short inpatient
hospital stays
Finalizes change to the physician certification
requirement associated with 96-hour condition of
payment for CAHs CAHs will now have until one day
before the date on which the claim for payment is
submitted to complete all requirements
Clarifies funding of GME for rural hospitals and urban
partners that are now classified as urban in the revised
CBSAs
Finalizes MDHLow Volume Adjustments for the period
Oct 1 2014 through March 31 2015
Price Transparency bull ACA requires each hospital to establish
update and make public a list of its standard
charges for items and services it provides
bull ldquoRemindsrdquo hospitals of this obligation
bull Post publicly or be in response to inquiry
bull Must be updated annually
bull The AHA has developed tools and resources
to assist hospitals in making this information
available to patients
IPPS Final Rule FY15
Direct Supervision of HOTS
CMSrsquo June 5 Statement on HOP Panel
Recommendations
Next Meeting Aug 25-26
Accepted Direct to General
bull G0176 Activity therapy
bull 36593 Declotting by thrombolytic
agent
bull 36600 Arterial puncture withdrawal
of blood for diagnosis
bull 94667 Manipulation chest wall initial
demonstration andor evaluation
bull 94668 Manipulation chest wall
subsequent
Extended Duration to General
bull 96370 Subcutaneous infusion for
therapy or prophylaxi
Direct to Extended Duration
bull 36430 Transfusion blood or blood
components
Remaining Extended Duration
bull 96369 71 Subcutaneous infusion for
therapy or prophylaxis
Not Accepted Direct to General
bull 96401-2 Chemotherapy
administration
bull 96409 11 Chemotherapy
intravenous push techniques
bull 96413 15 16 17 Chemotherapy
intravenous infusion techniques
bull 97597 Debridement open wound
Outpatient Therapy Caps
bull ATRA subjects CAHs to the therapy cap beginning
Jan 1 2014
bull Pathway for SGR Reform Act of 2013
ndash Therapy cap exceptions process extended
ndash Temporary application of the therapy cap to
hospital outpatient departments
1
SUBJECT Applying the Therapy Caps to CAHs
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Regulatory
Policy
OMB Bulletin No 13-01
Office of Management and Budget Bulletin No 13-01 (Who is Rural)
Revised delineations establish new CBSAs urban counties that
would become rural rural counties that would become urban and
existing CBSAs that would be split apart In summary there are
34 New Micropolitan Statistical Areas
55 Deleted Micropolitan Statistical Areas
27 Micropolitan Statistical Areas now Metropolitan Statistical Areas
3 Metropolitan Statistical Areas now Micropolitan Statistical Areas
Program Efficiency Transparency and
Burden Reduction
Conditions of Participation
Conditions for Coverage bull Removes a regulation requiring that a hospitalrsquos governing
board include a member of the medical staff
bull Allows qualified dieticians to order patient diets
bull Allows CMS-approved accrediting organizations to assess
compliance with ldquoswing bedrdquo requirement (CAH already eligible)
bull Removes a requirement that CAHs consult with a non-staff
member in developing patient care policies
bull Eliminates requirement for CAHs RHCs and FQHCs that a
physician must be on site at least once in every two-week period
bull Allows long-term care facilities to apply for a deadline extension
for automatic sprinkler system installation requirements
DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Centers for Medicare amp
Medicaid Services
42 CFR Parts 411 412 416
419 422 423 and 424
[CMS-1613-P]
RIN 0938-AS15
Medicare and Medicaid
Programs Hospital
Outpatient Prospective
Payment and
Ambulatory Surgical
Center Payment Systems
and Quality Reporting
Programs
OPPS Proposed Rule
Provisions in the proposed rule include bull Outpatient Department fee schedule
increase factor of 21
bull Increasing payments to SCHs by 71 percent
for all services paid under the OPPS
bull Making a single packaged payment for
ancillary services when they support a
primary service
bull Addition of one measure to outpatient
quality reporting requirements and removal
of three others
bull Collecting data on site-of-service for off-
campus provider-based departments
bull Changes to data requirements for rural
physician-owned hospitals
bull Revision of the requirements for physician
certification of hospital inpatient admissions
IPPS Final Rule
FY 2015 INPATIENT HOSPITAL PPS
FINAL RULE
Note This update does not include hospital-specific payment changes due to
readmissions VBP HACs MU etc
IPPS Final Rule CMS will continue working with stakeholders to address
how to improve payment policy for short inpatient
hospital stays
Finalizes change to the physician certification
requirement associated with 96-hour condition of
payment for CAHs CAHs will now have until one day
before the date on which the claim for payment is
submitted to complete all requirements
Clarifies funding of GME for rural hospitals and urban
partners that are now classified as urban in the revised
CBSAs
Finalizes MDHLow Volume Adjustments for the period
Oct 1 2014 through March 31 2015
Price Transparency bull ACA requires each hospital to establish
update and make public a list of its standard
charges for items and services it provides
bull ldquoRemindsrdquo hospitals of this obligation
bull Post publicly or be in response to inquiry
bull Must be updated annually
bull The AHA has developed tools and resources
to assist hospitals in making this information
available to patients
IPPS Final Rule FY15
Direct Supervision of HOTS
CMSrsquo June 5 Statement on HOP Panel
Recommendations
Next Meeting Aug 25-26
Accepted Direct to General
bull G0176 Activity therapy
bull 36593 Declotting by thrombolytic
agent
bull 36600 Arterial puncture withdrawal
of blood for diagnosis
bull 94667 Manipulation chest wall initial
demonstration andor evaluation
bull 94668 Manipulation chest wall
subsequent
Extended Duration to General
bull 96370 Subcutaneous infusion for
therapy or prophylaxi
Direct to Extended Duration
bull 36430 Transfusion blood or blood
components
Remaining Extended Duration
bull 96369 71 Subcutaneous infusion for
therapy or prophylaxis
Not Accepted Direct to General
bull 96401-2 Chemotherapy
administration
bull 96409 11 Chemotherapy
intravenous push techniques
bull 96413 15 16 17 Chemotherapy
intravenous infusion techniques
bull 97597 Debridement open wound
Outpatient Therapy Caps
bull ATRA subjects CAHs to the therapy cap beginning
Jan 1 2014
bull Pathway for SGR Reform Act of 2013
ndash Therapy cap exceptions process extended
ndash Temporary application of the therapy cap to
hospital outpatient departments
1
SUBJECT Applying the Therapy Caps to CAHs
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
OMB Bulletin No 13-01
Office of Management and Budget Bulletin No 13-01 (Who is Rural)
Revised delineations establish new CBSAs urban counties that
would become rural rural counties that would become urban and
existing CBSAs that would be split apart In summary there are
34 New Micropolitan Statistical Areas
55 Deleted Micropolitan Statistical Areas
27 Micropolitan Statistical Areas now Metropolitan Statistical Areas
3 Metropolitan Statistical Areas now Micropolitan Statistical Areas
Program Efficiency Transparency and
Burden Reduction
Conditions of Participation
Conditions for Coverage bull Removes a regulation requiring that a hospitalrsquos governing
board include a member of the medical staff
bull Allows qualified dieticians to order patient diets
bull Allows CMS-approved accrediting organizations to assess
compliance with ldquoswing bedrdquo requirement (CAH already eligible)
bull Removes a requirement that CAHs consult with a non-staff
member in developing patient care policies
bull Eliminates requirement for CAHs RHCs and FQHCs that a
physician must be on site at least once in every two-week period
bull Allows long-term care facilities to apply for a deadline extension
for automatic sprinkler system installation requirements
DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Centers for Medicare amp
Medicaid Services
42 CFR Parts 411 412 416
419 422 423 and 424
[CMS-1613-P]
RIN 0938-AS15
Medicare and Medicaid
Programs Hospital
Outpatient Prospective
Payment and
Ambulatory Surgical
Center Payment Systems
and Quality Reporting
Programs
OPPS Proposed Rule
Provisions in the proposed rule include bull Outpatient Department fee schedule
increase factor of 21
bull Increasing payments to SCHs by 71 percent
for all services paid under the OPPS
bull Making a single packaged payment for
ancillary services when they support a
primary service
bull Addition of one measure to outpatient
quality reporting requirements and removal
of three others
bull Collecting data on site-of-service for off-
campus provider-based departments
bull Changes to data requirements for rural
physician-owned hospitals
bull Revision of the requirements for physician
certification of hospital inpatient admissions
IPPS Final Rule
FY 2015 INPATIENT HOSPITAL PPS
FINAL RULE
Note This update does not include hospital-specific payment changes due to
readmissions VBP HACs MU etc
IPPS Final Rule CMS will continue working with stakeholders to address
how to improve payment policy for short inpatient
hospital stays
Finalizes change to the physician certification
requirement associated with 96-hour condition of
payment for CAHs CAHs will now have until one day
before the date on which the claim for payment is
submitted to complete all requirements
Clarifies funding of GME for rural hospitals and urban
partners that are now classified as urban in the revised
CBSAs
Finalizes MDHLow Volume Adjustments for the period
Oct 1 2014 through March 31 2015
Price Transparency bull ACA requires each hospital to establish
update and make public a list of its standard
charges for items and services it provides
bull ldquoRemindsrdquo hospitals of this obligation
bull Post publicly or be in response to inquiry
bull Must be updated annually
bull The AHA has developed tools and resources
to assist hospitals in making this information
available to patients
IPPS Final Rule FY15
Direct Supervision of HOTS
CMSrsquo June 5 Statement on HOP Panel
Recommendations
Next Meeting Aug 25-26
Accepted Direct to General
bull G0176 Activity therapy
bull 36593 Declotting by thrombolytic
agent
bull 36600 Arterial puncture withdrawal
of blood for diagnosis
bull 94667 Manipulation chest wall initial
demonstration andor evaluation
bull 94668 Manipulation chest wall
subsequent
Extended Duration to General
bull 96370 Subcutaneous infusion for
therapy or prophylaxi
Direct to Extended Duration
bull 36430 Transfusion blood or blood
components
Remaining Extended Duration
bull 96369 71 Subcutaneous infusion for
therapy or prophylaxis
Not Accepted Direct to General
bull 96401-2 Chemotherapy
administration
bull 96409 11 Chemotherapy
intravenous push techniques
bull 96413 15 16 17 Chemotherapy
intravenous infusion techniques
bull 97597 Debridement open wound
Outpatient Therapy Caps
bull ATRA subjects CAHs to the therapy cap beginning
Jan 1 2014
bull Pathway for SGR Reform Act of 2013
ndash Therapy cap exceptions process extended
ndash Temporary application of the therapy cap to
hospital outpatient departments
1
SUBJECT Applying the Therapy Caps to CAHs
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Program Efficiency Transparency and
Burden Reduction
Conditions of Participation
Conditions for Coverage bull Removes a regulation requiring that a hospitalrsquos governing
board include a member of the medical staff
bull Allows qualified dieticians to order patient diets
bull Allows CMS-approved accrediting organizations to assess
compliance with ldquoswing bedrdquo requirement (CAH already eligible)
bull Removes a requirement that CAHs consult with a non-staff
member in developing patient care policies
bull Eliminates requirement for CAHs RHCs and FQHCs that a
physician must be on site at least once in every two-week period
bull Allows long-term care facilities to apply for a deadline extension
for automatic sprinkler system installation requirements
DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Centers for Medicare amp
Medicaid Services
42 CFR Parts 411 412 416
419 422 423 and 424
[CMS-1613-P]
RIN 0938-AS15
Medicare and Medicaid
Programs Hospital
Outpatient Prospective
Payment and
Ambulatory Surgical
Center Payment Systems
and Quality Reporting
Programs
OPPS Proposed Rule
Provisions in the proposed rule include bull Outpatient Department fee schedule
increase factor of 21
bull Increasing payments to SCHs by 71 percent
for all services paid under the OPPS
bull Making a single packaged payment for
ancillary services when they support a
primary service
bull Addition of one measure to outpatient
quality reporting requirements and removal
of three others
bull Collecting data on site-of-service for off-
campus provider-based departments
bull Changes to data requirements for rural
physician-owned hospitals
bull Revision of the requirements for physician
certification of hospital inpatient admissions
IPPS Final Rule
FY 2015 INPATIENT HOSPITAL PPS
FINAL RULE
Note This update does not include hospital-specific payment changes due to
readmissions VBP HACs MU etc
IPPS Final Rule CMS will continue working with stakeholders to address
how to improve payment policy for short inpatient
hospital stays
Finalizes change to the physician certification
requirement associated with 96-hour condition of
payment for CAHs CAHs will now have until one day
before the date on which the claim for payment is
submitted to complete all requirements
Clarifies funding of GME for rural hospitals and urban
partners that are now classified as urban in the revised
CBSAs
Finalizes MDHLow Volume Adjustments for the period
Oct 1 2014 through March 31 2015
Price Transparency bull ACA requires each hospital to establish
update and make public a list of its standard
charges for items and services it provides
bull ldquoRemindsrdquo hospitals of this obligation
bull Post publicly or be in response to inquiry
bull Must be updated annually
bull The AHA has developed tools and resources
to assist hospitals in making this information
available to patients
IPPS Final Rule FY15
Direct Supervision of HOTS
CMSrsquo June 5 Statement on HOP Panel
Recommendations
Next Meeting Aug 25-26
Accepted Direct to General
bull G0176 Activity therapy
bull 36593 Declotting by thrombolytic
agent
bull 36600 Arterial puncture withdrawal
of blood for diagnosis
bull 94667 Manipulation chest wall initial
demonstration andor evaluation
bull 94668 Manipulation chest wall
subsequent
Extended Duration to General
bull 96370 Subcutaneous infusion for
therapy or prophylaxi
Direct to Extended Duration
bull 36430 Transfusion blood or blood
components
Remaining Extended Duration
bull 96369 71 Subcutaneous infusion for
therapy or prophylaxis
Not Accepted Direct to General
bull 96401-2 Chemotherapy
administration
bull 96409 11 Chemotherapy
intravenous push techniques
bull 96413 15 16 17 Chemotherapy
intravenous infusion techniques
bull 97597 Debridement open wound
Outpatient Therapy Caps
bull ATRA subjects CAHs to the therapy cap beginning
Jan 1 2014
bull Pathway for SGR Reform Act of 2013
ndash Therapy cap exceptions process extended
ndash Temporary application of the therapy cap to
hospital outpatient departments
1
SUBJECT Applying the Therapy Caps to CAHs
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Centers for Medicare amp
Medicaid Services
42 CFR Parts 411 412 416
419 422 423 and 424
[CMS-1613-P]
RIN 0938-AS15
Medicare and Medicaid
Programs Hospital
Outpatient Prospective
Payment and
Ambulatory Surgical
Center Payment Systems
and Quality Reporting
Programs
OPPS Proposed Rule
Provisions in the proposed rule include bull Outpatient Department fee schedule
increase factor of 21
bull Increasing payments to SCHs by 71 percent
for all services paid under the OPPS
bull Making a single packaged payment for
ancillary services when they support a
primary service
bull Addition of one measure to outpatient
quality reporting requirements and removal
of three others
bull Collecting data on site-of-service for off-
campus provider-based departments
bull Changes to data requirements for rural
physician-owned hospitals
bull Revision of the requirements for physician
certification of hospital inpatient admissions
IPPS Final Rule
FY 2015 INPATIENT HOSPITAL PPS
FINAL RULE
Note This update does not include hospital-specific payment changes due to
readmissions VBP HACs MU etc
IPPS Final Rule CMS will continue working with stakeholders to address
how to improve payment policy for short inpatient
hospital stays
Finalizes change to the physician certification
requirement associated with 96-hour condition of
payment for CAHs CAHs will now have until one day
before the date on which the claim for payment is
submitted to complete all requirements
Clarifies funding of GME for rural hospitals and urban
partners that are now classified as urban in the revised
CBSAs
Finalizes MDHLow Volume Adjustments for the period
Oct 1 2014 through March 31 2015
Price Transparency bull ACA requires each hospital to establish
update and make public a list of its standard
charges for items and services it provides
bull ldquoRemindsrdquo hospitals of this obligation
bull Post publicly or be in response to inquiry
bull Must be updated annually
bull The AHA has developed tools and resources
to assist hospitals in making this information
available to patients
IPPS Final Rule FY15
Direct Supervision of HOTS
CMSrsquo June 5 Statement on HOP Panel
Recommendations
Next Meeting Aug 25-26
Accepted Direct to General
bull G0176 Activity therapy
bull 36593 Declotting by thrombolytic
agent
bull 36600 Arterial puncture withdrawal
of blood for diagnosis
bull 94667 Manipulation chest wall initial
demonstration andor evaluation
bull 94668 Manipulation chest wall
subsequent
Extended Duration to General
bull 96370 Subcutaneous infusion for
therapy or prophylaxi
Direct to Extended Duration
bull 36430 Transfusion blood or blood
components
Remaining Extended Duration
bull 96369 71 Subcutaneous infusion for
therapy or prophylaxis
Not Accepted Direct to General
bull 96401-2 Chemotherapy
administration
bull 96409 11 Chemotherapy
intravenous push techniques
bull 96413 15 16 17 Chemotherapy
intravenous infusion techniques
bull 97597 Debridement open wound
Outpatient Therapy Caps
bull ATRA subjects CAHs to the therapy cap beginning
Jan 1 2014
bull Pathway for SGR Reform Act of 2013
ndash Therapy cap exceptions process extended
ndash Temporary application of the therapy cap to
hospital outpatient departments
1
SUBJECT Applying the Therapy Caps to CAHs
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
IPPS Final Rule
FY 2015 INPATIENT HOSPITAL PPS
FINAL RULE
Note This update does not include hospital-specific payment changes due to
readmissions VBP HACs MU etc
IPPS Final Rule CMS will continue working with stakeholders to address
how to improve payment policy for short inpatient
hospital stays
Finalizes change to the physician certification
requirement associated with 96-hour condition of
payment for CAHs CAHs will now have until one day
before the date on which the claim for payment is
submitted to complete all requirements
Clarifies funding of GME for rural hospitals and urban
partners that are now classified as urban in the revised
CBSAs
Finalizes MDHLow Volume Adjustments for the period
Oct 1 2014 through March 31 2015
Price Transparency bull ACA requires each hospital to establish
update and make public a list of its standard
charges for items and services it provides
bull ldquoRemindsrdquo hospitals of this obligation
bull Post publicly or be in response to inquiry
bull Must be updated annually
bull The AHA has developed tools and resources
to assist hospitals in making this information
available to patients
IPPS Final Rule FY15
Direct Supervision of HOTS
CMSrsquo June 5 Statement on HOP Panel
Recommendations
Next Meeting Aug 25-26
Accepted Direct to General
bull G0176 Activity therapy
bull 36593 Declotting by thrombolytic
agent
bull 36600 Arterial puncture withdrawal
of blood for diagnosis
bull 94667 Manipulation chest wall initial
demonstration andor evaluation
bull 94668 Manipulation chest wall
subsequent
Extended Duration to General
bull 96370 Subcutaneous infusion for
therapy or prophylaxi
Direct to Extended Duration
bull 36430 Transfusion blood or blood
components
Remaining Extended Duration
bull 96369 71 Subcutaneous infusion for
therapy or prophylaxis
Not Accepted Direct to General
bull 96401-2 Chemotherapy
administration
bull 96409 11 Chemotherapy
intravenous push techniques
bull 96413 15 16 17 Chemotherapy
intravenous infusion techniques
bull 97597 Debridement open wound
Outpatient Therapy Caps
bull ATRA subjects CAHs to the therapy cap beginning
Jan 1 2014
bull Pathway for SGR Reform Act of 2013
ndash Therapy cap exceptions process extended
ndash Temporary application of the therapy cap to
hospital outpatient departments
1
SUBJECT Applying the Therapy Caps to CAHs
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
IPPS Final Rule CMS will continue working with stakeholders to address
how to improve payment policy for short inpatient
hospital stays
Finalizes change to the physician certification
requirement associated with 96-hour condition of
payment for CAHs CAHs will now have until one day
before the date on which the claim for payment is
submitted to complete all requirements
Clarifies funding of GME for rural hospitals and urban
partners that are now classified as urban in the revised
CBSAs
Finalizes MDHLow Volume Adjustments for the period
Oct 1 2014 through March 31 2015
Price Transparency bull ACA requires each hospital to establish
update and make public a list of its standard
charges for items and services it provides
bull ldquoRemindsrdquo hospitals of this obligation
bull Post publicly or be in response to inquiry
bull Must be updated annually
bull The AHA has developed tools and resources
to assist hospitals in making this information
available to patients
IPPS Final Rule FY15
Direct Supervision of HOTS
CMSrsquo June 5 Statement on HOP Panel
Recommendations
Next Meeting Aug 25-26
Accepted Direct to General
bull G0176 Activity therapy
bull 36593 Declotting by thrombolytic
agent
bull 36600 Arterial puncture withdrawal
of blood for diagnosis
bull 94667 Manipulation chest wall initial
demonstration andor evaluation
bull 94668 Manipulation chest wall
subsequent
Extended Duration to General
bull 96370 Subcutaneous infusion for
therapy or prophylaxi
Direct to Extended Duration
bull 36430 Transfusion blood or blood
components
Remaining Extended Duration
bull 96369 71 Subcutaneous infusion for
therapy or prophylaxis
Not Accepted Direct to General
bull 96401-2 Chemotherapy
administration
bull 96409 11 Chemotherapy
intravenous push techniques
bull 96413 15 16 17 Chemotherapy
intravenous infusion techniques
bull 97597 Debridement open wound
Outpatient Therapy Caps
bull ATRA subjects CAHs to the therapy cap beginning
Jan 1 2014
bull Pathway for SGR Reform Act of 2013
ndash Therapy cap exceptions process extended
ndash Temporary application of the therapy cap to
hospital outpatient departments
1
SUBJECT Applying the Therapy Caps to CAHs
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Price Transparency bull ACA requires each hospital to establish
update and make public a list of its standard
charges for items and services it provides
bull ldquoRemindsrdquo hospitals of this obligation
bull Post publicly or be in response to inquiry
bull Must be updated annually
bull The AHA has developed tools and resources
to assist hospitals in making this information
available to patients
IPPS Final Rule FY15
Direct Supervision of HOTS
CMSrsquo June 5 Statement on HOP Panel
Recommendations
Next Meeting Aug 25-26
Accepted Direct to General
bull G0176 Activity therapy
bull 36593 Declotting by thrombolytic
agent
bull 36600 Arterial puncture withdrawal
of blood for diagnosis
bull 94667 Manipulation chest wall initial
demonstration andor evaluation
bull 94668 Manipulation chest wall
subsequent
Extended Duration to General
bull 96370 Subcutaneous infusion for
therapy or prophylaxi
Direct to Extended Duration
bull 36430 Transfusion blood or blood
components
Remaining Extended Duration
bull 96369 71 Subcutaneous infusion for
therapy or prophylaxis
Not Accepted Direct to General
bull 96401-2 Chemotherapy
administration
bull 96409 11 Chemotherapy
intravenous push techniques
bull 96413 15 16 17 Chemotherapy
intravenous infusion techniques
bull 97597 Debridement open wound
Outpatient Therapy Caps
bull ATRA subjects CAHs to the therapy cap beginning
Jan 1 2014
bull Pathway for SGR Reform Act of 2013
ndash Therapy cap exceptions process extended
ndash Temporary application of the therapy cap to
hospital outpatient departments
1
SUBJECT Applying the Therapy Caps to CAHs
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Direct Supervision of HOTS
CMSrsquo June 5 Statement on HOP Panel
Recommendations
Next Meeting Aug 25-26
Accepted Direct to General
bull G0176 Activity therapy
bull 36593 Declotting by thrombolytic
agent
bull 36600 Arterial puncture withdrawal
of blood for diagnosis
bull 94667 Manipulation chest wall initial
demonstration andor evaluation
bull 94668 Manipulation chest wall
subsequent
Extended Duration to General
bull 96370 Subcutaneous infusion for
therapy or prophylaxi
Direct to Extended Duration
bull 36430 Transfusion blood or blood
components
Remaining Extended Duration
bull 96369 71 Subcutaneous infusion for
therapy or prophylaxis
Not Accepted Direct to General
bull 96401-2 Chemotherapy
administration
bull 96409 11 Chemotherapy
intravenous push techniques
bull 96413 15 16 17 Chemotherapy
intravenous infusion techniques
bull 97597 Debridement open wound
Outpatient Therapy Caps
bull ATRA subjects CAHs to the therapy cap beginning
Jan 1 2014
bull Pathway for SGR Reform Act of 2013
ndash Therapy cap exceptions process extended
ndash Temporary application of the therapy cap to
hospital outpatient departments
1
SUBJECT Applying the Therapy Caps to CAHs
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Outpatient Therapy Caps
bull ATRA subjects CAHs to the therapy cap beginning
Jan 1 2014
bull Pathway for SGR Reform Act of 2013
ndash Therapy cap exceptions process extended
ndash Temporary application of the therapy cap to
hospital outpatient departments
1
SUBJECT Applying the Therapy Caps to CAHs
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Physician Fee Schedule
bull Transitions the Ambulance Fee
Schedule to the new OMB CBSA
and RUCA delineations for the
purpose of payment calculations
bull Adds several codes to the
telehealth list
ndash Psychotherapy services
ndash Prolonged service office and
ndash Annual wellness visit bull Removes employment requirements for services
furnished incident to RHC and FQHC visits
effectively allowing them to contract rather than
employ non-practitioner staff
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Meaningful Use of EHRs
CMS Proposed Rule Meeting meaningful use in 2014
bull Rule released May 20
bull Recognizes that delays in certification have created a
timeline challenge for providers
bull Win Greater flexibility in 2014 would allow more
hospitals and physicians to both receive incentives in
2014 and avoid future Medicare payment penalties
bull More to do Address Stage 2 challenges in 2015
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
340B Orphan Drug Lawsuit
1 HRSA Issues Orphan
Drug Final Rule ndash July
2013
2 PhRMA Sues HRSA ndash
Sept 2013
3 AHA supports HRSA in
amicus brief ndash Dec 2013
4 US Federal Court Decided in Favor of
PhRMA ndash May 23 2014
5 HRSA will continue to allow purchase of
orphan drugs through the 340B program
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Fiscal Flashpoints December 31 2014
bull Medicaid physician ldquocliffrdquo
April 1 2015
bull Medicare physician ldquocliffrdquo
Debt Ceiling 2015
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Options for offsets and deficit reduction bull Prospective coding offsets ($8 billion)
bull Site neutral payment policies EampM codeHOPD ($10 billion)
66 additional APCs procedures ($9 billion)
12 procedures performed in ASCs ($6 billion)
bull Hospital bad-debt reductions ($20 billion)
bull GME reductions ($10 billion)
bull CAH payment reductions and qualification criteria
($2 billion)
bull Post acute care ($70 billion)
bull IPAB expansion ($41+ billion)
bull Medicaid State provider assessments ($22 billion)
Medicaid DSH ldquorebasingrdquo
Hospital Vulnerability List
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Deficit Reduction Alternatives include bull Reduce Medicare costs by changing cost-sharing
structures for Parts A and B (means testing)
bull Reform Medigap
bull Combine Medicare Parts A and B
bull Increase the eligibility age for Medicare
bull Enact medical liability reform
bull Develop programs to coordinate care for individuals
eligible for both Medicare and Medicaid
bull Eliminate barriers to integrated care models
bull Modernize the Medicaid long-term care benefit
Alternatives and Solutions
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Advocacy Agenda
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Payment bull Prevents 24
percent
reduction in
Medicare
payments to
physicians
(+158)
bull Nothing from our
list
bull Reserve fund (-23)
bull VBP for nursing
homes (-20)
bull Diagnostic and
imaging quality
program (-2)
bull Valuation of services
in Medicare
physician fee
schedule (-44)
bull ERSD PPS revisions
(-18)
bull Clinical labs (-25)
bull Extends Medicaid
DSH cuts into FY
2024 (-44)
bull Realigns Medicare
sequester at 4
percent for first 6
months of FY
2024 and zero
percent for
second six
months (-49)
Policy bull Medicare
extenders (+36)
bull Medicaid DSH
cut delay
bull Two midnight
delay
bull One year delay
of ICD-10
Protecting Access to Medicare Act
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Protecting Access to Medicare Act
delaying the start of the Medicaid DSH cuts for one year
extending delay in the CMS 2-midnight policy through March 31 2015
delaying implementation of the ICD-10 coding system
extending the work GPCI floor
extending the therapy cap exceptions process
Whatrsquos missing from PAMA includes
eliminating the 96-hour physician certification requirement
suspending the direct supervision of HOTS
relieving hospitals from cuts to Medicare DSH permanently
establishing beneficiary equity in hospital readmissions
fixing RAC permanently
permanent fixes for Medicare extenders
PAMA contains important hospital-related provisions
extending MDH LVA and ambulance add-on
payments
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Medicare Audit Improvement Act HR
1250S 1012
Two-Midnight Rule Coordination and
Improvement Act (S 2082)
Two Midnight Rule Delay Act of 2013
(HR 3698)
DSH Reduction Relief Act of 2013 (HR
1920S 1555)
Establishing Beneficiary Equity in the
Hospital Readmission Program Act of
2014 (HR 4188)
Advocacy Action
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Offers care from a civilian health care provider at the
departmentrsquos expense to any veteran enrolled in the
VA health system who cannot get an appointment
within the departmentrsquos current wait-time goal (14
days) or who lives more than 40 miles from a VA
medical facility
Veterans Access Choice and
Accountability Act
Advocacy Action
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Rural Hospital
Advocacy Agenda
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Rural Hospital and Provider Equity
(R-HoPE) Act Sens Tom Harkin (D-IA) John Barasso (R-WY)
Pat Roberts (R-KS) and Al Franken (D-MN)
Rural Advocacy Agenda
Provisions
ndash Extend the outpatient hold harmless
ndash Extend and increase the low-volume adjustment
ndash Extend cost-based payment for rural outpatient labs
ndash Extend CAH rural ambulance payments
ndash Extend the billing for the technical component
of pathology services
ndash Reimburse CAHs for CRNA on-call services
ndash Address 96 hour condition of payment
ndash Implement enforcement delay of direct supervision
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
The Protecting Access to Rural
Therapy Services Act
Would protect access to outpatient
therapeutic services by adopting a
default standard of ldquogeneral
supervisionrdquo
Rural Advocacy Agenda
Would provide for the extension of
the enforcement instruction on
supervision requirements for
outpatient therapeutic services in
critical access and small rural
hospitals through 2014
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Critical Access Hospital Relief Act
AHA is working with concerned lawmakers to
pass legislation that would remove the 96-
hour piece of the physician certification
requirement as a condition of payment
Rural Advocacy Agenda
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Critical Access Flexibility Act
Would give CAHs needed flexibility to accommodate
fluctuations in patients through the option of
meeting an average annual daily census of 20
Rural Advocacy Agenda
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Improving Medicare Post-Acute Care
Transformation Act of 2014
The IMPACT Act would require LTCHs inpatient rehabilitation
facilities SNFs and home health agencies to report
standardized patient assessment data and quality and
resource use measures
The IMPACT Act would not require hospitals to report patient
assessment data
Hospitals would use PAC quality measure data are used to
inform the discharge planning process
Rural Advocacy Agenda
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Legal Actions
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
AHA Litigation
AHA Legal Actions in
Process 1 CMS hospital rebilling policy
2 The two-midnight rule
bull unlawful arbitrary standards and
documentation requirements
bull 02 percent cut to FY 2014 IPPS
payments
3 Statutory deadlines for timely
review of Medicare claims denials
4 Federal court decision that will
exclude all drugs with an orphan
designation from the 340B Drug
Pricing Program
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Shirley Ann Munroe Award
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
Resources
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information
John Supplitt
Sr Director
AHA Section for
Small or Rural
Hospitals
312-422-3306
jsupplittahaorg
Contact Information