CMS reverses on dual enrollment determination

 

At the agencies

On May 25, Andy Slavitt, Deputy Administrator , of the Centers for Medicare and Medicaid Services (CMS) published a blog post that discussed the agency’s  move toward further reducing patient harm and hospital readmission rates. Slavitt reported that there has been a 39 percent reduction of preventable harm to patients and significant reduction in hospital readmission rates in recent years. His post reveals a CMS proposal to create Hospital Improvement and Innovation Networks (HIINs) to further these efforts. HIINs will be part of the Quality Improvement Organization initiatives, and CMS is requesting proposals from interested parties for developing these networks. The goal of the HIINs will be to reduce overall harm to patients by 19 percent and to reduce hospital readmissions by 12 percent by 2019.

On May 27, CMS announced that it will allow Medicare accountable care organizations to participate in the agency’s new primary care pilot program, CPC+. When CMS first unveiled the program they had prohibited providers from dual participation in the two programs. CMS is limiting the number of dual enrollees to only 1,500 of the 5,000 primary care practices that will be participating in the pilot program.

 

On the Hill

On May 24, The House Ways and Means Committee approved the “Helping Hospitals Improve Patient Care Act of 2016,” which aims to revise portions of the Bipartisan Budget Act of 2015 including the exemption of certain hospitals from new site neutral policies and would allow off-campus cancer facilities to still be paid at cancer hospital rates. The legislation also proposes to implement a risk adjustment methodology for the Hospital Readmissions Reduction Program to account for certain socioeconomic factors.

On May 25, members of the House of Representatives sent a letter to CMS requesting that the agency halt the implementation of a demonstration project that would require home health facilities to receive prior authorization before providing services. The letter was signed by a group of 100 bipartisan congressional members representing districts in various states. In the letter, the members expressed concern that prior authorization might delay care and extend hospital stays for patients. They also questioned CMS’s authority to require prior authorization.

 

In the courts

The Third Circuit decided to bar the pending merger of Penn State Hershey Medical Center and Pinnacle Health System while the court hears an appeal from Pennsylvania regulators and the Federal Trade Commission (FTC). The appeal argues that the deal would undermine healthcare competition in central Pennsylvania. Earlier this month Judge John Jones issued a decision that the disputed deal would be allowed to move forward due to his assessment that the state could not put the merger on hold for an administrative challenge.


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