CMSPROPOSES POLICIESON PATIENTSAFETY AND HEALTH EQUITY Proposed Rule Would Reward Hospitals that Deliver High-Quality Care to Underserved Populations

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for inpatient and long-term care hospitals that builds on the Biden-Harris Administration?s key priorities to advance health equity and support underserved communities.

As required by statute, the fiscal year (FY) 2024 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) rule updates Medicare payments and policies for hospitals The rule would also adopt hospital quality measures to foster safety, equity, and reduce preventable harm in the hospital setting

CMSis proposing to recognize homelessness as an indicator of increased resource utilization in the acute inpatient hospital setting, which may result in higher payment for certain hospital stays. This action aligns with the Administration?s goal of providing support to historically underserved and under-resourced communities

?CMSis helping to build a resilient health care system that promotes good outcomes, patient safety, equity, and accessibility for everyone,?said CMSAdministrator Chiquita Brooks-LaSure

?This proposed rule reflects our person-centric approach to better measure health care quality and safety in hospitals to reduce preventable harm and our commitment to ensure that people with Medicare in rural and underserved areas have improved access to high-quality health care.?

For acute care hospitals paid under the IPPSthat successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful electronic health record users, the proposed increase in operating payment rates for FY2024 is projected to be 2 8% This reflects an FY2024 projected hospital market basket update of 3.0%, reduced by a projected 0 2 percentage point productivity adjustment For FY2024, CMSexpects the proposed increase in operating and capital IPPSpayment rates would generally increase hospital payments by $3.3 billion. For LTCHs, CMSproposes to increase the LTCH PPSstandard Federal payment rate by 2 9%

Overall, CMSexpects LTCH payments under the dual-rate payment system to decrease by 0 9%, or $24 million, primarily due to a projected decrease in high-cost outlier payments in FY2024 compared to FY2023.

Cmsproposes Policieson Patientsafety And Health Equity

?With this proposed rule, CMSis more accurately paying hospitals and recognizing for the first time that homelessness, as a social determinant of health, also impacts resource utilization,? said CMSDeputy Administrator Dr Meena Seshamani

?Creating incentives for hospitals to provide excellent care for underserved populations lays the foundation for a health system that delivers higher-quality, more equitable, and safer care for everyone.?

Advancing Health Equity

CMSis proposing to make health equity adjustments in the Hospital Value-Based Purchasing Program by providing incentives to hospitals to perform well on existing measures and to those who care for high proportions of underserved individuals, as defined by dual eligibility status

This builds on previous efforts to advance health equity through the finalized health equity adjustment in the Medicare Shared Savings Program and finalized policies in Medicare Advantage and Part D Star Ratings Program. CMSalso proposes to recognize the higher costs that hospitals incur when treating people experiencing homelessness, when hospitals report social determinants of health codes on claims. In addition, CMSis requesting comment on how to further support safety-net hospitals

CMSis also proposing that rural emergency hospitals could be designated as graduate medical education training sites As a result, more medical residents would be able to train in rural settings, which can help address workforce shortages in these communities. This proposal builds on other policies to support access to care in rural and other underserved communities.

Promoting Patient Safety

Consistent with the CMSNational Quality Strategy and theHHSNational Healthcare System Action Alliance to Advance Patient Safety goals to promote the highest quality outcomes and safest care for all individuals, the proposed set of quality measures aims to foster safety and equity and to reduce preventable harm in hospital settings. Among this set is a proposal to measure the rate of patients and residents in long-term care hospitals who are up to date on their COVID-19 vaccinations and new, additional measures for screenings for cancer and social drivers of health

The FY2024 IPPS/LTCH PPSproposed rule has a 60-day comment period. The proposed rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/2023-07389/medicare-program-proposedhospital-inpatient-prospective-payment-systems-for-acute-care-hospitals

On Monday, April 10, 2023, President Biden signed a bill passed through Congress that ended the COVID-19 National Emergency, but it did not end the Public Health Emergency

The PHEwill end as planned on May 11, 2023

Biden?s signature enacted Public LawNo 118-3 on April 10, 2023: https://www.congress.gov/bill/118th-congress/house-joint-resolution/7/text

Resolved bytheSenateand Houseof Representativesof theUnited Statesof America in Congress assembled, That, pursuant to section 202 of the National Emergencies Act (50 U SC 1622), the national emergency declared by the finding of the President on March 13, 2020, in Proclamation 9994 (85 Fed. Reg. 15337) is hereby terminated.

CMSissued a statement on its ?Current Emergencies?website which reiterates that the PHEwill end as planned on May 11, 2023: https://www cms gov/about-cms/agency-information/emergency/epro/current-emergencies /current-emergencies-page https://www.ngsmedicare.com/web/ngs/events?lob=96664&state=97244&rgion=93624

CorroHealt h rem inds our readers t hat Medicare Adm inist rat ive Cont ract or Nat ional Governm ent Services (NGS) has m any upcom ing t raining sessions, free of cost , for Part A and Part B providers.

Topics Available bet w een April 10 t o April 21, 2023:

Part A

- Submitting Revalidation via CMS-855A Paper Application for Pt A Providers

- Counseling to Prevent Tobacco Use

- Over-the-Counter COVID-19 Tests

- Let?s Chat About Provider Enrollment Revalidation

- PECOS: Manage Signatures and Additional Information Requests

- Let?s Chat about Medicare Secondary Payer for Part A Providers

Part B

-

Part B Appeals, Clerical Error Reopenings, ADRs and Prior Auth Requests

- Submitting Revalidation via CMS-855I Paper Application for Pt B Providers

- Introduction to Medicare Part I and II

- End of the PHEand Billing Telehealth Services

- NCCI Edits

- How to Avoid Duplicate Claims

NGSalso offers computer-based training through its Medicare University portal. To access these sessions, you must register and create a login. Once logged in, registrars have access to hundreds of courses

According to an MLN Fact Sheet published in December, 2022, Medicare will require all 340(B) entities, including Critical Access Hospitals, which submit claims for separately payable Part B drugs and biologicals to report modifier ?JG?or ?TB?on claim lines for drugs acquired through the 340(B) discount program.

The MLN is available at the following website: www cms gov/files/document/mln4800856-medicare-part-b-inflation-rebate-guidance-use340b-modifier pdf