IHA Daily Briefing: Dec. 5

AHA Lawsuit Challenges Site-Neutral Payment Policies
IHA Submits MedPAC Comment Letter
Survey Shows Top Health Concerns for Chicago's Youth
CMS Addresses Staffing Adequacy in Nursing Homes
Briefly Noted

AHA Lawsuit Challenges Site-Neutral Payment Policies
Yesterday, the American Hospital Association (AHA), along with the Association of American Medical Colleges and other hospitals, filed a lawsuit against the U.S. Department of Health & Human Services (HHS) challenging the Centers for Medicare & Medicaid Services’ (CMS’) two-year phase-in of reductions in Medicare payment for clinic (Evaluation & Management) visits furnished in “excepted” off-campus hospital-based outpatient departments (HOPDs). In the calendar year (CY) 2019 Medicare Outpatient Prospective Payment System (OPPS) final rule, CMS changed the current payment methodology (based on 100 percent of the OPPS rates) to require payments for these services to be the same as those paid for services in “non-excepted” departments (i.e., based on 70 percent of the OPPS rates in 2019 and 40 percent of the OPPS rates in 2020).

The lawsuit contends CMS overstepped its authority by expanding the payment cuts in a manner that is not budget neutral and by extending the cuts to HOPDs that were specifically excepted in Section 603 of the Bipartisan Budget Act of 2015.

IHA Submits MedPAC Comment Letter
Today, IHA submitted its comment letter to the Medicare Payment Advisory Commission (MedPAC) in anticipation of its December meeting to be held Dec. 6 & 7 in Washington D.C. IHA submitted comments covering payment adequacy and updating payments for 2020 for various services, including:  physician services, hospital inpatient and outpatient services, skilled nursing services, inpatient rehabilitation services, long-term care hospital services, hospice services and home health services.

In addition, IHA offered comments on topics discussed at previous MedPAC meetings that continue to be of interest to its members, including:

  • Medicare payment reductions for 340B program drugs administered to patients at eligible hospitals;
  • Availability of emergency services in rural communities; and
  • Continued opposition to the Centers for Medicare & Medicaid Services’ various applications of site-neutral payment reductions.

MedPAC’s next meeting is scheduled for January 10 & 11.

Survey Shows Top Health Concerns for Chicago’s Youth
Drug abuse, obesity, and child abuse and neglect are the top three big health problems for children and adolescents in the city, according to a telephone poll of Chicago adults. That’s according to survey results released by Ann & Robert H. Lurie Children’s Hospital of Chicago and the Chicago Department of Public Health on Monday. The results show that seven of the top 10 health problems for youth are thought to be related to mental health directly or through health conditions connected to mental health.

The top 10 health problems for youth rated by poll participants (with proportions of adults rating each as a “big problem”) are:

  • Drug Abuse – 64 percent
  • Childhood Obesity – 62 percent
  • Child Abuse and Neglect – 61 percent
  • Stress Among Children and Teens – 60 percent
  • Depression Among Children and Teens – 58 percent
  • Smoking and Tobacco – 53 percent
  • Alcohol Abuse by Youth – 51 percent
  • Parents’ Health Problems Affecting Children’s Health – 49 percent
  • Suicide Among Children and Teens – 49 percent
  • Teen Pregnancy – 49 percent

More than 3,300 phone interviews were conducted in randomly selected households across Chicago, with participants in all 77 community areas, from Dec. 2017 through June 2018.

CMS Addresses Staffing Adequacy in Nursing Homes
On Friday, the Centers for Medicare & Medicaid Services (CMS) announced actions it is taking to ensure that nursing home facilities are staffed adequately to provide high-quality care.

Among those actions are:

  • Sharing data with states when potential issues arise concerning staffing levels and the availability of onsite nurses;
  • Clarifying how facilities should report hours and deduct time for staff meal breaks; and
  • Providing facilities with new tools to help ensure their resident census is accurate.

"We're deeply concerned about potential inadequacies in staffing, such as low weekend staffing levels or times when registered nurses are not onsite, and the impact that this can have on patient care," said CMS Administrator Seema Verma. “These oversight initiatives are part of broader efforts CMS has undertaken to strengthen safety and health outcomes for nursing home residents.”

Briefly Noted
The Centers for Medicare & Medicaid Services (CMS) released its September 2018 Medicaid and Children’s Health Insurance Program (CHIP) enrollment data, noting nearly 73 million individuals nationwide were enrolled in Medicaid and CHIP for the month. As of September 2018, Illinois had more than 2.9 million individuals enrolled in Medicaid and CHIP.

Findings from a Kaiser Family Foundation Tracking Poll, conducted after the 2018 midterm elections, show that the public wants the new U.S. House Democratic majority to work with Republicans to address key issues facing the country, including healthcare. Also, 69 percent of Americans are unaware or unsure that Congress eliminated the penalty for not having health insurance in 2019. In regards to the health insurance marketplace open enrollment, 61 percent of people who purchase their own insurance or who are currently uninsured are unaware of the open enrollment deadline—Dec. 15.