IHA Daily Briefing: June 7

Friday, June 7, 2019
HFS Delays ORP Requirement to Oct. 1
IHA Submits Comments on Price Transparency
IHA Distributes Medicare IPPS Payment Impacts
CMS Issues RFI to Reduce Administrative Burden
Briefly Noted

HFS Delays ORP Requirement to Oct. 1
The Dept. of Healthcare and Family Services (HFS) has informed IHA that it will delay the implementation of the ordering, referring, prescribing (ORP) requirement until Oct. 1, 2019. Under federal law, all Medicaid claims for services requiring an order or referral must include the name and National Provider Identifier (NPI) of the clinician who ordered, referred, or prescribed the services. The ORP requirement applies to claims billed to traditional Medicaid, including Medicare crossover claims, and to Medicaid managed care organizations. An IHA memo with additional information is forthcoming.


IHA Submits Comments on Price Transparency
IHA submitted comments to the U.S. Department of Health and Human Services on price transparency questions included in the 21st Century Cures Act Interoperability, Information Blocking and the ONC Health IT Certification Program Proposed Rule.  IHA expressed its opposition to the agency’s proposal to require hospitals to include pricing information within a patient’s electronic health information record. Specifically, IHA does not believe the 21stCentury Cures Act intended for this information to be included in the definition of electronic health information. Additionally, this proposal would fail to provide patients with information on their out-of-pocket costs, which is what patients want to know when making decisions about their healthcare. The letter outlined several existing price transparency requirements in Illinois and urged a multi-stakeholder approach for advancing further transparency efforts.

“IHA supports price transparency that provides relevant and meaningful information to patients about their care,” wrote A.J. Wilhelmi, IHA President and CEO. “What we hear most often is that patients want to know what their out-of-pocket financial obligations will be. Given that 93% of Illinoisans have health coverage and their health plan sets their cost-sharing financial obligations, we believe this information is best provided by health plans. For patients without healthcare coverage, healthcare providers should provide estimates of pricing, including available financial assistance, as well as additional information regarding public health coverage options.”


IHA Distributes Medicare IPPS Payment Impacts
Today, IHA made available to its member hospital CEOs and CFOs via the IHA C-Suite (password required) hospital-specific reports estimating the financial impact of Medicare payment changes for the Inpatient Acute Prospective Payment System (IPPS) for federal fiscal year (FFY) 2020.  Also available are estimates for Illinois, the U.S., a report description and a rule summary.  Comparisons between the impacts of the proposed changes affecting major provisions of the FFY 2020 and final FFY 2019 rules are provided. Comments on the proposed rule must be filed with the Centers for Medicare & Medicaid Services no later than June 24.

IHA also plans to distribute estimated impact reports of Medicare proposed FFY 2020 changes for inpatient rehabilitation, psychiatry, skilled nursing and long-term care services this month.


CMS Issues RFI to Reduce Administrative Burden
Yesterday, the Centers for Medicare & Medicaid Services (CMS) published a request for information (RFI), inviting comments on its Patients Over Paperwork initiative to further reduce administrative and regulatory burdens on clinicians to ultimately reduce healthcare costs. 

This latest RFI solicits ideas on:

  • Reporting and documentation requirements;
  • Coding and documentation requirements;
  • Prior authorization procedures;
  • Policies for rural providers, clinicians and beneficiaries;
  • Polices for dual-eligible beneficiaries;
  • Beneficiary enrollment and eligibility determination; and
  • CMS processes for issuing regulations and policies.

CMS noted that the Patients Over Paperwork initiative, launched in 2017, has significantly streamlined regulations, allowing clinicians to spend more time on their primary mission—caring for patients. The agency estimates that 40 million hours and $5.7 billion will be saved through 2021.

Additional details are available in CMS’ press release.  Comments are due to CMS no later than 60 days after the rule is published in the Federal Register; that publication date is expected to be June 11.


Briefly Noted
The May employment report issued by the U.S. Bureau of Labor Statistics today showed 75,000 jobs added for the month, with unemployment remaining at 3.6%. Hospitals added 3,000 jobs for the month. The healthcare sector added 16,000 jobs in May and 391,000 jobs over the past 12 months.