IHA Daily Briefing: Nov. 4

Monday, November 4, 2019
CMS Delays Final Rule on Hospital Prices
CMS Releases OPPS Final Rule
Integrated Health Homes Delayed to April 1
FDA Advisory Committee Meeting on EtO Nov. 6-7
T-Card Flyer Available for Medicaid Applicants
Briefly Noted

CMS Delays Final Rule on Hospital Prices
The Centers for Medicare & Medicaid Services (CMS) has delayed issuing a final rule that would require hospitals to publicly disclose the rates they negotiate with health insurers, with possible fines of up to $300 a day for not complying. The final rule is being split from other portions of the Calendar Year 2020 Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center payment system rule that was issued on Friday.

CMS Administrator Seema Verma tweeted on Friday that CMS had received over 1,400 stakeholder comments on the hospital price transparency provisions in its proposed OPPS rule: “We considered the thoughtful and innovative ideas provided during the comment period as we work to finalize the hospital price transparency rule alongside a comprehensive proposal for health plan price transparency.”

A CMS statement to the news media indicated that the agency “intends to summarize and respond to public comments on the proposed policies in a forthcoming final rule.”

IHA had submitted an extensive comment letter to CMS in late September, raising numerous objections about the proposed policies while suggesting health plans are better equipped to provide meaningful information to patients on out-of-pocket costs:

“IHA strongly supports price transparency that provides meaningful and relevant information to patients making healthcare decisions. We appreciate the Centers for Medicare & Medicaid Services’ (CMS) desire to increase price transparency. However, we believe this proposed rule would cause significant confusion for patients while failing to provide the information they want, which is what their out-of-pocket obligation will be. The requirements in the proposed rule would create substantial administrative burden for hospitals. Furthermore, we believe the proposed requirement for hospitals to disclose their negotiated rates exceeds the agency’s statutory authority. Health plans are the entities that dictate what a patient’s financial obligation will be and are therefore in the best position to provide this information on what a patient’s out-of-pocket costs will be.”


CMS Releases OPPS Final Rule
On Friday the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2020 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System final rule. CY 2020 hospital outpatient rates will increase by a net 2.6% compared to CY 2019. The final rule also completes the phase-in of the site-neutral rate for clinic visits provided in grandfathered off-campus provider-based departments as well as payment cuts for 340B-acquired drugs.

CMS did not include proposed hospital price transparency provisions in the final rule, instead separating these provisions into a forthcoming rule. IHA will provide additional details on the OPPS final rule, as well as hospital-specific impact reports, in the coming days.


Integrated Health Homes Delayed to April 1
The Illinois Dept. of Healthcare and Family Services (HFS) will delay the implementation of the two-year Medicaid Integrated Health Homes (IHH) program until April 1, 2020, Medicaid Administrator Doug Elwell told members of the Medicaid Advisory Committee on Friday. The initiative, aimed at integrating physical and behavioral health, is a key part of the state’s overhaul of behavioral healthcare in Medicaid. The program had been previously delayed under the Rauner administration. HFS had announced earlier this spring it intended to begin the program Jan. 1, 2020 and develop separate state plan amendments for children and adults. The new implementation date aligns with the federal government’s quarterly fiscal year, intended to maximize the federal funding opportunity.

The IHH delay to April 1 will be used to ensure there would be enough trained facilitators, specifically for the child-focused IHH. The child-focused IHH will have more requirements on facilitators, designed to mirror many aspects of the Oklahoma IHHs. Training materials shared by Oklahoma will be used for the facilitator population in Illinois, as noted by Elwell. HFS will also work with the University of Illinois on establishing training centers and doing outreach to train the program's workforce.

As proposed, IHH staffing would be limited to nurse and social work case manager leaders and care coordinators, the latter requirement only being a high school diploma or GED. Unlike the previous plan, Illinois Medicaid Program Advanced Cloud Technology (IMPACT) enrollment would not be required. The adult and child-focused IHHs will have separate rates and certification requirements for staff. HFS has not shared any documentation of the IHH plans on its website at this time.

Although plans are incomplete, the proposed details do appear to have fewer restrictions than the plan under the previous administration. Health home services would still encompass those required by federal CMS, including comprehensive care management, care coordination, health promotion, comprehensive transitional care/follow-up, patient and family support, and referral to community and social support services.


FDA Advisory Committee Meeting on EtO Nov. 6-7
The U.S. Food and Drug Administration’s (FDA’s) General Hospital and Personal Use Devices Panel of the Medical Devices Advisory Committee will meet in Gaithersburg, Maryland on Wednesday and Thursday this week to discuss industrial ethylene oxide (EtO) sterilization of medical devices and its role in maintaining public health as well as the risks of infection with reprocessed duodenoscopes. The general function of the committee is to provide advice and recommendations to FDA on regulatory issues.

Subject matter of the panel meeting will include potential methods and expert assessment of how to reduce EtO emissions to the environment from medical device sterilization processes without compromising assurance of sterility or effective processing of medical devices. The panel will also discuss recommendations to reduce the risk of infection from reprocessed duodenoscopes. 

The FDA has posted background materials and instructions on submitting comments by Dec. 6. See the notice for the meeting. The meeting will be available via webcast on Nov. 6 here and on Nov. 7 here.

Late last month, the FDA issued a statement on “Concerns with medical device availability due to certain sterilization facility closures.”


T-Card Flyer Available for Medicaid Applicants
The Illinois Dept. of Human Services (DHS) is required to make eligibility determinations on applications for and redeterminations of eligibility for medical assistance within federal mandated timeframes. If a medical assistance determination is not made timely, the applicant may request a temporary medical card (i.e., T-card). Temporary coverage is effective from the day the card is issued until the day the state makes a determination on the application.

The Legal Council for Health Justice, EverThrive Illinois, the Shriver Center on Poverty Law, and the DuPage Federation on Human Service have created a flyer to assist providers in informing patients who are awaiting a determination of their right to request temporary medical assistance and how to obtain a T-card via one of the following methods:

  • Call the All Kids Unit toll free at 877-805-5312 and press 8 to request a T-card;
  • Log in to the Application for Benefits Eligibility’s Manage My Case web portal;
  • Contact the applicable Family and Community Resource Center (i.e., local office); or
  • Write to P.O. Box 19138, Springfield, IL 62794.

A similar flyer is available from the DHS website (Aug. 28).


Briefly Noted
Helena Lefkow, senior director, Revenue Cycle and Managed Care, IHA, has been appointed to the Illinois Workers’ Compensation Medical Fee Advisory Board by Gov. J.B. Pritzker. Once her appointment is confirmed by the Illinois Senate, Lefkow will serve a four-year term on the nine-member board.