IHA Daily Briefing: Nov. 8

Leapfrog Issues Fall Hospital Safety Grades - IL 13th
Governor-Elect Announces Transition Committee
Health Insurance Exchange Rules Issued
ACA Open Enrollment Week 1 Update
Briefly Noted

Leapfrog Issues Fall Hospital Safety Grades – IL 13th 
Today, the Leapfrog Group issued its Fall 2018 Hospital Safety Grades, assigning letter grades for patient safety. Of more than 2,600 hospitals graded, 32 percent earned an “A,” 24 percent earned a “B,” 37 percent a “C,” 6 percent a “D” and just under 1 percent an “F”.

“Healthcare was an important issue in the 2018 mid-term elections, yet both parties are still neglecting the third leading cause of death in America—errors and infections in hospitals,” said Leah Binder, president and CEO of The Leapfrog Group. “Every elected official, from city councilors, to senators, to the President, should hold hospitals accountable and support efforts to improve patient safety.”

Illinois ranked 13th nationwide, based on its percentage of “A” hospitals (39 percent) out of the total number of hospitals graded – moving up from 15th in the Spring 2018 rankings. Forty-three Illinois hospitals received an “A,” 31 a “B,” 31 a “C,” three a “D,” and two an “F” (See Illinois list).

Hospitals and health systems across Illinois are actively engaged in and committed to improving quality and safety. The Great Lakes Partners for Patients Hospital Improvement Innovation Network (HIIN), a collaborative between IHA, the Michigan Health & Hospital Association and the Wisconsin Hospital Association, includes 130 Illinois hospitals that are working to substantially reduce hospital-acquired conditions and readmissions. The Midwest Alliance for Patient Safety (MAPS), a federally certified Patient Safety Organization, supports many patient safety initiatives, providing full privileges and confidentiality, secure adverse event data-collection solutions, peer networking/learning, and educational tools to improve patient care.


Governor-Elect Announces Transition Committee
Governor-elect J.B. Pritzker announced his Transition Committee yesterday. Lieutenant Governor-elect Juliana Stratton will chair the Transition Committee comprised of the following c-chairs: 

  • Barbara Bowman;
  • Mike Carrigan;
  • Former Governor Jim Edgar;
  • Sol Flores; and
  • Marty Nesbitt.

Campaign Manager Anne Caprara, who was named chief of staff, is part of the Transition Committee staff which includes:

  • Transition Director, Nikki Budzinski;
  • Deputy Transition Director, Sean Rapelyea;
  • Senior Advisor, Former Comptroller Dan Hynes;
  • Senior Advisor, State Representative Christian Mitchell;
  • Senior Advisor, Michael Sacks; and
  • Counsel, Jesse Ruiz.

Read more about the appointees in a press release.

Individuals who are interested in positions within the Pritzker administration can apply online.


Health Insurance Exchange Rules Issued
Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule, “Patient Protection and Affordable Care Act (PPACA): Exchange Program Integrity.” The proposed rule states that issuers must send a separate bill and collect separate payments for the portion of the consumer’s premium attributable to certain abortion services for which public funding is prohibited. The proposed rule would also add new compliance reviews to monitor Federally-facilitated Exchange issuer compliance with the requirement.

In addition, the proposed rule would address several recommendations based on audits of both State and Federal Exchanges by the Office of Inspector General (OIG) and the Government Accountability Office (GAO) identifying substantial weaknesses in the process for determining eligibility for advance payments of the premium tax credit (APTCs) and cost-sharing reductions (CSRs).

CMS also proposes a number of new initiatives that would place additional safeguards on the eligibility and enrollment process across all platforms, including State-based Exchanges (SBEs), State-based Exchanges using the Federal Platform (SBE-FPs), and Federally-facilitated Exchanges (FFEs). Under this proposal, SBEs will not only have to provide annual reports showing their compliance, but they will also have to demonstrate their compliance around eligibility and enrollment processes through various auditing vehicles.

Included in this proposed rule are ways to safeguard taxpayer funds through improvements to CMS’ data matching processes to ensure people are enrolled in the most appropriate type of coverage for them. CMS is proposing revisions to the periodic data matching (PDM) requirements that would allow the organization to identify and resolve issues related to consumers who are dually enrolled in both Medicare and a Qualified Health Plan (QHP) through the Exchange more frequently. If finalized, beginning with plan year 2020, CMS would require the Exchange to conduct Medicare, Medicaid/CHIP, and as applicable, Basic Health Plan PDM at least twice a year for QHP enrollees who receive subsidies.

“This administration is committed to making sure taxpayer dollars are spent appropriately,” said CMS Administrator Seema Verma. “Maintaining a high level of program integrity on the Exchange is essential, including ensuring that premium tax credits only go to those who are eligible for them. This proposed rule represents CMS’ commitment, consistent with the law, to continuously improve and strengthen oversight over the programs we administer on behalf of the American taxpayer.”

More information can be found in a CMS fact sheet.

Dovetailing on CMS’ announcement yesterday, the Departments of Health and Human Services (HHS), Treasury, and Labor released two final rules to provide conscience protections for Americans who have a religious or moral objection to health insurance that covers contraception methods. Under the Affordable Care Act, employer-provided health insurance plans are required to cover certain “preventative services” – which were defined through guidance by the Obama Administration as including all contraception methods approved by the Food and Drug Administration, including methods viewed by many as abortifacients and sterilization procedures.

The first final rule provides an exemption from the contraceptive coverage mandate to entities that object to services covered by the mandate on the basis of sincerely held religious beliefs. The second final rule provides protections to nonprofit organizations and small businesses that have non-religious moral convictions opposing services covered by the mandate. The religious and moral exemptions provided by these rules also apply to institutions of education, issuers, and individuals. The Departments are not extending the moral exemption to publicly traded businesses, or either exemption to government entities.

Read more in a HHS fact sheet.


ACA Open Enrollment Week 1 Update
The Centers for Medicare & Medicaid Services (CMS) released its Affordable Care Act (ACA) weekly enrollment snapshot for Nov. 1-3 (week one) of open enrollment for the health insurance exchange (also known as marketplace). Enrollment weeks are measured Sunday through Saturday. However, the start of open enrollment last Thursday means that week one data only spans three days.

During week one, 371,676 consumers either renewed their health insurance coverage or purchased new coverage using the HealthCare.gov platform. More than 226,000 consumers took advantage of previewing available plans during the window shopping period prior to open enrollment.

Open enrollment ends Dec. 15.


Briefly Noted
Massachusetts voters overwhelmingly rejected a ballot measure Tuesday – by a margin of 70 percent to 30 percent – that would have imposed rigid mandated nurse-patient staffing ratios. Massachusetts Health & Hospital Association President & CEO Steve Walsh said: “What we won was the ability to continue providing the best possible care for patients throughout Massachusetts.”