CMS Issues Proposed Rule for 2019 Payment and Policy Updates
For Medicare Hospital Admissions and a Request for Information
On April 24, 2018, the Centers for Medicare & Medicaid Services (CMS) issued proposed updates to Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS), as well as a Request for Information (RFI) to solicit feedback on ways to better achieve interoperability.
The changes outlined in the proposed rule aim to:
- Empower patients through better access to hospital price information;
- Improve patients’ access to their electronic health records; and
- Make it easier for providers to spend time with their patients.
The deadline for submitting comments on the proposed rule and RFI is June 25, 2018. CMS will provide further instructions on how to submit comments after the rule has been published in the Federal Register in early May.
EHR Incentive Programs Name Change
Effective immediately, CMS has changed the name of the EHR Incentive Programs to the Promoting Interoperability (PI) Programs for eligible hospitals, critical access hospitals (CAHs) and Medicaid providers.
This new name better reflects the new focus of the programs.
Major Provisions in the Proposed Rule
CMS has proposed the following changes:
- Eliminate a total of 19 measures (and decrease duplication for an additional 21 measures) acute care hospitals are currently required to report across the 5 hospital quality and value-based purchasing programs, while still maintaining meaningful measures of hospital quality and patient safety.
- For eligible hospitals and CAHs that report clinical quality measures (CQMs) electronically, make the PI reporting period one, self-selected calendar quarter of the calendar year (CY) 2019 and report on 4 self-selected CQMs from the set of 16. The submission period would be January 1- February 29, 2020.
- Beginning with the 2020 reporting period, remove 8 of the 16 CQMs consistent with CMS’ commitment to producing a smaller set of more meaningful measures and in alignment with the Hospital IQR Program.
- Make the PI EHR reporting period in 2019 and 2020 for new and returning participants attesting to CMS or their State Medicaid agency be a minimum of any continuous 90-day period within each of the calendar years 2019 and 2020.
- Overhaul the PI Programs to focus on interoperability, improve flexibility, relieve burden, and incentivize providers to make it easier for patients to obtain their medical records electronically.
Other proposals include:
- Removing certain measures that do not emphasize interoperability and the electronic exchange of health information;
- Adding new measures, such as Query of the PDMP, and Verify Opioid Treatment Agreement, related to e-prescribing of opioids (Schedule II controlled substances) that align with the overall agency initiative on the treatment of opioid and substance use disorders; and
- Creating a new scoring methodology.
In the rule, CMS also reaffirms its commitment to APIs (Application Programming Interfaces) and the use of the most current version of Certified EHR Technology by 2019.