BNA’s Health Care Daily Report™ sets the standard for reliable, high-intensity coverage of breaking health care news, covering all major legal, policy, industry, and consumer developments in a...
Oct. 9 — A bipartisan group of 95 House members recently urged the CMS to reverse a proposed pay cut to outpatient hospitals in 2016.
The lawmakers, in a letter to Andrew M. Slavitt, the acting Centers for Medicare & Medicaid Services administrator, said “Medicare already pays providers less than the cost of care.” Furthermore, implementing a negative payment update would only make it more difficult for hospitals to serve their patients and communities, the Oct. 5 letter said.
In July, the CMS issued a proposed rule (80 Fed. Reg. 39,199) that would cut payments to outpatient hospitals by 0.2 percent, or $43 million in the 2016 calendar year.
Comments (CMS-1633-P) were due Aug. 31. An agency fact sheet on the outpatient proposal said a final rule will be released “on or around” Nov. 1.
The House members chided the Medicare agency's justification for the cuts.
According to the letter, the payment reduction largely results from a proposed 2 percentage point cut intended to account for the CMS Office of the Actuary's (OACT's) overestimation of the amount of packaged laboratory payments for laboratory tests that were previously paid under the Clinical Laboratory Fee Schedule (CLFS). “Specifically, the agency states that OACT estimates it included about $1 billion in the OPPS payment rates for laboratory tests that were instead paid under the CLFS,” the House members said.
In calculating the $1 billion figure, however, the OACT used data that aren't public, the lawmakers wrote. Moreover, they said, the OACT “used CY 2014 claims, which were paid under CY 2014's laboratory packing policy” to justify its laboratory packing policy for CY 2016. “It is inequitable for the agency to apply a cut calculated under one set of policies to payment rates calculated under a different set of policies,” the letter said.
Given the number of questions regarding this policy, the lawmakers asked the CMS to reconsider its approach and provide better scrutiny and transparency of the data used to justify the OACT's conclusion. “It is not appropriate to apply a negative update for hospitals in any given calendar year and we urge CMS to work with Congress in order to ensure all annual updates remain positive,” they wrote.
Reps. Pat Tiberi (R-Ohio) and Richard Neal (D-Mass.) were the lead signers of the letter.
To contact the reporter on this story: Michael D. Williamson in Washington at email@example.com
To contact the editor responsible for this story: Brent Bierman at firstname.lastname@example.org
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)