State Regulatory Focus

Innovative Hospital Models

DOH posted new guidance about how it will approach future requests for licensure for “innovative hospital models”—facilities that offer fewer services than existing hospitals. DOH provides information about how the department will interpret regulations in two key areas, Continuous Medical Services and Diagnostic and Treatment Areas. HAP is evaluating the guidance, engaging member input, and working with DOH to ensure hospitals have the flexibility necessary to deliver efficient, patient-centered care.

State Hospital Licensure Regulations

HAP has been working with state regulators to update hospital licensure regulations that are extremely outdated and no longer align with modern medical care.

Federal Regulatory Focus
 

Regulatory Burden Relief

HAP has been engaged with the hospital community to identify and advocate for regulatory reforms that reduce administrative complexity and streamline duplicative, antiquated and contradictory provider regulations. HAP has actively worked to inform a significant body of work by the American Hospital Association (AHA). Additionally, HAP has directly elevated the voice of the Pennsylvania hospital community through advocacy with the Administration and Congress. In August 2017, HAP issued a response to the Ways & Means Committee call for stakeholder feedback on behalf of Pennsylvania hospitals and health systems.

HAP has made recommendations to the Administration and Congress on behalf of the Pennsylvania hospital community that Congress and/or the Centers for Medicare & Medicaid Services (CMS) could adopt to speed health care innovation, improve patient care, and tamp down the growth in health care spending—providing relief for federal Medicare and Medicaid budgets. The recommendations covered a broad range of topics including:

• Reforming the Stark Law to promote greater coordination of care, and prioritize the value of care delivered rather than volume. The Trump Administration issued two proposed rules that address restrictions on physician self-referrals (Stark Law) and relax some constraints in the Federal Anti-Kickback Statute that limit the ways in which providers can coordinate care for patients. Both rules reflect important steps to modernize the regulatory framework
• Expanding payment for telehealth services to provide less expensive and more convenient care options for patients
• Offering flexibility to provide services in ways that address gaps in patient access to care—such as allowing flexibility for rural providers to appropriately manage the length of stay of patients served by critical access hospitals (CAH) and better leveraging the clinical workforce to provide care to patients in underserved communities
• Promoting more reasonable program integrity reviews by federal contingency fee contractors
• Adjusting Medicare value-based purchasing programs to continue to drive quality
• Addressing burdens on post-acute care providers that inhibit patient choice

Publishing Standard Charges and Negotiated Rates

Two requirements in the proposed calendar year 2020 Outpatient Rule mandate that hospitals:

• Post a list of all of their standard charges and payer-specific negotiated rates for all items and services in a machine-readable format on their websites
• Publish the negotiated rates for 300 "shoppable" services, including 70 defined by CMS.

HAP opposes these requirements because posting standard charges and negotiated rates does not provide consumers with helpful information about out-of-pocket costs.  In addition to a host of legal and operational concerns, requiring the posting of negotiated rates would likely undermine competition in the private market and result in increased prices.
 

Site-neutral Payment

The 2019 Outpatient Prospective Payment System (OPPS) final rule expanded the scope of site-neutral payments impacting hospital off-campus provider-based departments. Under the policy, hospitals would receive just 70 percent of the outpatient payment rate for clinic visits during calendar year 2019, and CMS proposed to pay 40 percent of the outpatient payment rate during calendar year 2020 and subsequent years.

The hospital community challenged the payment policy, and a federal judge ruled in favor of the American Hospital Association and other hospital plaintiffs, saying the Centers for Medicare & Medicaid Services (CMS) did not have the authority to implement these new site-neutral payment cuts. An order issued on October 21 called for the Trump administration to reverse Medicare payment cuts for basic visits to hospital outpatient clinics. 

Despite the judge's ruling, the 2020 final rule for the Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment System and quality reporting programs retained a two-year phase-in of the “site neutral” policy. The rule takes effect January 1, 2020.

Protecting Statutory Conscience Rights in Health Care; Delegation of Authority

The final rule addresses the rights of individual health care employees who object to participating in medical procedures that violate their conscience, as well as the rights of faith-based health care facilities to provide services consistent with their religious mission and identity. The rule has major implications for access to care. On November 6, a federal judge struck down the new rule. 

Sharing Substance Use Disorder Treatment Records

The Substance Abuse and Mental Health Services Administration published a proposed rule amending its Confidentiality of Substance Use Disorder Patient Records regulations to better support the exchange of information for individuals in treatment for substance use disorder. HAP is reviewing the proposed rule and engaging member input on whether the proposed changes achieve the goal of improving care coordination across the care continuum.
 

Discharge Planning Rule

CMS issued a final rule revising the discharge planning requirements that hospitals, critical access hospitals (CAH), and home health agencies (HHA) must meet in order to participate in the Medicare and Medicaid programs. Effective November 29, 2019, hospitals and CAHs must create discharge planning evaluations for patients who are likely to suffer adverse health consequences in the absence of adequate discharge planning, and when a patient, their representative, or physician requests a plan. Hospitals, CAHs, and HHAs all must provide certain medical information to the receiving facility when transferring patients, and assist patients in selecting post-acute care services by sharing quality and resource use measures. HAP is reviewing the final rule and will help members with implementation.
 

“Public Charge” Rule

The final rule could limit legal immigrants’ future immigration status based on their receipt of public benefits. The rule likely will impact access to Medicaid services for legal immigrants and social services that address social determinants of health. The policy was set to take effect October 15, but has been blocked by legal challenges. HAP opposes the final rule and will be working to mitigate the chilling effect of the policy on legal immigrants' access to the health care benefits they are entitled to receive.
 

HAP Contacts

For more information, contact Jennifer Jordan, vice president, equity & behavioral health. Media inquiries should be directed to Liam Migdail, vice president, strategic communications.

HAP News