Is the Transparency Rule on Its Way Out? And Other Federal Updates Banner Image

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Is the Transparency Rule on Its Way Out? And Other Federal Updates

May 7, 2021

For more information about this blog post, please contact Khaled J. KleleRyan M. Magee, or Labinot Alexander Berlajolli.

CMS Scales Back Part of the Transparency Rule

The Centers for Medicare & Medicaid Services ("CMS") issued its annual proposed Hospital Inpatient Prospective Payment Systems. Under the proposed rule, CMS seeks to repeal the requirement that acute care hospitals report median payer-specific negotiated rates with Medicare Advantage insurers, which was finalized in 85 FR 58432. This has created some excitement in the industry that CMS may be pulling back its transparency rules. However, at least for now, CMS is not seeking to repeal its other transparency rule, the Hospital Price Transparency Final Rule, 84 FR 65524. The Hospital Price Transparency Final Rule requires hospitals make publicly available via the internet their standard charges (including, as applicable, gross charges, payer-specific negotiated charges, de-identified minimum negotiated charges, de-identified maximum negotiated charges, and discounted cash prices) in two different ways: (1) A single machine-readable file containing a list of standard charges for all items and services provided by the hospital and (2) a consumer-friendly list of standard charges for as many of the 70 CMS-specified shoppable services that are provided by the hospital, and as many additional hospital-selected shoppable services as is necessary for a combined total of at least 300 shoppable services. In fact, CMS recently issued guidance on how acute care hospitals can comply with the Hospital Price Transparency Final Rule.

In addition, under the proposed rule, acute care hospitals that report quality data and are meaningful users of EHRs will see a net 2.8 percent increase in Medicare rates in fiscal year 2022. This means that hospitals will see an increase of about $3.4 billion in payments in fiscal year 2022.  In addition, CMS plans to extend the add-on payment for COVID-19 treatment through the end of the fiscal year in which the public health emergency ends. To further assist hospitals that suffered financially during the pandemic, CMS is seeking to halt most hospital value-based purchasing program measures during the public health emergency for COVID-19. As a result, hospitals would receive neutral payment adjustments under the value-based program in fiscal year 2022. Lastly, CMS is proposing several changes to the Inpatient Quality Reporting Program. In that regard, CMS is seeking to add five new measures, including COVID-19 vaccination rates among healthcare personnel. Comments are due by June 28, 2021.

New Guidelines Reinstate Previous Guidelines On Prescribing Buprenorphine

Before the Biden Administration took over, the Department of Health and Human Services (“HHS”) issued guidelines waiving the training and waiver requirements for prescribing buprenorphine, a drug that treats opioid addiction. Prior to this time, physicians seeking to prescribe buprenorphine outside of opioid treatment programs were required to complete an eight-hour course, and then wait several months to receive their waiver once the course was completed. When President Joe Biden took office, the guidelines were cancelled. HHS once again recently issued new guidelines on prescribing practices for buprenorphine. The new guidelines allow most healthcare providers to prescribe the drug without undergoing a separate training or having to apply for a waiver. A provider will still need to submit a notice of intent to the Substance Abuse and Mental Health Services Administration stating their intention to prescribe the drug.

Comprehensive Care for Joint Replacement Model

CMS issued a final rule, 86 FR 23496, extending the Comprehensive Care for Joint Replacement model for three performance years, from October 2021 through December 2024. Numerous changes were made including the payment methodology, revising the episode definition as well as others to reverse early results from when the model was created regarding the model’s ability to achieve savings while sustaining quality. As part of the changes, CMS is excluding rural and low-volume hospitals in the 34 mandatory Metropolitan Statistical Areas (MSAs) and any voluntary hospitals in the 33 voluntary MSAs that had initially opted into the model for performance years 3 through 5.  CMS issued a fact sheet explaining the changes to the model. The rule is effective July 2, 2021.

HHS to Cover COVID-19 Vaccine Administration Costs

HHS recently announced that it will reimburse providers for administering COVID-19 vaccines to underinsured and uninsured patients. The COVID-19 Coverage Assistance Fund ("CAF"), will cover the costs of vaccine administration for providers treating patients enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing.

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