September 7th, 2017
• The August 30, 2017 “Open Claims Issues” is attached with the dates for the scheduled fixes.
• The listing of the top “Part A Claim Submission Errors” is attached.
• Change Request 9911 has been revised. The revision identifies beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program. The QMB is a Medicaid program. The system will trigger notifications to providers and to beneficiaries that the beneficiary is enrolled in the QMB program and not responsible to pay deductibles, coinsurance or copayments. (See Attachment)
New Jersey Hospital Association (NJHA) Update
1. Budget: After a 3-day government shut down, the budget was signed into law in the early morning of July 4.
a. Charity Care – the $50 million cut was not restored so charity care will be funded at $252M in SFY 2018.
b. GME – GME received a $30 million increase, for total funding of $218M in SFY 2018.
2. Medicaid Waiver: The state has received approval from CMS to extend the 1115 demonstration waiver entitled “NJ FamilyCare Comprehensive Demonstration,” effective from Aug. 1, 2017 through June 30, 2022.
a. Included in that five-year extension was an extension of the New Jersey Delivery System Reform Incentive Payment Program (DSRIP) for the first three years of the renewal period at level funding ($166.6 million), meaning DSRIP will be funded at the $166.6M for SFY 2018 – 2020 (DYs 6 – 8).
b. Effective July 1, 2020, the state must have a successor program in place. The state must submit the outline of that successor program by next year.
c. The state must develop new funding and mechanics protocols by Aug. 31, 2017. CMS must approve the new funding and mechanics protocols by Oct. 1, 2017. Therefore, no DY6 payments can be made until October at the earliest.
d. In prior years, the hospitals provided monthly progress reports which dictated payments. Under this new structure the state anticipates that hospitals will provide progress reports every six months and payments will be made semi-annually.
3. Reorganization of Mental Health and Addiction Services:
a. In late June, Gov. Christie proposed a reorganization plan to move mental health and addiction services from the Department of Human Services to the Department of Health. This will automatically take effect 60 days after the proposal unless the Legislature passes concurrent resolutions opposing the move.
b. On July 31 the Assembly passed a resolution officially disapproving of the reorganization. If the Senate approves this resolution before the 60-day deadline, the plan will be rejected.
1. ACA Repeal: three bills were voted on the Senate in late July:
a. Better Care Reconciliation Act (BCRA) – to replace the American Health Care Act (House Bill). This vote was a no, 43-57.
b. Obamacare Repeal and Reconciliation Act (ORRA) – a bill similar to 2015 bill passed in the Senate and subsequently vetoed by President Obama. This vote was a no, 45-55.
c. “Skinny” Repeal – to eliminate the individual and employer mandates. This vote was a no, 49-51.
d. Both the House and Senate are now on summer recess until after Labor Day. Likely after Labor Day discussions will shift to the debt ceiling and tax reform.
2. FY 2018 IPPS Final Rule Released:
a. Imputed Floor: CMS reversed its position in the FY 2018 IPPS proposed rule to discontinue the imputed (“rural”) wage index floor provision. The final rule confirms the policy will be extended for one year, through Sept. 30, 2018. The imputed floor wage index for New Jersey will be 1.1136 in FY 2018. NJHA estimates 17 N.J. hospitals will benefit by $36.5 million in inpatient and outpatient payments in FY 2018 due to the imputed floor.
b. Market Basket: The final rule includes an initial market basket update of 2.7 percent for hospitals that submit data on quality measures. The final rule also includes the following changes to the market basket:
i. A reduction of 0.6 percent to remove the one-time positive adjustment made in FY 2017 to restore cuts associated with the two-midnight policy.
ii. An increase of 0.4588 percentage points to partially restore cuts made as a result of a requirement in the American Taxpayer Relief Act (ATRA) of 2012.
iii. Two market basket reductions mandated by the Affordable Care Act (ACA): a 0.75 percent reduction and a 0.6 percent “productivity” cut.
iv. This results in a net market basket of 1.2 percent.
c. Medicare DSH:
i. The rule finalizes a three-year phase-in of using Worksheet S-10 data to determine the amounts and distribution of uncompensated care payments. As the FY 2014 data will be used in the FY 2018 calculation, CMS is allowing hospitals to submit revised FY 2014 S-10 worksheet data. NJHA encourages hospitals to review their data and submit any revisions to their Medicare Administrative Contractor (MAC) by the Sept. 30, 2017 deadline
ii. In FY 2018, CMS will begin using data from its National Health Expenditure Accounts (NEHA) instead of data from the Congressional Budget Office to estimate the percent change in the uninsured. Using NHEA data certified by the CMS Chief Actuary, the uninsured rate decreased from 14 percent in 2013 to 8.15 percent in FY 2018. This results in an increase in DSH payments of approximately $800 million versus FY 2017 levels. As compared to FY 2017, NJHA estimates an increase in Medicare DSH payments to N.J. hospitals totaling $84.5 million in FY 2018.
d. Hospital Readmissions Reduction Program (HRRP): NJHA estimates a reduction of $30.9 million for N.J. acute care hospitals in FY 2018 from the HRRP.
e. Value-based Purchasing (VBP): NJHA estimates a reduction of $8.7 million for N.J. acute care hospitals in FY 2018 from VBP.
3. HMS RAC Audits:
a. HMS has received CMS approval to initiate reviews in the JL MAC Region. The initial Additional Documentation Request (ADRs) letters were mailed on Tuesday, August 1st to approximately 49 providers in the entire JL region which includes NJ, DE, PA and MD.
b. Action needed: HMS encourages all providers to access the portal and customize their address and contact information to ensure all letters are reaching the correct contact in your facility. This is critical for hospitals, physicians, skilled nursing facilities, rehabilitation hospitals and long term care hospitals as there are audit issues already approved for many different provider types. To get to the portal, go to https://racinfo.hms.com/home.aspx.