In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Don Berwick, MD, last week, the American Hospital Association (AHA) urged CMS to require consistent designations of healthcare-acquired conditions (HACs) across states and to relax deadlines in the proposed regulation for Medicaid HACs.
The association’s recommendations include the following:
CMS and states should use the Medicare HACs list as the sole source from which the Medicaid HACs may be selected. Lists of HACs that vary from state to state would make it extremely difficult to manage interstate health systems, so AHA “strongly recommends” that CMS and states focus on a core set of conditions for consistency. CMS should first rely on the Patient Protection and Affordable Care Act (PPACA) to guide states toward establishing a consistent list of Medicaid HACs.
CMS should provide more guidance to states around condition selection criteria. There are several criteria built into the Medicare policy around selection of conditions that should be applied to the Medicaid policy. “We believe that it was Congress’ intent that these criteria be applied to conditions selected for the Medicaid program,” the letter stated.
CMS should work with states to determine the frequency of HACs in each state Medicaid program. “It is incumbent on CMS and states to publish in a transparent manner the frequency of healthcare-acquired conditions in the Medicaid program prior to finalizing any payment prohibitions,” the association said.
CMS should work with states on a later start date for the Medicaid policy. The PPACA requires Medicaid to prohibit payments to states for HACs by July 1: “We are very concerned about the limited time available to implement this section,” stated the AHA letter. “States and CMS are given 90 days to negotiate changes to a State Amendment Plan (SAP) after a regulation is finalized. Given the late nature of this proposed regulation, it is unlikely that SAPs will be modified prior to July 1.”
In addition to modifications to the SAP, states will need time to implement changes to their systems, educate providers about the changes and train their staff. There is not enough time for these steps, the letter asserts. If the July 1 deadline is missed, reprocessing of claims could place a burden on providers and create additional expenses for the states, “whose budgets are already severely stretched,” AHA said.
CMS should host at least one public hearing prior to completing the final regulation for the Medicaid program. “We are concerned that the tight timeline will force circumvention of the necessary public vetting that must take place for this program,” stated the letter. The AHA recommended that CMS partner with the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality when selecting conditions to include in the Medicaid program.
Finally, the association urged CMS to consider implementing a mechanism that, at a minimum, would enable hospitals to appeal decisions if they believe they were improperly penalized under the HAC policy.
The AHA, based in Washington, D.C., includes more than 40,000 individual members in 5,000 member hospitals, health systems and other healthcare organizations. Click here to read the entire letter.