Friday, February 17, 2017

CMS Delays EPM Bundling Rule Timeline

Mike Cheek

Last week, the Centers for Medicare and Medicaid Services (CMS) delayed the effective date for the second mandatory hospital bundling program issued on January 3, 2017. AHCA/NCAL had asked for the delay. In a letter to the Trump Transition Team, the Association included a request that the incoming administration carefully scrutinize the Episode Payment Models (EPM) final rule for possible significant changes or to completely rescind the rule.

The rule implemented three new mandatory EPMs: coronary artery bypass graft (CABG); acute myocardial infarction (AMI); and surgical hip/femur fracture treatment (SHFFT). The two cardiac episodes will be tested in 98 Metropolitan Statistical Areas (MSAs) across the country, while the SHFFT episode will be tested in the 67 MSAs currently participating in the Comprehensive Care for Joint Replacement (CJR) demonstration.

Under the program, hospitals will be held accountable for total Medicare Parts A and B spending, as well as performance on certain quality measures, during 90-day episodes of AMI, CABG and SHFFT episodes, depending on where the hospital is located. Hospitals may share in risk and in savings with other provider types, including skilled nursing centers, but they are not required to do so. The EPMs will begin on July 1, 2017, and will run for almost five years, through 2021.

Last week’s action delays the effective day of the regulation by 60 days, from an effective day of February 18, 2017 to an effective date of March 21, 2017. The implementation date for the EPM program and related changes to the CJR bundling demonstration remains July 1, 2017. In the Federal Register notice, CMS states: “We are postponing the effective date for 60 days to ... allow for further review and consideration of new regulations.”

While this is a step in the right direction, it is important to continue advocating on behalf of the millions of patients and residents we serve. AHCA/NCAL will host a Congressional fly-in on March 21-22 to visit Capitol Hill and ask members of Congress to put pressure on CMS over the issue of excessive Civil Monetary Penalties and survey relief. For more information or to participate, please contact Matt Smyth. AHCA’s Intellectual and Developmental Disabilities Residential Services Providers annual Hill Fly-In event will occur on March 22. Contact Dana Halvorson with any questions or to register. Furthermore, AHCA/NCAL will host its annual Congressional Briefing June 5-6 at the Hyatt Regency Washington.

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