Senators Call on CMS to Delay Star Ratings for Overall Hospital Quality

On April 11, 60 senators sent a letter to CMS Acting Administrator Andy Slavitt urging the agency to delay the release of the overall hospital quality star ratings to provide more time to analyze the methodology of the star ratings, examine its impact on different types of hospitals and increase transparency regarding how ratings are calculated. The agency is set to release the star ratings on April 21.

In the letter led by Sens. Rob Portman (R-OH) and Bob Casey (D-PA), lawmakers expressed concern that the current star ratings system may not accurately account for hospitals that provide care to patients with low socioeconomic status or multiple chronic diseases. The letter also says CMS has not provided enough information to hospitals about how the agency derived the star ratings. Reps. Bill Pascrell (D-NJ) and Jim Renacci (R-OH) authored a similar letter in the House.

CMS Unveils New Primary Care Initiative

On April 11, CMS introduced a five-year primary care initiative to improve the way that nearly 25 million patients receive care and reduce health care spending by an estimated $2 billion. The Comprehensive Primary Care Plus model, which is slated to be implemented in January 2017, will give primary care practices the ability to opt in to one of two payment tracks in an effort to move away from the current fee-for-service system.

In the first track, CMS will pay practices a fee of $15 per patient each month in addition to fee-for-service payments. In the second track, the agency will pay practices a fee of $28 per patient each month as well as a combination of reduced Medicare fee-for-service payments and upfront comprehensive primary care payments. Practices in the second track will also be required to sign an agreement with CMS to support the use of enhanced health information technologies. The agency expects the second track will result in $2 billion in savings over the course of the five-year initiative.

The primary care program will involve over 20,000 health care providers and as many as 5,000 practices in 20 regions throughout the country. CMS will start soliciting applications from primary care practices in the selected regions on July 15. The agency will host an informational webinar regarding the initiative on Thursday, April 19 at 3:00 PM.

House Republicans Begin Work on ACA Replacement

Members of House Speaker Paul Ryan’s (R-WI) GOP health task force, including Ways and Means Committee Chairman Kevin Brady (R-TX), Energy and Commerce Committee Chairman Fred Upton (R-MI) and Education and the Workforce Committee Chairman John Kline (R-MN), met on April 13 to discuss the provisions of an alternative plan to the Affordable Care Act (“ACA”) that include the tax treatment of health insurance plans and the Medicaid program.

One policy under consideration for the ACA alternative is a cap on the health care tax exclusion, which would restrict the amount employees can contribute to their health care premiums without being taxed. Employers would continue to be allowed to deduct their health insurance coverage costs from their tax expenditures.

The April 13 meeting follows a number of listening sessions hosted by the task force to draft a health care law replacement before the Republican National Convention in July. Speaker Ryan’s office confirmed last week that the health task force is on track to meet its summer deadline.

Health-Related Bills Introduced This Week

Sen. Shelley Moore Capito (R-WV) introduced a bill that is intended to improve access to hospice care in rural areas. The measure (S. 2786) would amend Title XVIII of the Social Security Act to provide a technical fix to enable rural health clinics and federally qualified health centers to receive payment for physicians’ services in hospice care under Medicare Part B.

On April 13, Sen. Mark Warner (D-VA), along with a number of Senate Democrats, introduced a bill (S. 2787) that would codify the president’s budget proposal to cover the full cost of Medicaid expansion for states yet to expand the program. The bill is similar to both a current bill in the House and the proposal included in the president’s most recent budget proposal.

Next Week in Washington

The Senate is set to begin a long stretch of work on annual appropriations bills. Earlier this week, the Senate Appropriations Committee adopted its 302(b) spending allocations, which divides over $1.07 trillion in discretionary spending into 12 pieces. $161 billion was allocated for Labor-HHS-Education, which funds discretionary spending within HHS, CMS and other health-related programs. The caps represent a slight increase from fiscal 2016 discretionary levels. The House has yet to pass a budget resolution and, without a budget in place, the 302(b) spending allocations for each subcommittee have yet to be revealed.