CMS proposes to create an additional appeal process that would be available to hospitals that have completed the existing appeal process under 42 C.F.R. § 412.167(b) to challenge CMS’s determination of their VBP scores, but are dissatisfied with the result. Such hospitals would be permitted to request an additional, independent review by CMS. CMS proposes to provide its independent review decision within 90 days of receiving a hospital’s proper request. Section 412.167(b) enumerates the specific appealable elements of the VBP program, which are generally limited to technical errors, such as the failure to weight or sum the domains properly. Many areas of appeal are expressly foreclosed by statute. Although CMS categorizes its current proposal as an “additional appeal process . . . beyond the existing review and correction process,” CMS does not propose to expand the scope of a provider’s appeal rights under 412.167(b). Exhaustion of the appeal process under 412.167(b) would be a prerequisite to receiving an independent review under CMS’s proposal.
Also, CMS notes in this Proposed Rule that in the FY 2014 Hospital Inpatient Prospective Payment System Proposed Rule (78 Fed. Reg. 27486, 27610-11 (May 10, 2013)), it inadvertently did not propose FY 2016 performance and baseline periods for the proposed new VBP measures, CLABSI, CAUTI, and SSI. CMS now proposes to adopt CY 2014 as the performance period for the CLABSI, CAUTI, and SSI measures for the FY 2016 Hospital VBP Program, with CY 2012 as the baseline period.