AHA News

A proposed rule establishing unique identifiers for health plans and other entities should help facilitate appropriate routing of electronic health care claims, the AHA said in comments submitted today. The rule would require health plans and other entities covered by the Health Insurance Portability and Accountability Act to use the health plan ID in health care transactions, and allow pharmacists and other providers exempt from HIPAA to apply for a national provider identifier for use in health care claims. Among other changes, AHA recommends CMS require health plans to use the HPID on subscriber enrollment cards, and provide more guidance on the appropriate use of sub-health plan identifiers. AHA also urged CMS to extend the rule's effective date and compliance deadline, which currently coincides with the new ICD-10 compliance date. The proposed rule implements the Patient Protection and Affordable Care Act's administrative simplification provisions. AHA commented on the rule's ICD-10 provisions in a separate letter this week.

The AHA today voiced support for the Centers for Medicare & Medicaid Services' preliminary decision to allow general supervision for 27 hospital outpatient therapeutic services. "In particular, we believe that this decision will support access to hospital-based outpatient mental health services, especially in rural communities where the number of hospitals offering these services has been rapidly declining but demand remains high," AHA said in a comment letter. Most of the services deal with psychotherapy, and the rest relate to bladder catheterization, immunization administration, and smoking and tobacco cessation counseling. CMS also should allow the Hospital Outpatient Payment Panel to recommend additional services for the "hybrid" supervision level, and "provide more time for hospitals to respond to requests for code changes and for HOP panel members to review submitted information prior to a meeting," AHA said. 

The AHA and Healthcare Financial Management Association yesterday asked the Internal Revenue Service to withdraw Part V of Schedule H, or make it optional until the Office of Management and Budget reviews and approves a revised Schedule H in light of public comments. IRS revised the form to implement new requirements for tax-exempt hospitals under the Patient Protection and Affordable Care Act. Responding to an IRS notice last week providing a five-day period to comment on the changes, the groups note that the Paperwork Reduction Act requires a 60-day comment period and OMB approval before the changes can be mandatory. "Because of the duplicative questions posed and the redundant and excessive paperwork currently required by the Schedule, hospitals will not only spend excessive amounts of time completing the Schedule but they will also incur additional expenses and divert greater resources collecting information to comply with the Schedule," the letter states. It includes line-by-line recommendations to improve the form that were submitted to the IRS last summer and reflect the input and experience of hospitals across the country.

A new ad by the AHA, American Society of Health-System Pharmacists, Institute for Safe Medication Practices, and American Society of Clinical Oncology urges Congress to "keep the drug shortages provisions" in the Prescription Drug User Fee Act. "It's the best prescription for fighting drug shortages in America," the print and online ad appearing today in Politico states. "Drug shortages can adversely affect patients' drug therapy, compromise medical procedures, result in medication errors, or worse…Reauthorize PDUFA so we can make sure patients continue to get the medication they need." The provisions strengthen requirements that drug makers report production interruptions and discontinuations to the FDA and give the agency other authority to prevent shortages and better communicate with stakeholders. The White House today said it "strongly supports" passage of the legislation, which the Senate may take up this week. The legislation then must be reconciled with a similar measure in the House.

The Department of Health and Human Services today issued guidance for states implementing health insurance exchanges under the Patient Protection and Affordable Care Act. The guidance includes a draft blueprint for approval of state-based and partnership exchanges, and general guidance on federally facilitated exchanges. According to the blueprint, states seeking to operate a state-based exchange or electing to participate in a partnership exchange for plan year 2014 must submit a complete "exchange blueprint" by Nov. 16, 2012. In related news, HHS awarded six states $181 million in grants to help establish exchanges: Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington. To date, 34 states and the District of Columbia have received the Exchange Establishment grants, which states can apply for through 2014. Under the ACA, individuals and small businesses will use the exchanges to purchase health insurance beginning in 2014. HHS has scheduled several regional forums for states and stakeholders implementing the exchanges.

A new report from the Missouri Hospital Association shares lessons learned by hospitals responding to an exceptional series of natural disasters in the state last year, including a catastrophic tornado that struck the city of Joplin May 22. "During storms that brought unprecedented snow, ice, floods and tornadoes to Missouri in 2011, hospitals throughout the state once again demonstrated their ability to serve their communities," said MHA President and CEO Herb Kuhn. "In times of emergency, communities depend on hospitals for immediate, lifesaving medical assistance. This report demonstrates that Missouri's hospitals fulfilled that role and more, especially following the Joplin tornado. Sharing the experiences of 2011 will help every hospital prepare for the unexpected." The report focuses on nine key areas of hospital and health system preparedness:  planning, communications, resources and assets, safety and security, staffing, volunteers, utilities, medical surge and evaluation.

In response to a federal court decision invalidating its expedited union election rule, the National Labor Relations Board yesterday announced it will temporarily suspend implementation of changes to its process for union representation cases while it considers how to respond to the court decision. "About 150 election petitions were filed under the new procedures," the Board said. "Many of those petitions resulted in election agreements, while several have gone to hearing. All parties involved in the 150 cases will be contacted and given the opportunity to continue processing the case from its current posture rather than re-initiating the case under the prior procedure." A federal district court ruled Monday that the Board did not have the statutorily required quorum when it adopted the rule, which was challenged by the U.S. Chamber of Commerce and Coalition for a Democratic Workplace. In February, the AHA and its American Society for Healthcare Human Resources Administration and American Organization of Nurse Executives affiliates joined the HR Policy Association and Society for Human Resource Management in filing a friend-of-the-court brief supporting the Chamber and CDW challenge.

The House Ways and Means Oversight Subcommittee today held the first in a series of hearings on oversight of tax-exempt organizations by the Internal Revenue Service. Testifying on the concerns of tax-exempt hospitals, Michael Regier, senior vice president of legal and corporate affairs for VHA Inc., said VHA, AHA and the Healthcare Financial Management Association have urged the IRS to streamline and simplify its revised Schedule H for hospitals. Noting that the agency has yet to issue any regulations implementing the new requirements for tax-exempt hospitals under the Patient Protection and Affordable Care Act, Regier urged Congress to ensure "that hospitals are able to direct their limited resources toward meeting their communities' most significant health needs as opposed to complying with excessively burdensome paperwork requirements." In the context of comprehensive tax reform, he urged the committee to avoid taking any action that would jeopardize the income tax exemption for charitable hospitals, tax-exempt financing for hospital facilities, or deductibility of charitable contributions and bequests for hospital donors. Testifying for the National Association of College and University Business Officers, Cornell University Chief Financial Officer Joanne DeStefano called the revised 990 Form "so complicated that our trustees don't know where to begin."

On May 22, AHA will hold the first of six members-only educational webinars to help hospitals manage the growing number of payment audits from government contractors and reduce vulnerability to payment denials. As part of the AHA Audit Education Series, AHA also will issue educational resources to help members navigate the audit and appeals process, which include a new member advisory on "Reducing Vulnerabilities to Payment Denials." The webinars will feature top officials from the Centers for Medicare & Medicaid Services, congressional staff, compliance and legal experts, and hospital representatives who will share successful practices. Each webinar also will include an update on AHA efforts to advocate for Congress and CMS to streamline auditing programs and eliminate duplicative audits and inappropriate denials. For more information and to register for the first two webinars, click here.

The AHA supports the Centers for Medicare & Medicaid Services' proposed one-year delay in the compliance date for the International Classification of Diseases 10th Edition Clinical Modification and Procedure Coding System, and strongly recommends that CMS move forward with both the CM and PCS coding systems at the same time, the association said in comments submitted today. The comment letter includes highlights from an AHA survey in February, which found most hospital leaders prefer limiting the delay to one year and finalizing the deadline soon so they can adjust their implementation plans. The survey also found that while many hospitals are well prepared for the transition, a short delay will allow them to address competing initiatives, such as adoption of electronic health records. AHA plans to submit separate comments on other elements of the proposed rule, including adoption of a standard for a unique health plan identifier and changes to the national provider identifier requirements. "However, we are very concerned about establishing the same compliance date for ICD-10 and the [health plan ID]," AHA said. "We recommend that the date for the HPID be one year later than the revised Oct. 1, 2014 date for ICD-10-CM and ICD-10-PCS" to isolate the cause of any processing problems that occur.