The Feb 20 proposed rule, if finalized, will extend the CJR Model through December 31, 2023 for certain participating hospitals and proposes to expand the eligible procedures to include certain outpatient hip and knee replacement procedures. The CJR model is currently scheduled to end December 31, 2020. The rule also seeks to refine aspects of the model such as target pricing, risk adjustment, reconciliation process, and eliminating the current 50% cap on gainsharing with physicians and non-physician practitioners.
The proposed rules seek to codify or create new operational requirements for the plans including: proposed credits for achieving network adequacy, new care management and model of care requirements for all SNPs, additional appeals process provisions, and a discussion of the impact on plans when providers consolidate.
Much of the proposed changes seek to convert CMS existing and past sub-regulatory guidance and practices into regulation. By doing this, CMS provides a little more certainty to plans and providers that certain positions, approaches and policies of the agency will remain in force until a rule change is made through the prescribed process instead of simply a change in decision by the agency. It also seeks to clarify in regulation how certain issues have been addressed in practice but for which there is no clear law or regulation that supports the practice.
Here’s an overview of our work for you in January 2020.
As of this writing (November 12), the Committee has not announced the names of the invited witnesses. Names have been mentioned by inside observers, including someone from the Elder Justice Coalition, to which LeadingAge belongs, and a lead witness from the Altarum Institute. Another unconfirmed witness may be from the Long-Term Care Community Coalition.
The proposed rule would revise the disparate impact standard under the Fair Housing Act (FHA). Disparate impact is a legal doctrine under the FHA which states a policy may be considered discriminatory if it has a disproportionate “adverse impact” against any group based on race, national origin, color, religion, sex, familial status, or disability when there is no legitimate, non-discriminatory business need for the policy.
LeadingAge and ElevatingHOME/VNAA submitted extensive recommendations to the Senate Special Committee on Aging on falls prevention in response to a formal request from the Committee for ideas on prevention and treatment of falls by older persons.
Here’s an overview of our work for you in December 2018.
