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Date ArticleType
9/7/2017 Payment/Reimbursement
Final AHCA Comments on CMS Advanced Notice of Proposed Rulemaking

AHCA's final, submitted comments to CMS in response to its Advanced Notice of Proposed Rulemaking (ANPRM) can be found here. You can view the rule here.

In terms of next steps, an ANPRM is a more flexible regulatory vehicle. Essentially, an ANRPM is a combination of a Request for Information and a formal signal of possible action. After the comment period closed, CMS may do nothing with RCS - the Agency is not required to implement RCS or even to respond in writing to the comments submitted by interested parties. Alternatively, CMS might release a proposed rule or release an interim final rule to advance RCS. A 60-day comment period would then follow with implementation beginning possibly as soon as 60 days after promulgation of a final rule.

Currently, it is unclear what course of action CMS will take. However, most professional organizations and SNF beneficiary stakeholder groups are opposing implementation based upon analysis of the current RCS iteration. This is due to serious concerns about:

- Revenue Estimate Reliability: CMS’ contractor used a number of questionable statistical methods and made sweeping assumptions about patient case mix hinging upon data dating back to 2006. AHCA’s member work group does not believe the CMS simulated payments are reliable because of these, and other, analytic flaws.

- New Operational Costs: While therapy delivery methods described in the ANPRM may offer some savings and possible reductions in MDS assessments, the member work group believes new overhead costs would emerge which very likely would not be offset by any, new possible revenue. New costs include information technology and staff time to secure and track diagnoses codes (e.g., ICD-10) across stays to support classification and reclassification, new and more highly trained MDS coordinators and clinical staff to support new clinical information requirements, and entirely new billing/coding staff who will work with the new coding and claims formats.

- Budget Neutral Implementation: CMS is unlikely to implement the new system in a budget neutral manner. The Home Health Proposed Rule is as possible example of what we might see in a SNF FY19 NPRM which contains RCS. 

To view the array of changes proposed in the CY19 Home Health Proposed Rule, click here.