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 Advanced Care Bundling Rule Goes To OMB For Review

The Centers for Medicare & Medicaid Services (CMS) has sent the Advancing Care Coordination through Episodic Payment Models final rule to the Office of Management and Budget (OMB), which is the last step before a final rule is published in the Federal Register.
The final rule would implement a mandatory demonstration of two new cardiac episodic payment models (EPMs) and one new orthopedic EPM in several locations nationally.
The two cardiac episodes—coronary artery bypass graft (CABG) and acute myocardial infarction (AMI)—would be tested in 98 markets. The specific markets will be listed in the final rule. The surgical hip/femur fracture treatment (SHFFT) episode would be implemented in the 67 markets currently testing the Comprehensive Care for Joint Replacement (CJR) EPMs.
The new demonstrations are scheduled to begin on July 1, 2017, and end on Dec. 31, 2021—an almost five-year run.
The rule proposes 90-day episodes, beginning with a hospital inpatient admission and ending 90 days post-discharge. All Medicare Part A and B spending would be included in the episode, including inpatient skilled nursing facility care, rehabilitation therapy, and outpatient services.
The skilled nursing care profession has expressed concerns about this rule.
“Inpatient hospitals in the selected markets would be held at-risk for total spending, as well as for outcomes in defined quality measures, across the 90-day episodes,” says Mike Cheek, senior vice president for reimbursement policy and legal affairs at the American Health Care Association (AHCA). “Hospitals will be able to establish gainsharing relationships with other ‘collaborators,’ which include skilled nursing facilities [SNFs] and outpatient therapy providers.”
Cheek notes that the proposed rule also includes a waiver of the SNF three-day rule.
Cheek says that AHCA had suspected that the Center for Medicare & Medicaid Innovation (CMMI) and CMS would delay finalizing major proposed rules following the presidential election to allow the next administration to make decisions about whether to finalize proposed rules.
Typically, the incoming president directs agency and cabinet department heads to hold any rules that the agency is preparing to finalize until a political appointee representing the new president has reviewed and approved those regulations.
“AHCA will convey to the incoming Congress and President-elect Trump’s transition team our deep concerns about the rule and advocate for the rule to be delayed or revoked,” says Cheek. “There are a variety of mechanisms the president can use, either on his own or in conjunction with Congress, to overturn existing regulations or to stop the promulgation of new regulations. We will be exploring all of these options.”
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