CMS Announces Proposed Cancelling of Mandatory Bundling Programs

Deanna Stephenson in Managed Care

AHCA / NCAL posted positive news that aims to reduce the regulatory burden on providers. Please read below for the full announcement. 

CMS Proposes Cancelling Most Recent Mandatory Bundling Program, Proposes Major Modifications to Original Mandatory Bundling Program

AHCA/NCAL Members:

There is significant, positive news from D.C. today. Our efforts to get the new Administration to reduce our regulatory burden continue to bear fruit.

Late today, CMS announced major changes to the mandatory post-acute bundling programs. You may recall that these are the large-scale demonstrations created by the Obama Administration that forced bundling in large parts of the country and gave the bundles to hospitals. 

The full proposed rule is online here. There are two significant parts to the proposed rule that was released today.

  1. Today's proposed rule cancels the most recent mandatory bundling program. This is the program that added two cardiac episodes to mandatory bundling and gave hospitals the bundle. CMS had delayed this program until January 1, 2018 and is now proposing to cancel it.
     
  2. The proposed rule also makes major changes to the initial mandatory bundle, the Comprehensive Care for Joint Replacement (CJR).  The rule reduces the Metropolitan Statistical Areas (MSAs) included in the demonstration from 67 to 34.  For the 33 that MSAs that are eliminated, bundling can continue, but only on a voluntary basis.  Even in the 34 remaining MSAs, bundling becomes voluntary in low volume rural hospitals. A complete list of the MSAs that are included in the proposed rule is online here.

AHCA/NCAL began pushing for these changes immediately after the election. The changes announced today were part of what we presented to the Trump transition team. We have continued our efforts communicating with Secretary Price, given his leadership against mandatory bundles when he was a member of Congress. We have been clear that AHCA/NCAL is not against bundling, but our Board has taken a position against mandatory bundling, where we have no ability to hold the bundle.

When combined with recent success we have had on the survey and Civil Monetary Penalty (CMP) issues, the proposed rule removing the ban on arbitration, and now this, it certainly appears that our efforts to obtain regulatory relief are finally paying off.

It's important to keep in mind that today's announcement is a proposed rule. The regulation must go through the formal rulemaking process, but we feel very good that ultimately CMS will finalize this rule.

Thank you for your support and efforts working on these critical issues. Our interesting year continues.

Sincerely,

Mark Parkinson
President & CEO

NYSHFA CONTACT:

Deanna Stephenson
Director, Managed Programs
518-462-4800 x16