AHA Wants Congress To Pressure CMS To Reverse Updates For Inpatient Payment Rule

CMS issues first price transparency fines to 2 Georgia hospitalsSource: Fierce Healthcare, by Robert King

The American Hospital Association (AHA) is turning to lawmakers to pressure the Biden administration to change “woefully inadequate” payment rates proposed for next year.

 

The AHA sent a letter Friday to congressional leaders surrounding the proposed Inpatient Prospective Payment Systems (IPPS) rule, which sets inpatient rates for next year. The hospital lobbying group charged that facilities are facing major challenges not just from the pandemic.

“Historic inflation has extended and heightened the already severe economic instability brought on by the pandemic resulting in razor-thin operating margins from massive surges in input costs, including a struggling workforce, drug costs, supplies and equipment,” the letter said.

 
 

The Centers for Medicare & Medicaid Services (CMS) had proposed a market basket update of 3.2% to Medicare payments for the 2023 federal fiscal year that begins this fall. This was on top of a 2.7% payment update for 2022. The proposed rule released in April calls for a proposed 0.4 percentage point productivity adjustment.

AHA contends that the market basket and productivity update don’t reflect the major inflation jump and growth in expenses.

“More recent data shows the market basket for [fiscal year] 2022 is trending toward 4%, well above the 2.7% CMS actually implemented last year,” the group wrote. “Additionally, the latest data also indicate decreases in productivity, not gains.”

Court Rules On Payment of Medical Services

Tran Liang & Wang LLP blocked a plaintiff’s attempt to compel arbitration against a defendant who was not a party to the arbitration agreement. The firm represented the City of Long Beach in an action brought by Promise Hospital of East Los Angeles. The Hospital alleged that CIGNA and the City failed to pay for medical services that it provided to a City employee under the City’s health plan. (Promise Hospital of East Los Angeles, L.P. v. Cigna Corporation et. al., Case No. B243126). The Hospital argued that it could compel arbitration against the City, even though the City was not a party to the agreement containing the arbitration provision, which was entered into by the Hospital and CIGNA. The trial court ruled that the arbitration provision was not enforceable against the City, and the Court of Appeal affirmed. The Court’s detailed opinion adopted all of the firm’s arguments, holding that none of the grounds to compel a non-signatory to an arbitration provision applied in this case. Namely, the Court ruled that: 1) the City was not a third-party beneficiary; there were no grounds for direct-benefits; and CIGNA was not the City’s authorized agent for purposes of agreeing to arbitration. A contrary ruling could have had far-reaching effects for companies and individuals seeking to exercise their constitutional right to a jury trial. For more information, visit www.ltlw.com.

Last Updated 08/10/2022

Arch Apple Financial Services | Individual & Family Health Plans, Affordable Care California, Group Medical Insurance, California Health Insurance Exchange Marketplace, Medicare Supplements, HMO & PPO Health Care Plans, Long Term Care & Disability Insurance, Life Insurance, Dental Insurance, Vision Insurance, Employee Benefits, Affordable Care Act Assistance, Health Benefits Exchange, Buy Health Insurance, Health Care Reform Plans, Insurance Agency, Westminster, Costa Mesa, Huntington Beach, Fountain Valley, Irvine, Santa Ana, Tustin, Aliso Viejo, Laguna Hills, Laguna Beach, Laguna Woods, Long Beach, Orange, Tustin Foothills, Seal Beach, Anaheim, Newport Beach, Yorba Linda, Placentia, Brea, La Habra, Orange County CA

12312 Pentagon Street - Garden Grove, CA 92841-3327 - Tel: 714.638.0853 - 800.731.2590
Email:
Jay@ArchApple.com
Copyright @ 2015 - Website Design and Search Engine Optimization by Blitz Mogul