CMS’ New Payment Rules Upset Some Hospital Groups; Others Say Changes Are Overdue

Modern Healthcare: CMS' Plan To End Inpatient-Only List Worries Providers
Providers want CMS to proceed cautiously in its attempt to phase out paying for some services only in inpatient settings, according to comments on CMS' proposed outpatient payment rule due Monday. CMS in August proposed to phase out the inpatient-only list over three years. The agency claimed the list wasn't necessary, saying physicians should use their knowledge, judgment and assess patient needs to determine the right care site. Under the proposal, Medicare would start paying for nearly 270 musculoskeletal-related services delivered in outpatient departments in 2021. (Brady, 10/6)

Healthcare Dive: Citing COVID-19, Providers Push Back On CMS Payment Rule Rate Cuts, Telehealth Rollback In 2021
Providers are fiercely opposing changes in two CMS payment rules for 2021, decrying physician rate cuts amid the COVID-19 pandemic, pushing for more telehealth flexibility and urging a stop to a controversial plan to eliminate the list of procedures that can be done on an inpatient-only basis. CMS released its annual proposals for the Physician Fee Schedule and Outpatient Prospective Payment System in August and official comments were due Monday. In their comments, doctor and hospital groups largely focused on what they think is needed — and what should be avoided — as the nation continues to battle the novel coronavirus, which could bring new challenges this winter. (Mensik, 10/6)

FierceHealthcare: Hospital Groups Demand CMS Halt Expansion Of Certain Physician-Owned Hospitals In Payment Rule
Several major hospital groups and systems are pushing for the Trump administration to halt a proposed expansion of certain physician-owned hospitals in an upcoming payment rule. Several groups posted comments on the Centers for Medicare & Medicaid Services’ (CMS') proposed hospital payment rule for 2021, furious about the change. Hospitals also opposed the elimination of the Inpatient Only Procedure List that details which procedures aren’t payable under the Outpatient Prospective Payment System (OPPS). (King, 10/6)

In news about Medicare Advantage —

Modern Healthcare: Medicare Advantage Startup Clover Health To Go Public
Medicare Advantage startup Clover Health is slated to become public through a merger with Social Capital Hedosophia Holdings Corp. III, a special purpose acquisition company, Clover said Tuesday. The deal values Clover at $3.7 billion. Clover's management team, including CEO Vivek Garipalli and President Andrew Toy, will continue to lead Clover following the transaction, which is expected to close in the first quarter of 2021. (Livingston, 10/6)

Axios: Tech Investor Chamath Palihapitiya Bets Big On Medicare Advantage Provider 
Conventional investor wisdom is to steer clear of next month's election, due to its inherent uncertainty and consequential volatility. But, this morning, Chamath Palihapitiya bet big on a company whose fortunes may be significantly impacted by the presidential victor. Driving the news: Clover Health, a tech-enabled provider of Medicare Advantage plans, agreed to go public via a reverse merger with a Palihapitiya-led SPAC called Social Capital Hedosophia Holdings III. (Primack, 10/6)

In Medicaid news —

Louisville Courier Journal: Kentucky Launches Kynect Website For Medicaid Access, Benefits
"Kynect" is back, repurposed as a one-stop, online shop for people to apply for Medicaid and a host of other resources such as food and child care assistance, job training and help for the elderly and people with disabilities. Gov. Andy Beshear announced the launch of the state website Monday, initially created under his father, former Gov. Steve Beshear, as a state-run site where people could shop for health insurance plans under the Affordable Care Act. Kynect won't feature commercial insurance plans in time for this year's open enrollment for health coverage in November. (Yetter, 10/5)

AP: Kansas Replacing Contractor Handling Medicaid Applications
Kansas is replacing a private contractor that inspired years of complaints about backlogs and other problems in its handling of applications for the state’s Medicaid health coverage for the needy. The Kansas City Star reports that state Department of Health and Environment in August signed a six-year contract worth nearly $135 million with New Jersey-based company Conduent to handle Medicaid applications starting next year. Conduent will replace Maximus, based in the Washington, D.C., area. (10/5)

Richmond Times Dispatch: Virginia To Get Additional Federal Boost For Medicaid Costs As State Looks Ahead To Next Budget 
rginia will get additional federal emergency relief for Medicaid through the end of March on top of more than half a billion dollars that the state saved in reduced spending in the last fiscal year, primarily because of an abrupt decline in use of medical services during the COVID-19 pandemic. U.S. Secretary of Health and Human Services Alex Azar announced late Friday that the federal government would extend the public health emergency through late January, ensuring that the federal government will pay an additional 6.2% share of Virginia’s Medicaid costs through March 31, state Medicaid officials told legislators on Monday. (Martz, 10/5)