CHA Regulatory Update – July 11, 2023

Welcome to the July 2023 edition of the CHA Regulatory Update. Monthly updates cover important information on regulatory issues in the health care field, specifically those associated with the federal government, as well as Colorado state agencies involved in health care issues – including the Colorado Behavioral Health Administration (BHA), Colorado Department of Human Services (CDHS), Colorado Department of Public Health and Environment (CDPHE), Colorado Department of Regulatory Affairs (DORA), Colorado Department of Health Care Policy and Financing (HCPF), and the Colorado Department of Labor and Employment (CDLE).

As a reminder, July’s CHA Regulatory Briefing Call is scheduled from 10-11 a.m. on Wednesday, July 12. To join, please click on this link. This month’s deep dive presentation will be a review of CHA’s top regulatory priorities coming out of legislative session – facility fees, behavioral health, community benefit, and Medicaid recovery audit contractor (RAC) audits. To elicit feedback on regulatory items, during Wednesday’s call, CHA will be using Menti. Join with code: 6749 2207.

Additional information on CHA’s regulatory priorities can be found in CHA’s 2023 Implementation Overview document. To receive calendar invites for future calls, please contact Marie Cone LeBeaumont, CHA program coordinator, at [email protected].

State Updates

AQCC: Building Performance Standards Written Comments Due August 1

The Air Quality Control Commission has scheduled a rulemaking hearing for regulations to implement House Bill (HB) 21-1286, Building Performance Standards, for Aug. 16-18. Written comments are due by Aug. 1 here and oral comments can be provided during a public comment session from 4:30-7:30 p.m. on Aug. 15 (registration will be posted here shortly). The proposed rule would provide hospitals with two main compliance pathways to come into compliance with building performance standards by 2026 and 2030 – meet certain energy efficiency metrics or greenhouse gas intensity reductions. CHA is collecting feedback on the proposed rule and planning to submit a comment letter. Please share feedback on the proposed rule with Adeline Ewing, [email protected].

Additionally, hospitals must submit yearly benchmarking data as well as pay an annual fee of $100 per covered building to the Colorado Energy Office by June 1 of each year. Submit benchmarking data for 2022 here if you have not already done so.

BHA: CHA Submits Comments on 27-65 Proposed Rules

On June 23, CHA submitted comments to the BHA in response to proposed regulations implementing HB 22-1256, modifications to civil involuntary commitments (Note: implementation date delayed from July 1, 2023 to Jan. 1, 2024). The proposed rules make significant changes to Title 27, Article 65 (also known as 27-65), which governs the process for involuntary and voluntary screening and treatment for mental health services, which includes emergency mental health holds (i.e., M-1 holds). CHA’s comments request immense guidance from the BHA in coordination with hospital operational teams given the significant operational, procedural, and regulatory changes to ensure that facilities can safely make these transitions in a way that supports both access to care for the communities they serve and patients safety. BHA anticipates finalizing these rules in November for a Jan. 1, 2024 effective date. Additional information on BHA changes can be found on CHA’s Regulatory Webpage.

CDLE: Division of Labor Standards and Statistics Adopts New Rules

On May 11, CDLE adopted two new rules:

These rules are relevant to hospitals’ labor conditions and contain information on things such as wages and became effective on July 1. If you have any questions about any of these rules, email the division’s director of operations and rulemaking coordinator.

CDPHE: Applications for Practice-Based Health Education Grants Opened

CDPHE has opened the second funding cohort of the Colorado Practice-Based Health Education Grant Program. Established as part of Senate Bill (SB) 22-226, the CHA-championed workforce bill from last legislative session, this program awards funding to organizations that seek to increase clinical practice-based training capacity and quality programs for health professions students. Applications must be submitted by 5 p.m. on Monday, July 31. Learn more here. Eligible applicants include private for-profit, or nonprofit organizations that seek to increase clinical practice-based training capacity and quality programs for health professions students. This includes health care employers, accredited education organizations, health care education training programs, Colorado medical schools, and ACGME-accredited residency programs.

CDPHE: CO-CARES Registration for First Priority Peer Support Program for the Health Care Workforce Opened

CO-CARES and the Institute for Human Resilience at the University of Colorado Colorado Springs have partnered to create a hybrid First Priority Peer Support Program (FPPSP) for the Health Care Workforce.

Through this hybrid training program, employees will learn the knowledge and skills to act as a peer supporter for coworkers. Peer supporters proactively reach out and are ready to respond when needed. As a peer supporter, employees will provide support for daily work and life stressors as well as respond to peers after critical or stressful events. FPPSP trains peer supporters in a variety of mental health topics, confidentiality, and crisis navigation. This is an advanced training for volunteer employees to become peer supporters.

Click here to register for the training.

CDPHE: Nurse Staffing Plan Submission Deadline Passed

HB 22-1401 builds on the work from the past two years to update the nursing section of the Chapter 4 regulations governing hospital and nurse staffing and address “hospital readiness” for pandemic response. Per the finalized HB 22-1401 rules, hospitals are required to submit nurse staffing plans. The first staffing plan was due on June 30. If you have not submitted your staffing plan, please do so now. Plans can be submitted to [email protected][email protected]. For any questions, contact CDPHE’s Acute Care Section Manager, Erica Brudjar, [email protected]. The next staffing plan submissions will be due at the time of the hospital license renewal. 

CDPHE has also released information on the health facilities complaint process, which can be found here. Anyone with knowledge or concerns about a health care entity can file a complaint, including family members, concerned citizens, and health care professionals.

More information about HB 22-1401 is available on CHA’s Regulatory Page here.

CDPHE: Sterile Processing Survey Extended

CDPHE has extended the deadline to complete its 15-minute survey on current infection prevention needs of Sterile Processing Departments and non-centralized reprocessing locations in hospitals and ambulatory surgical centers. Survey responses are now due by Thursday, July 13, and multiple responses can be submitted for each health care facility.

Questions? Contact [email protected].

DOI: All Colorado Public Option Hearings Vacated

All public hearings concerning 2024 rate reductions for both individual and small group Colorado option plans have been vacated. The vacated hearings were structured around four carriers – Cigna, Kaiser, Rocky Mountain Health Plans, and Anthem. In total, 30 allegations were made against hospitals across all complaint types, with significant overlap among the complaints. Prior to the vacation of the hearings, CHA submitted comments to DOI.

More information can be found here.

DOI: Friday Health Plans Will Leave Colorado, Rehabilitation Order Approved

On June 1, DOI announced that Friday Health Plans will exit the Colorado insurance market. Friday Health Plans joins three other carriers – Humana, Bright Health, and Oscar Health – in leaving the Colorado marketplace.

On June 21, DOI announced that it sought and received approval from the company’s leadership for a rehabilitation order for the insolvent Friday Health Plans. Under such an order, the Colorado insurance commissioner will be appointed as receiver, with the authority to administer the company’s assets. As the receiver, the commissioner is granted authority to take any necessary actions to protect policyholders, creditors, claimants, and the public. DOI awaits an order from the court granting the petition or setting a hearing date on the matter.

Health care providers can expect to still be paid for their services in accordance with the contracts they have with Friday Health. In addition, because of HB 23-1303, Friday Health Plans is a member of the Colorado Guaranty Association. If Friday is unable to pay claims, the Guaranty Association will provide protection for providers and consumers up to the statutory cap of $500,000 for each insured. For more information, please see the Friday Health Plans winding down FAQ.

FAMLI: Q2 Reporting Due July 31

The Q2 2023 reporting deadline for the FAMLI Program is Monday, July 31. By this date, employers must submit their Q2 wage reports and corresponding premiums payments. If the deadline is missed, employers will be charged late fees and interest on past due employers need assistance in preparing your wage reports, check out the how-to-videos, user guides, file specifications, and sample templates for help.

HCPF: Announces Annual Meeting

On Tuesday, Aug. 8, HCPF will host its annual stakeholder webinar to discuss priorities for the fiscal year and invite stakeholder feedback and comments. Register here.

HCPF: CHA Raises Concerns about HCPF RAC Audit Proposed Rule

On June 23, CHA and the Colorado Medical Society submitted comments to the HCPF RAC program team about the draft “rule enhancement” that would create an information reconsideration and appeals processes for the RAC audit program notice of adverse action for overpayment. The letter notes that the proposed rule puts burdens and limitations on providers without addressing the recurring problems that providers encounter with the RAC audit process. CHA led an effort in the 2023 legislative session to pass legislation that will require a comprehensive audit of Colorado’s RAC audit activity. Additional information can be found on CHA’s Regulatory Webpage here.

HCPF: Hospital Discounted Care Data Reporting Template Finalized

On June 30, HCPF finalized a data template that hospitals must use to report information on hospital discounted care by Sept. 1. CHA successfully scaled back the required data elements in the template to reduce the administrative burden on providers in pulling the necessary data together. In the template, the blue columns with stars represent required data and the grey columns represent optional data. Additional information on the required and optional elements can be found here. HCPF will be holding another training on the data template at 11 a.m. on Wednesday, July 19 – register here.

HCPF has also finalized two policy decisions:

Physicians Renting Space – HCPF has reviewed the statute language and determined that uninsured patients who are seen within the hospital must be screened for HDC, even if they are only being seen by a physician renting space. Hospitals will need to work with the physicians to ensure patients are being screened as mandated by Hospital Discounted Care.
Limit on Payment Plans – HCPF has determined that the guidance related to payment plans is correct based on the statute language, and that bills from a hospital may only carry a 4 percent payment plan regardless of whether the bill includes only facility charges or includes licensed health care professional charges as well. Bills that come from a licensed health care professional who bills separately from the hospital are limited to a 2 percent payment plan for each licensed health care professional who provided services to the patient during the episode of care.

HCPF: Hospital Expenditure and Community Benefit Templates Due July 14

Hospitals must submit the hospital expenditure and community benefit templates to HCPF by Friday, July 14. The templates were shared with hospitals on June 30 and can be found on HCPF’s website here and here. In the hospital expenditures template, CHA is recommending that hospitals report information as required by statute (‘total payroll expense and associated hours’, ‘physician payroll expense and associated hours’, ‘employee benefit expense’ and ‘contract labor expense and associated hours’) and use their own discretion in reporting any additional details requested, such as reporting by employee class and details on compensation and contract labor.

Per HB 19-1001 and HB 19-1320, hospitals must submit specific information to HCPF on their expenditures and community benefit spending. The templates do not include the added elements required in HB 23-1226 and HB 23-1243 – the templates will be updated next year to reflect these changes as the bills’ effective dates are in August. Additional information about the upcoming changes can be found on CHA’s Regulatory Website here.

HCPF: IHRP Will Go Live in Two Stages

HCPF is soliciting provider feedback regarding the Inpatient Hospital Review Program (IHRP) implementation and, in response, has announced a two-stage “go live” process.

Step 1 – Pre-Admission Reviews for a subset of procedures will go live on Sept. 1. The current “soft launch” period has been extended by a month while the department works with Kepro and providers on processes and workflow.

Steps 2 and 3 – Post Admission Reviews on hospital inpatient stays for a subset of DRG groups and continued stays for all members at days 30, 60, 90, and each 30 days thereafter went live on May 1. Claims are not denied if required Post Admission Reviews are not entered.

The IHRP Joint Operating Committee will continue to meet monthly through the summer to discuss questions, issues, results, and best practices. Please email [email protected] to be added to the invitation list. Contact either the ColoradoPAR program utilization management team at [email protected] or Kepro provider relations at [email protected] with questions or for assistance.

Opioid and Other Substance Use Disorders Study Committee Holds First Meeting

The Opioid and Other Substance Use Disorders Study Committee convened for its first meeting on Friday, June 29. For more information on this meeting, see notes from CHA’s lobbying team here.

The committee is led by Rep. Chris deGruy Kennedy as chair and Sen. Kevin Priola as vice chair and is charged with identifying possible legislative options to address gaps and hurdles to accessing prevention, intervention, harm reduction, treatment, and recovery resources.

The committee will request bill drafts at the Aug. 30 meeting and can request up to 10 bill drafts, however, it only has the authority to proceed with five bills. Public comment will be allowed at the Sept. 27 meeting. The committee will vote on bill drafts at the Oct. 30 meeting.

The committee schedule and meeting materials can be found here.

Federal Updates

AHA: Human Rights Watch Report on Nonprofit Hospitals

On June 15, AHA and Catholic Health Association of the United States released a joint statement on “How the U.S. government’s regulation of nonprofit hospitals’ medical billing and debt collection practices impact the right to health.” This statement responded to the Human Rights Watch report on nonprofit hospitals and the community benefits they provide, and attempted to set the record straight and educate them on bias and shortcomings.

In addition, AHA compiled some key messages to refute and/or offer additional context. Other resources include a new fact sheet on medical debt and AHA’s patient billing guidelines.

Use this opportunity to review your hospital’s billing and collection practices. Make sure that your financial assistance policies are clear and easily accessible.
Increase your efforts to tell your own hospital story by illustrating the many ways in which your organization meets the unique needs of your community through advancing health and wellness for all those you serve. Identify a hospital ambassador.
AHA is working with a group of hospital and health system ambassadors to tell the hospital story through op-eds, radio spots, and other AHA-supported media opportunities. Sign up to receive updates and resources and join in this critical effort.

CISA: Warns of High-risk Cyber Vulnerability for Medtronic Cardiac Device Data Management System

The Cybersecurity and Infrastructure Security Agency is warning of a significant, high-risk vulnerability in Medtronic’s Paceart Optima System, which is used to compile and manage patients’ cardiac device data. CISA says the system’s versions 1.11 and prior are at risk of exploitation by unauthorized users, who can then perform remote code executions or launch denial-of-service attacks. The latter could slow or render the system unresponsive.

Medtronic recommends immediately updating the Paceart Optima system to v1.12 to mitigate this issue. Contact Medtronic to schedule an upgrade and read CISA’s alert for a list of mitigation steps Medtronic recommends taking until the upgrade to v1.12 can be completed.

“As with many medical device cyber vulnerabilities, hospitals and health systems are dependent upon third-party medical device manufacturers (MDM) to develop and deploy patches, which may require an extended time for the MDM to fully implement across its customer base,” said John Riggi, AHA’s national advisor for cybersecurity and risk. “In this case, we hope that Medtronic has devoted sufficient resources to handle the increased demand for the upgrade to v1.12 to mitigate this critical vulnerability in an expedited manner. In the interim, per CISA and Medtronic, it is recommended that organizations manually disable the Paceart Messaging Service on the application server. This issue also serves as reminder for hospitals and health systems to ensure efficient communication and alignment between clinical engineering and information security teams for efficient monitoring and mitigation of cyber vulnerabilities present in medical devices.”

CMS: CAH 96-Hour Calculation Adjusted for COVID-19 PHE Waiver Period

CMS announced that it will make a one-time adjustment to the 96-hour average annual patient length-of-stay requirement for critical access hospitals (CAHs) in the Medicare program to account for its blanket waiver of the requirement during the COVID-19 public health emergency (PHE). The agency has instructed Medicare Administrative Contractors to resume calculating the 96-hour average with the first cost reporting period starting after the end of the PHE.

 The evaluation of the average 96-hour patient length of stay requirements will resume with the CAHs first full cost reporting period after May 11, which will not include any of the months covered under the COVID-19 PHE blanket waiver. This will be a one-time change to the CAH 96-hour length of stay calculation.

CMS: National Spending on Hospital Care Grew 0.8 Percent in 2022

New expenditure data from CMS estimates national health spending grew 4.3 percent in 2022, including just 0.8 percent growth in spending for hospital care, as increases in federal spending for public health outpaced slower growth for most major payers. The low growth in hospital spending was attributed in part to declines in utilization and pandemic-related public spending.

CMS projects national health spending will average 5.4 percent per year through 2031, led by a 7.5 percent increase in Medicare spending as the last Baby Boomers enroll in the program and hospitals continue to face higher costs than clinicians to provide care.

CMS: Partnership with Colorado on Making Primary Care Model

Colorado will be a pilot state for the new CMS primary care model – Making Care Primary (MCP) – to enhance access to and quality of primary care services. MCP will build off HCPF’s current APM 2 payment model and align with the DOI as Colorado implements HB 22-1325, Primary Care Alternative Payment Models. HCPF indicated that their goal is to financially reward primary care doctors who improve care quality and support patient care management through value-based payments.

If you have any questions, please contact the MCP Help Desk at [email protected].

HRSA: Opens Reporting for Provider Relief Fund Period 5

The Provider Relief Fund (PRF) Reporting Portal is open from Saturday, July 1 to 9:59 p.m. MT. on Saturday, Sept. 30.

Providers who received one or more PRF (General or Targeted) and/or American Rescue Plan Rural payments exceeding $10,000, in the aggregate from Jan. 1 to June 30, 2022, must report on their use of funds during Reporting Period 5 to comply with PRF Reporting Requirements.

More information and resources can be found on the PRF Reporting webpage.

MedPAC: Recommendations to Congress Include Site-Neutral Policy

The Medicare Payment Advisory Commission (MedPAC) released its June report to Congress that recommended the adoption of additional site-neutral payment policies for certain outpatient services. The MedPAC recommendation, which was discussed as being budget-neutral, would redistribute $7.5 billion in Medicare spending for certain services performed in outpatient departments and ambulatory surgical centers. A current legislative proposal modeled after MedPAC’s recommendation but not budget-neutral would lead to a $180.6 billion cut to hospitals over 10 years. Additional resources from AHA about the proposed policies can be found here.

SAMHSA: Model Standards for Peer Support Certification Programs Released

The Substance Abuse and Mental Health Services Administration (SAMHSA) released National Model Standards for Peer Support Certification for people who help others address a substance use or mental health issue through their own lived experience. The national model standards are not intended as a substitute for any state certifications, but guidance for states and others “to promote quality and encourage alignment and reciprocity across often disparate state peer support certifications,” the agency said.

If you are not currently receiving the monthly CHA Regulatory Update and would like to be added to the list or for more information, contact Marie Cone LeBeaumont, CHA program coordinator, at [email protected].