CHA Regulatory Update – June 5, 2023

Welcome to the June 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, June’s CHA Regulatory Briefing Call is scheduled from 10-11 a.m. on Wednesday, June 7. To join, please click on this link. This call allows for informal discussion regarding priority regulatory issues. To receive calendar invites for future calls, please contact Marie Cone LeBeaumont, CHA program coordinator, at [email protected]. This month’s deep dive will be presentations from the Division of Disease Control and Public Health Response and the Health Facilities and Emergency Medical Services Division at CDPHE on the finalized Chapter 4 nurse staffing regulations implementing HB 22-1401. Please submit any questions for CDPHE in advance to Bridget Garcia, at [email protected]. The finalized regulations adopted by the Board of Health on April 19 are: 6 CCR 1009-5, outlining hospital bed reporting; 6 CCR 1011-1, Chapter 4, General Hospitals, outlining requirements for hospital nurse staffing committees, nurse staffing plans, and emergency management plans; 6 CCR 1011-1, Chapter 2, General Licensure Standards, establishing regulations regarding infection control and prevention practices in licensed health facilities; and 6 CCR 1009-1, Epidemic and Communicable Disease Control, outlining communicable diseases and related events reporting.

State Updates
CDPHE: Release Regarding the End of the COVID-19 Public Health Emergency On May 11, the COVID-19 public health emergency (PHE), and its various waivers and flexibilities that helped hospitals during and after the pandemic, ended. CDPHE issued this release, noting the changes Coloradans can anticipate. Of note, COVID-19 vaccines will continue to be covered by insurance plans, through the Vaccines for Children federal program, or under a new state law, Senate Bill (SB) 23-260, that aims to help Coloradans get vaccinated regardless of coverage. For additional resources on the end of the PHE, refer to the CHA Executive Brief here. CDPHE: Extensive Wellness Programs Available for Health Care Workers Launched on May 16, the Colorado Alliance for Resilient and Equitable Systems (CO-CARES) is serving the health care and public health workforce. A direct result of CHA-led workforce legislation, SB 22-226, CO-CARES connects health care and public health workers, their teams, and their organizations to a variety of resources and tools that support recovery, improve wellbeing, and foster resilience. The initiative is made possible due to a collaborative partnership with CDPHE, the University of Colorado, Colorado Springs Lyda Hill Institute for Human Resilience; University of Colorado Department of Psychiatry; University of Colorado School of Public Health; Colorado Hospital Association; and Switchback Institute. As new resources and opportunities become available through the CO-CARES program, CHA will continue to update members to ensure meaningful engagement with hospital-specific initiatives. Upcoming event: Past The Pandemic: Next Echo Series begins June 8 Visit co-cares.org for more information on the program offerings, including dates, times, sign-up forms, and additional contact information. Questions? Please contact [email protected]. CDPHE: Funding Opportunity Through Colorado Practice-based Health Education Grant Program CDPHE’s Primary Care Office announced that the Request for Applications (RFA) #41324 is now open for applications under the second funding cohort. 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 healthcare employers, accredited education organizations, health care education training programs, Colorado medical schools, and ACGME-accredited residency programs. Applications for Cohort 2 funding must be submitted as indicated in the RFA no later than 5 p.m. on July 31. The RFA, attachments, and guidance documents are available on the Practice-based Health Education Grants Program website. CHA: Implementation Briefs Released, Upcoming Webinar To help member hospitals and health systems implement new laws that passed this session, CHA has developed issue briefs with key details that hospitals need to know. Some of the bills in this first wave have not yet been signed into law, but all are expected to be before the June 8 deadline. Facility Fees – House Bill (HB) 23-1215 Community Benefit – HB 23-1243 Hospital Price Transparency – HB 23-1226, Senate Bill (SB) 23-252 and transparency components of HB 23-1215 Behavioral Health – HB 23-1236, HB 23-1269, SB 23-064, HB 23-1071, and HB 23-1130 Additional issue briefs will be released to members in early June, covering employer issues, operational patient notifications, changes to red flag laws, and more. Register here for CHA’s webinar, Health Care Under the Gold Dome: A Recap of the 2023 Legislative Session: 11 a.m. – noon, on Tuesday, June 13. CHA: SDoH Screening Webinar Series – Starts June 21 CHA partnered with the Iowa Hospital Association and Cynosure Health to create the Health Equity in Action Webinar Series to help hospital leaders better understand the CMS requirements for screening for social determinants of health (SDoH) and to build screening processes to improve quality and health outcomes, particularly for care transitions. This two-part series is complimentary for CHA member hospitals and health systems. Register here. Session 1: Introduction to SDoH Screening and the Impact on Quality of Care and Health Outcomes \| Noon -1 p.m. \| Wednesday, June 21 Session 2: Practical Strategies for Implementing SDoH Screening and Addressing Social Risk Factors \| Noon -1 p.m. \| Wednesday, July 12 DOI: CHA Submits Comments on Public Option Rate Hearings On May 30, CHA submitted comments to the Division of Insurance in advance of the hearings starting Tuesday, June 13. The hearings will be 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. The hearings will be run as described in regulation 4-2-92. Additional information can be found here. FAMLI: New Rules Adopted, Health Care Provider User Testing On May 25, the FAMLI Division finalized and adopted new rules. These rules will become effective on July 15: Regulations Concerning Program Intensity Coordination of Benefits and Reimbursement of Advanced Payments Investigations, Determinations, and Appeals Job Protection, Anti-retaliation, and Anti-interference The FAMLI Division is looking for health care providers to participate in user testing for the new portal they are designing to streamline the patient experience when submitting documentation to support claims for family and medical leave benefits. Payments become available in 2024, but patients will be able to begin applying for anticipated leave later this year. The health care provider portal will: Reduce paperwork when patients ask you to verify a serious health condition. Improve the patient experience for people who need to step away from work because of a serious health condition. Protect health care providers’ credentials by reducing the potential for fraud. Allow you to view family and medical leave details for the patients in your care all in one place. To get the first look at the health care provider portal, sign up for user testing here. HCPF: Changes to Price Transparency and Community Benefit Reporting Templates On May 15, HCPF hosted a stakeholder meeting to discuss updates to the community benefit and transparency data templates for the 2023 reporting year. Price Transparency Reporting differences to be aware of include: Added report certification tab; Added ratio analysis tab to provide hospitals with insight into how formulas on ratios and margins are calculated by HCPF; and Removed columns from employee compensation and hours based on suggestions from CHA. Community Benefit Reporting differences to be aware of include: Added section within investments and expenses tab for summing categories and validation checks to help ensure totals match the component parts; and Added Schedule H tab, which is optional for hospitals to submit their pro-forma Schedule Hs if they are a consolidated reporter HCPF: Hospital Base Rates Finalized for 2023-24 On May 26, HCPF posted the Fiscal Year (FY) 2023-24 Hospital Base Rates for all hospitals participating in Health First Colorado. Once CMS approval is received, all inpatient hospital claims with last service dates from July 1, 2023, will be adjusted to reflect the new Hospital Base Rate. Inpatient hospital base rates were calculated using the new base rate methodology that HCPF has been working on in recent years. The recalculation details are available on the HCPF website. These rates also reflect the 3 percent provider rate increase effective July 1, as detailed in the state’s budget bill this year. Hospitals have 30 days to review their rates and respond to HCPF with questions or concerns.

State Updates

CDPHE: Release Regarding the End of the COVID-19 Public Health Emergency
On May 11, the COVID-19 public health emergency (PHE), and its various waivers and flexibilities that helped hospitals during and after the pandemic, ended. CDPHE issued this release, noting the changes Coloradans can anticipate. Of note, COVID-19 vaccines will continue to be covered by insurance plans, through the Vaccines for Children federal program, or under a new state law, Senate Bill (SB) 23-260, that aims to help Coloradans get vaccinated regardless of coverage. For additional resources on the end of the PHE, refer to the CHA Executive Brief here.

CDPHE: Extensive Wellness Programs Available for Health Care Workers
Launched on May 16, the Colorado Alliance for Resilient and Equitable Systems (CO-CARES) is serving the health care and public health workforce. A direct result of CHA-led workforce legislation, SB 22-226, CO-CARES connects health care and public health workers, their teams, and their organizations to a variety of resources and tools that support recovery, improve wellbeing, and foster resilience. The initiative is made possible due to a collaborative partnership with CDPHE, the University of Colorado, Colorado Springs Lyda Hill Institute for Human Resilience; University of Colorado Department of Psychiatry; University of Colorado School of Public Health; Colorado Hospital Association; and Switchback Institute. As new resources and opportunities become available through the CO-CARES program, CHA will continue to update members to ensure meaningful engagement with hospital-specific initiatives. Upcoming event: Past The Pandemic: Next Echo Series begins June 8 Visit co-cares.org for more information on the program offerings, including dates, times, sign-up forms, and additional contact information. Questions? Please contact [email protected].

CDPHE: Funding Opportunity Through Colorado Practice-based Health Education Grant Program
CDPHE’s Primary Care Office announced that the Request for Applications (RFA) #41324 is now open for applications under the second funding cohort. 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 healthcare employers, accredited education organizations, health care education training programs, Colorado medical schools, and ACGME-accredited residency programs. Applications for Cohort 2 funding must be submitted as indicated in the RFA no later than 5 p.m. on July 31. The RFA, attachments, and guidance documents are available on the Practice-based Health Education Grants Program website.

CHA: Implementation Briefs Released, Upcoming Webinar
To help member hospitals and health systems implement new laws that passed this session, CHA has developed issue briefs with key details that hospitals need to know. Some of the bills in this first wave have not yet been signed into law, but all are expected to be before the June 8 deadline. Facility Fees – House Bill (HB) 23-1215 Community Benefit – HB 23-1243 Hospital Price Transparency – HB 23-1226, Senate Bill (SB) 23-252 and transparency components of HB 23-1215 Behavioral Health – HB 23-1236, HB 23-1269, SB 23-064, HB 23-1071, and HB 23-1130 Additional issue briefs will be released to members in early June, covering employer issues, operational patient notifications, changes to red flag laws, and more. Register here for CHA’s webinar, Health Care Under the Gold Dome: A Recap of the 2023 Legislative Session: 11 a.m. – noon, on Tuesday, June 13.

CHA: SDoH Screening Webinar Series – Starts June 21
CHA partnered with the Iowa Hospital Association and Cynosure Health to create the Health Equity in Action Webinar Series to help hospital leaders better understand the CMS requirements for screening for social determinants of health (SDoH) and to build screening processes to improve quality and health outcomes, particularly for care transitions. This two-part series is complimentary for CHA member hospitals and health systems. Register here. Session 1: Introduction to SDoH Screening and the Impact on Quality of Care and Health Outcomes | Noon -1 p.m. | Wednesday, June 21 Session 2: Practical Strategies for Implementing SDoH Screening and Addressing Social Risk Factors | Noon -1 p.m. | Wednesday, July 12

DOI: CHA Submits Comments on Public Option Rate Hearings
On May 30, CHA submitted comments to the Division of Insurance in advance of the hearings starting Tuesday, June 13. The hearings will be 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. The hearings will be run as described in regulation 4-2-92. Additional information can be found here.

FAMLI: New Rules Adopted, Health Care Provider User Testing
On May 25, the FAMLI Division finalized and adopted new rules. These rules will become effective on July 15: Regulations Concerning Program Intensity Coordination of Benefits and Reimbursement of Advanced Payments Investigations, Determinations, and Appeals Job Protection, Anti-retaliation, and Anti-interference The FAMLI Division is looking for health care providers to participate in user testing for the new portal they are designing to streamline the patient experience when submitting documentation to support claims for family and medical leave benefits. Payments become available in 2024, but patients will be able to begin applying for anticipated leave later this year. The health care provider portal will: Reduce paperwork when patients ask you to verify a serious health condition. Improve the patient experience for people who need to step away from work because of a serious health condition. Protect health care providers’ credentials by reducing the potential for fraud. Allow you to view family and medical leave details for the patients in your care all in one place. To get the first look at the health care provider portal, sign up for user testing here.

HCPF: Changes to Price Transparency and Community Benefit Reporting Templates
On May 15, HCPF hosted a stakeholder meeting to discuss updates to the community benefit and transparency data templates for the 2023 reporting year. Price Transparency Reporting differences to be aware of include: Added report certification tab; Added ratio analysis tab to provide hospitals with insight into how formulas on ratios and margins are calculated by HCPF; and Removed columns from employee compensation and hours based on suggestions from CHA. Community Benefit Reporting differences to be aware of include: Added section within investments and expenses tab for summing categories and validation checks to help ensure totals match the component parts; and Added Schedule H tab, which is optional for hospitals to submit their pro-forma Schedule Hs if they are a consolidated reporter

HCPF: Hospital Base Rates Finalized for 2023-24
On May 26, HCPF posted the Fiscal Year (FY) 2023-24 Hospital Base Rates for all hospitals participating in Health First Colorado. Once CMS approval is received, all inpatient hospital claims with last service dates from July 1, 2023, will be adjusted to reflect the new Hospital Base Rate. Inpatient hospital base rates were calculated using the new base rate methodology that HCPF has been working on in recent years. The recalculation details are available on the HCPF website. These rates also reflect the 3 percent provider rate increase effective July 1, as detailed in the state’s budget bill this year. Hospitals have 30 days to review their rates and respond to HCPF with questions or concerns.

Federal Updates:
CMS: Extends COVID-19 Telehealth Flexibilities for Hospital Outpatient Therapies Hospitals may continue to bill through calendar year 2023 for certain outpatient physical therapy, occupational therapy, speech language pathology services, Diabetes Self-Management Training, and Medical Nutrition Therapy provided by hospital staff to Medicare beneficiaries in their homes through telecommunication technology, CMS said in an update to a FAQ on the end of the COVID-19 public health emergency. Congress: Bill Passed to Raise Debt Limit On June 3, President Biden signed a bill into law the raise the debt limit. The biggest impact to hospitals in the bill in the short term will be the downward pressure on discretionary spending due to the spending caps contained in the package. The agreement contains no changes to Medicare or Medicaid spending. Some hospitals will have employees impacted by the return of obligatory student loan payments. The work requirements were added for some TANF and SNAP beneficiaries. Text of the bill can be found here. Congress: Congressional Leaders Urged to Prevent Medicaid Disproportionate Share Hospital Cuts A bipartisan group of over 230 representatives, led by Rep. Diana DeGette (CD-1), urged House leaders to prevent $8 billion in cuts to Medicaid Disproportionate Share Hospital payments scheduled to begin Oct. 1, calling H.R. 2665 “a reasonable and responsible path to take in order to avoid the disastrous consequences to our safety net hospitals if the Medicaid DSH cuts were to take effect. It is imperative we continue to protect access to Medicaid beneficiaries who heavily rely on the essential services provided through Medicaid DSH program,” they wrote. CHA has been advocating for support of H.R. 2665 since its introduction. The legislation is sponsored by Rep. DeGette (CD-1) and is cosponsored by Reps. Yadira Caraveo (CD-8) and Jason Crow (CD-6). Congress: House Committee Advances Bills to Expand Site-Neutral Payment Cuts, Delay Medicaid DSH Cuts, and Add Reporting Requirements for 340B Hospitals On May 24, the House Energy and Commerce Committee voted unanimously to advance H.R. 3561, as amended, legislation that would impose billions of dollars a year in additional site-neutral payment reductions to services provided in off-campus hospital outpatient departments. In addition to the site-neutral cuts, H.R. 3561 would: Delay for two years $8 billion in annual Medicaid Disproportionate Share Hospital payment reductions scheduled to begin in October, as supported by a bipartisan group of more than 230 representatives, including four Colorado representatives; Modify hospital price transparency requirements; and Require mandatory reporting with respect to certain health-related ownership information. The committee also passed H.R. 3290, as amended, legislation that would impose onerous reporting requirements on hospitals participating in the 340B drug pricing program. The AHA has developed educational materials on site neutral payments for hospitals to use when interacting with congressional members. A fact sheet with the financial impact can be found here, a more general one pager can be found here, and a study on beneficiary characteristics between sites of care can be found here. HHS: Federal COVID-19 Vaccine Requirement Ending On May 31, CMS released a final rule that rescinds the health care worker vaccine mandate. At a high level, the rule: Eliminates the condition of participation (CoP) requirement for COVID-19 vaccination policies and procedures for health care staff, including health care worker COVID-19 vaccination requirements. Makes clear that CMS’ quality measures assessing the proportion of health care workers who are vaccinated for COVID-19 remain in place. Formally eliminates COVID-19 testing requirements for long-term care (LTC) facilities. Finalizes the continuation of COVID-19 vaccine education requirements for LTCs and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs-IID).

Federal Updates:

CMS: Extends COVID-19 Telehealth Flexibilities for Hospital Outpatient Therapies
Hospitals may continue to bill through calendar year 2023 for certain outpatient physical therapy, occupational therapy, speech language pathology services, Diabetes Self-Management Training, and Medical Nutrition Therapy provided by hospital staff to Medicare beneficiaries in their homes through telecommunication technology, CMS said in an update to a FAQ on the end of the COVID-19 public health emergency.

Congress: Bill Passed to Raise Debt Limit
On June 3, President Biden signed a bill into law the raise the debt limit. The biggest impact to hospitals in the bill in the short term will be the downward pressure on discretionary spending due to the spending caps contained in the package. The agreement contains no changes to Medicare or Medicaid spending. Some hospitals will have employees impacted by the return of obligatory student loan payments. The work requirements were added for some TANF and SNAP beneficiaries. Text of the bill can be found here.

Congress: Congressional Leaders Urged to Prevent Medicaid Disproportionate Share Hospital Cuts
A bipartisan group of over 230 representatives, led by Rep. Diana DeGette (CD-1), urged House leaders to prevent $8 billion in cuts to Medicaid Disproportionate Share Hospital payments scheduled to begin Oct. 1, calling H.R. 2665 “a reasonable and responsible path to take in order to avoid the disastrous consequences to our safety net hospitals if the Medicaid DSH cuts were to take effect. It is imperative we continue to protect access to Medicaid beneficiaries who heavily rely on the essential services provided through Medicaid DSH program,” they wrote. CHA has been advocating for support of H.R. 2665 since its introduction. The legislation is sponsored by Rep. DeGette (CD-1) and is cosponsored by Reps. Yadira Caraveo (CD-8) and Jason Crow (CD-6).

Congress: House Committee Advances Bills to Expand Site-Neutral Payment Cuts, Delay Medicaid DSH Cuts, and Add Reporting Requirements for 340B Hospitals
On May 24, the House Energy and Commerce Committee voted unanimously to advance H.R. 3561, as amended, legislation that would impose billions of dollars a year in additional site-neutral payment reductions to services provided in off-campus hospital outpatient departments. In addition to the site-neutral cuts, H.R. 3561 would: Delay for two years $8 billion in annual Medicaid Disproportionate Share Hospital payment reductions scheduled to begin in October, as supported by a bipartisan group of more than 230 representatives, including four Colorado representatives; Modify hospital price transparency requirements; and Require mandatory reporting with respect to certain health-related ownership information. The committee also passed H.R. 3290, as amended, legislation that would impose onerous reporting requirements on hospitals participating in the 340B drug pricing program. The AHA has developed educational materials on site neutral payments for hospitals to use when interacting with congressional members. A fact sheet with the financial impact can be found here, a more general one pager can be found here, and a study on beneficiary characteristics between sites of care can be found here.

HHS: Federal COVID-19 Vaccine Requirement Ending
On May 31, CMS released a final rule that rescinds the health care worker vaccine mandate. At a high level, the rule: Eliminates the condition of participation (CoP) requirement for COVID-19 vaccination policies and procedures for health care staff, including health care worker COVID-19 vaccination requirements. Makes clear that CMS’ quality measures assessing the proportion of health care workers who are vaccinated for COVID-19 remain in place. Formally eliminates COVID-19 testing requirements for long-term care (LTC) facilities. Finalizes the continuation of COVID-19 vaccine education requirements for LTCs and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs-IID).

Running Calendar
Wednesday, June 7: CHA Regulatory Update, Join Here (10-11 a.m.) Friday, June 9: Medical Services Board Meeting, Join Here (9 a.m.) Friday, June 9: Prescription Drug Affordability Advisory Council Meeting, Register Here (1-3 p.m.) Thursday, June 13: CHA’s webinar, Health Care Under the Gold Dome: A Recap of the 2023 Legislative Session, Register Here (11 a.m.- noon) Thursday, June 15- Friday, June 16: CHA CEO Forum in Vail, Register Here Thursday, June 29: 2023 CHA Labor Relations Call, Register Here (11 a.m.- noon) 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].

Running Calendar

Wednesday, June 7: CHA Regulatory Update, Join Here (10-11 a.m.)
Friday, June 9: Medical Services Board Meeting, Join Here (9 a.m.)
Friday, June 9: Prescription Drug Affordability Advisory Council Meeting, Register Here (1-3 p.m.) Thursday, June 13: CHA’s webinar, Health Care Under the Gold Dome: A Recap of the 2023 Legislative Session, Register Here (11 a.m.- noon)
Thursday, June 15- Friday, June 16: CHA CEO Forum in Vail, Register Here
Thursday, June 29: 2023 CHA Labor Relations Call, Register Here (11 a.m.- noon)

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].

• Adopted lates • HCPF: Hospital Base Rates Finalized for 2023-24 • CMS: Extends COVID-19 Telehealth Flexibilities for Hospital Outpatient Therapies • Congress: Bill Passed to Raise Debt Limit •