CMS Remarks Before NCVHS September 28, 2016 Shana Olshan Director - PowerPoint PPT Presentation

CMS Remarks Before NCVHS September 28, 2016 Shana Olshan Director National Standards Group Centers for Medicare & Medicaid Services

CMS .gov learn about your hea tt h care options Centers for Medicare & Medicaid Services Medicare­Medicaid Private Regulations & Research, Statistics, Outreach & Medicaid/CHIP Insu r ance Guidance Coordination Data & Systems Education Home > Regula ti ons and Gu idance > HIPAA and ACA > Ad mi nistra ti ve Simplifi ca tion Overview HIPAA and ACA Adm inis trative Simplif i cation Overvi ew Events and latest News To reduce pape rw ork and s tr eamline business processes across the health care system, the Statutes and Regulations Health Insurance Portability and Accountabili ty Act (HIPAA) of 1996 and the Patient Protection Adooted Standards and Operating and A ff ordable Care Act ( A< CA) set national standards for: Rules • Electronic transactions Are You a Covered Entity? • Code sets Privacy and Security Information • Unique identifiers Standards Adoption Process HIPAA includes Administrative Simplification provi si ons that th e ACA (Affordable Care Act) Standards­Setting and Related expanded in 2010. ACA introduced operating ru l es to standardize business practic es. Organizations It 's the Law HIPAA. Administrative Simplification. and ACA FAQs Health care providers, health plans, payers, and ot her HIPAA­covered entiti es must comply wi th Administrative Simplification. The requiremen ts app ly to a ll providers who conduct el ectronic t ransact i ons , not just providers who accept Medicare or Medicai d. Save Time and Costs Wh il e Helpi ng Patients Standard transactions. operating rules, code sets, and unique identifiers allow information to be shared electronically in co nsistent way s. With com mo n standards for content and formats, information moves quickly as it is shared be tw een pr oviders and health plans in pr edictable way s. These standards have the potenti al to decrease health costs, time spent on paperwork, and administrative burden, giving providers mo re time for patient care. 2 And qui ck com mu nications with insurers can h el p info rm patients upfront about coverage, benefits. and out­ of ­oocket costs.

Covered Entity Guidance: Providers, Clearinghouses, Health Plans Providers Clearinghouses Health Plans . .. .......................................................................................... . .. \ • i Is a person, business, Is a business or Is a government- Is a private benefit or agency a covered agency a health care funded program a plan a health plan? health care provider? clearinghouse? health plan? Click on the box that reflects the question you want to answer .. ·- ······· ···· ·· ··· ·· ·· Administrat i ve Simplification : Covered Entity Guidance

Timeline of Statutes and Regulations Law or Year Date To pic of Law/Reg Descr iption Reg 1996 Aug2 1 law HI PAA, Health Insurance The law requires HHS to adopt national standards Portabil ity and and code sets for electronic transactions. The Accountabil ity Act pro visions become known as Administrative Simpl if ic ation. HI PAA adds a new Part C­ Administrative Simplification to the Soc ial Security Act of 1935. 2000 Aug17 Reg Standards and Code Sets fo r HHS ado pts code sets (I CD ­9, CPT­4 , National Drug Electronic Transactions and Cod es, Code on De ntal Procedures and DSMO Proce ss Nomenclature, and HCPCS) and standards for electronic transactions: ASC X12 Version 4010 and NCPDP Version 5. 1. HHS publishes a regulation out lining the process fo r standards deve lop ment organizations to collaboratE on the review of propo se d modifications to standards and code sets, including the exec utio n of a Memorandum of Understanding on whi ch HHS is a signatory. The mandatory colla bor ation is ca lled the Designated Standards Maintenance Organization (DSMO). Adoption of the standards and code sets is required by Oct 16, 2002, fo r all HI PAA­covered entities, except small health plans, wh ich were required to comply on Oct 16, 2003. Health Insurance Reform : 2000 Aug17 Reg HHS announces the organizations that the Secretary Announ ce men t of Des i gna t ed designates as Designated Standard Mainte nance Standard Maintenance Organizations (DSMOs). Or gan iz atio ns law ASCA, Administra ti ve Co ngress requir es electronic su bmission of 2001 Jan 3 Sim(!lification Com(!liance Medicare claims. Act 2002 May3 1 Reg Em(!loyer Identification HHS adopts standard fo r Employer Identifier Number (EIN) Standard (E IN) which becomes man datory fo r use on July 30, 2002. 2003 Feb 20 Reg Transacti on St andards and HHS adopts modified specifications fo r 1) 4 transaction standards, and 2) how HIPAA­covered Code Sets entit ies use standards, effective Mar 24, 2003.

Administrative Simplification Website Visit go.cms.gov/AdminSimp Sign Up for Email Updates Follow Us on Twitter Comments on Our Website? NationalStandardsGroup_AdminSimp@cms.hhs.gov 5

~ Login Cr eate an Acco un t AS E TT Home Ab out AS E TT F AQ • Glossa ry Contact Us • Enforcemen t Vi deo User Gui de Privacy Complaint If you believe that a covered entity or bu siness associate violated y ou r health File HIPAA Complaint Test HIPAA Transactions inf orm ation privacy rights or commi tt ed another violation of the Privacy, C li ck here to J ea rn mor e about how to file a complaint. Test Transactions tool a ll ows a ll transactions to be Security or Breach checked consistently for compliance, syntax, and Submit co mp laints for the follo wi ng violations: Notification Rules, you bu siness rules. Validate transactions across various may file a complaint with formats including the fo llowing: the Office for Civil Rights Transactions Code Se ts <OC R\ o HIPAA 5010 o CA QH CORE Op erating Rules o J CD ­10 Diagnostic Unique Identifiers Operating Rules o Unique I de ntifiers Validate code values against 60­plus clinical and n on- To file a complaint, you must login by c li cking the login clinical code sets, including ICD-9 and lCD 10 button. If yo u do not have an account, create one now dia gn ostic procedures and code sets. This tool through the secure CMS Enter pr ise Portal by cl icking provides intuitive error reports and acknowle dgm ents on the Create Account button. to he lp identi fy and resolve error. 6

More Information About ASETT File a complaint, FAQs, and Quick Start Guide https://www.cms.gov/Regulations-and- Guidance/Administrative- Simplification/Enforcements/FileaComplaint.html ASETT https://htct.hhs.gov/asett/public/home.act Questions? hipaacomplaint@cms.hhs.gov 7

Planned Options for Quality Payment Program Reporting in 2017 • First Option – Test the Quality Payment Program – Submit some data to QPP from after 1/1/17 – Avoid a negative payment adjustment – Allows for testing systems to prepare for broader participation in later years • Second Option – Participate for part of the calendar year – Submit QPP information for a reduced number of days – First performance period could begin after 1/1/17 – May still qualify for a small positive payment adjustment • Third Option – Participate for the full calendar year – If ready to go 1/1/17, submit QPP information for a full calendar year – First performance period begins 1/1/17 – May qualify for a modest positive payment adjustment • Fourth Option – Participate in an Advanced Alternative Payment Model (AAPM) – Instead of reporting quality data and other information – Example includes participating in a Medicare Shared Savings Track 2 or 3 in 2017 8 – Based on achieving AAPM goals, qualify for a 5% incentive payment in 2019

Hospital Readmissions Reduction Program • Source: New data: 49 states plus DC reduce avoidable hospital readmissions 9