House leaders to CMS: Remove regulatory barriers to risk-based care

In a letter to CMS, 70 House representatives asked the federal agency to make it easier for providers to participate in risk-based payment models by removing regulatory barriers that encourage fee-for-service payment.  

Specifically, representatives asked CMS to waive certain regulations that offer cash incentives under fee-for-service delivery models, thereby hindering reform progress.

The letter calls on CMS to reconsider regulations like the Long-Term Care Hospital 25 percent rule because they have created challenges for care facilities starting to engage in value-based models. Implemented in 2005, the "25 percent" rule penalizes long-term care hospitals that admit more than 25 percent of Medicare cases from onsite or neighboring acute care facilities.

"The continued application of FFS regulatory barriers within downside risk payment reform models often hinders providers' ability to identify and place beneficiaries in the most clinically appropriate setting," said House leaders in the letter. "It also inhibits their ability to test new, more patient-centered and streamlined clinical pathways."

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