AHCA/NCAL President and CEO Mark Parkinson shares, “There is significant, positive news from D.C. this week. Our efforts to get the new Administration to reduce our regulatory burden continue to bear fruit,” as CMS announced major changes to the mandatory post-acute bundling programs. You may recall that these are the large-scale demonstrations created by the Obama Administration that forced bundling in large parts of the country and gave the bundles to hospitals. 

The full proposed rule is online here. There are two significant parts to the proposed rule.

1. The August 15 proposed rule cancels the most recent mandatory bundling program. This is the program that added two cardiac episodes to mandatory bundling and gave hospitals the bundle. CMS had delayed this program until January 1, 2018 and is now proposing to cancel it.
    
2. The proposed rule also makes major changes to the initial mandatory bundle, the Comprehensive Care for Joint Replacement (CJR).  The rule reduces the Metropolitan Statistical Areas (MSAs) included in the demonstration from 67 to 34.  For the 33 MSAs that are eliminated, bundling can continue, but only on a voluntary basis.  Even in the 34 remaining MSAs, bundling becomes voluntary in low volume rural hospitals. Richmond, Roanoke, and Staunton-Waynesboro were among the MSAs included in the proposed rule.  Click here to see the full list.

AHCA/NCAL began pushing for these changes immediately after the election. The changes announced today were part of what we presented to the Trump transition team. AHCA/NCAL has continued the efforts to communicate with Secretary Price, given his leadership against mandatory bundles when he was a member of Congress. AHCA/NCAL has been clear that the association is not against bundling, but our Board has taken a position against mandatory bundling, where we have no ability to hold the bundle.

According to Parkinson, “When combined with recent success on the survey and Civil Monetary Penalty (CMP) issues, the proposed rule removing the ban on arbitration, and now this, it certainly appears that our efforts to obtain regulatory relief are finally paying off.”  He adds, “It’s important to keep in mind that today’s announcement is a proposed rule. The regulation must go through the formal rulemaking process, but we feel very good that ultimately CMS will finalize this rule.”