Hospitals to lose Medicare, Medicaid access in 14 weeks if they don’t meet daily reporting requirements

• Hospitals will have 14 weeks from Oct. 7 to begin daily reporting of all newly required information on COVID-19 and the flu.
• Lack of compliance will result in termination from Medicare and Medicaid.
• Among hospitals, 86% already are reporting at least some of the required information daily.

More than 6,000 hospitals were scheduled to begin receiving letters Oct. 7 detailing their compliance status with daily data-reporting requirements related to the COVID-19 pandemic. Facilities that do not become compliant within 14 weeks will lose access to Medicare and Medicaid, said CMS Administrator Seema Verma.

CMS is implementing an Aug. 28 interim final rule with comment, which made daily reporting of COVID-19-related data and other data a condition of participation (COP) in Medicare and Medicaid.

Hospitals are required to report 31 data elements daily and six elements weekly, according to an Oct. 6 FAQ from the U.S. Department of Health and Human Services (HHS). The reporting requirements broadly apply to all types of hospitals, or more than 6,000 facilities. An exception is that psychiatric and rehabilitation hospitals must report five of the 31 elements weekly instead of daily.

 Hospital advocates condemned the approach as “overkill.”

“It is both inappropriate and frankly overkill for CMS to tie compliance with reporting to Medicare conditions of participation,” Chip Kahn, president and CEO of the Federation of American Hospitals, said in a written statement. “Caregivers will comply with reasonable data requests, but this sledgehammer enforcement may well weaken the response of frontline hospitals by diverting time and money from battling the pandemic and serving patients.”

But federal officials downplayed the challenge of daily data reporting, noting that most hospitals already are doing so for some data, and said the COP tie-in was their only legal option to enforce the requirement.

“It’s important to note that termination from Medicare and Medicaid is the only sanction at our disposal for hospitals,” Verma said in a call with reporters. “We’re going to do everything we can to facilitate reporting, including an enforcement timeline that will provide hospitals ample opportunity to come into compliance.”

After reviewing the updated HHS guidance issued this week, Kahn also was critical of the addition of six data elements for hospitals to report daily, including total hospitalized patients with laboratory-confirmed influenza. In the new guidance, HHS said the reporting requirements for those six measures were voluntary but would become mandatory “within the coming weeks.”

“Unfortunately, in the midst of the COVID-19 crisis, HHS is once again moving the goal posts by announcing six new items that hospitals must report or face heavy Medicare penalties,” Kahn said. “While we appreciate CMS removing one of the most obviously onerous and unnecessary data reporting elements  and extending a grace period for enforcement, the new rules reflect more questionable piling on.”

Verma said the information is “critical” to ensure the federal government can direct needed supplies and resources to hospitals facing an increased COVID-19 caseload.

Details of the reporting process

Hospitals can report the data using any of three options:

• Through their states
• Directly to HHS through teletracking
• Through their health IT vendors, which will send the data to HHS

These methods replace hospital reporting of the same COVID-19 information to the National Healthcare Safety Network site.

The 14-week compliance period will include:

• An initial letter stating whether a hospital is compliant
• A letter three weeks later to noncompliant hospitals
• Weekly enforcement notices for four weeks beginning three weeks after the second letter
• Termination from Medicare and Medicaid 30 days after the final enforcement notice

Hospitals can appeal any termination.

CMS plans to offer technical assistance, including a “hotline” that hospitals can call for details about their noncompliance or to address reporting issues, such as HHS not receiving submitted data. HHS also plans to release more details through sub-regulatory guidance.

“A lot of them may think they are in compliance, they may think they’ve been reporting, but we’re going to give them that feedback,” Verma said. “And if they’re not, then we’re going to be working with them over several weeks to help them come into compliance.” 

It was unclear whether the letters will state the specific ways in which hospitals are noncompliant or whether they will have to contact CMS to determine those details.

On Oct. 21, CMS will begin publicly reporting on each hospital’s compliance and, for noncompliant hospitals, which elements they are not reporting.

Increase seen in compliance with reporting requirements

Since HHS asked hospitals to begin reporting some of the data, weekly reporting has increased from 86% to 98% of all hospitals. Daily reporting has increased from 61% to 86%, said Deborah Birx, MD, White House coronavirus response coordinator.

However, it was unclear how many of those hospitals were in full compliance with the requirements that were in place at the time. The officials did not say how many hospitals will receive letters of noncompliance this week.

HHS estimated that daily reporting of data would cost hospitals as a group more than $212 million annually.

Hospitals that use in-house laboratories or commercial labs for COVID-19 testing need to report an additional 16 data elements daily. State labs will report their tests directly to the federal government.

HHS estimated the lab-reporting requirements would cost hospitals as a group between $1.5 million and $8.9 million per day. Additionally, the one-time estimated cost for labs to update their internal systems to report such data is $42.6 million.