Health Law Daily Rehab facility failed to supply ACA-required quality data, 2 percent penalty proper
Thursday, February 28, 2019

Rehab facility failed to supply ACA-required quality data, 2 percent penalty proper

By Robert B. Barnett Jr., J.D.

The failure of Rehabilitation Hospital of the Pacific, a Honolulu-based inpatient rehabilitation facility, to report Catheter-Associated Urinary Tract Infection data for two of the three of its locations for November and December 2015 justified the automatic imposition of a 2 percent reduction in its Market Basket Update for fiscal year 2017.

CMS’s decision to impose a 2 percent reduction in the Market Basket Update for the fiscal year 2017 for Rehabilitation Hospital of the Pacific (RHP) because it failed to submit certain quality data during the final two months of 2015 was proper because the Patient Protection and Affordable Care Act (ACA) requires that the data be supplied each month for all three of RHP’s locations, the Provider Reimbursement Review Board has ruled. The rules and the penalty are clear: if an inpatient rehabilitation facility fails to supply the required quality data to the National Healthcare Safety Network (NHSN) computer system for all of its locations, its Market Basket Update payment in the subsequent year will be reduced by 2 percent. RHP’s contention that it submitted the data on all three locations but NHSN failed to forward the data to CMS on two of those locations could not be substantiated (Rehabilitation Hospital of the Pacific v.Noridian Healthcare Solutions, PRRB Decision No. 2019-D13, January 30, 2019).

The ACA Act amended the Medicare laws to impose Quality Reporting Program requirements on inpatient rehabilitation facilities. Medicare pays the inpatient rehabilitation facilities for services under a prospective payment system in an amount that is increased each year by a Market Basket Update used to account for increases in operating costs. The reporting requirements for fiscal year 2017 required that the inpatient rehabilitation facility submit certain quality data for each month of fiscal year 2015. CMS notified RHP that it failed to submit Catheter-Associated Urinary Tract Infection data for two of the three of its locations for November and December 2015. Under federal law, any inpatient rehabilitation facility that fails to report required quality data is automatically assessed a 2 percent reduction in its prospective Market Basket Update. After RHP requested reconsideration, CMS upheld its original decision. RHP then appealed the decision to the Provider Reimbursement Review Board.

RHP argued that it submitted the data to the NHSN but that HNSN failed to forward the data to CMS. To support its claim, RHP provided NHSN printouts for November and December of 2015 that were dated in January 2016. As RHP admitted, however, its original submission for November and December 2015 listed only one location for data surveillance. Those documents were later edited to show three locations, but the edits occurred after the May 15, 2016, deadline for making edits. Furthermore, complaining, as RHP did, that it was never notified of the error was of no avail. The CMS reporting guidance provides numerous filing resources, and the guidance clearly states that providers are responsible for their own reporting. Also, if RHP was confused about its reporting requirements, the Board asked, why was it able to report properly for the 2015 months prior to November and December? The Board then concluded that RHP was out of compliance for November and December 2015. While the Board was also sympathetic to RHP’s plight, it noted that the Medicare statutes gave it little leeway to fashion an equitable remedy different from the 2 percent penalty. Some leeway exists for a "justifiable excuse" but this situation, which simply involved a failure to follow reporting instructions, did not qualify as a justifiable excuse. Consequently, the Board upheld CMS’s decision to impose the 2 percent penalty on RHP’s 2017 Market Basket Update.

Cost reporting period ending September 30, 2017.

MainStory: TopStory PRRBDecisions IPPSNews CMSNews MedicareContractorNews PaymentNews PartANews ProgramIntegrityNews QualityNews

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