The White House held one of the first in a series of private meetings Aug. 12 to get stakeholders' ideas for implementing Accountable Care Organizations, sources who attended the meeting at HHS said. The focus of the first meeting was CMS policy, and it included government officials from multiple agencies and a long list of representatives for hospitals, providers, patients and consumers.

Denied access to the stimulus law's health IT bonus payments for each campus of their hospital systems, some hospitals are applying for additional CMS Certification Numbers (CCNs) to create separate hospitals so they can receive more than one incentive payment for installing electronic health records, an industry source says. But stakeholders suggest that the application process and billing system changes that result from splitting their systems may cost more in the long run than the bonus payments are worth.

CMS refused to give lawmakers the list of winning bidders for the first round of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) program and took a swipe at the industry by reminding that the suppliers had originally asked that the names of the winners be kept secret, even though the industry now wants the list released. Providing the list would confuse beneficiaries, the agency states, and it would be inappropriate to announce the winners before notifying the losing bidders.

Primary care physicians continue to push CMS to recognize that the services they perform most are undervalued and urged the agency to establish an independent expert panel to review Medicare payment recommendations, according to comments submitted to CMS on the 2011 proposed physician fee schedule.

The American Hospital Association said that it was getting the runaround from CMS about concerns it has with a productivity adjustment to ambulatory surgical center payments called for in the health reform law and that the dearth of information in a proposed rule makes it hard to comment intelligently about the proposal.

CMS informed states that the National Correct Coding Initiative is the only system it will allow Medicaid programs to use to curb inappropriate payments to providers, according to an agency letter sent to state Medicaid directors Wednesday (Sept. 1).

The Senate's HHS appropriations bill includes an unrequested $40 million to expand medical home demonstration programs called for in the health overhaul law and gives the agency just 90 days to get those demonstrations underway. Advocates said that while they appreciated the swift timeline, they'd also like to see more funding.

The Senate is using its HHS appropriations bill to urge CMS to consider a mix of large and small, urban and rural training programs as the agency implements a provision of health reform law that is expected to increase the number of advanced practice registered nurses (APRN). The law authorizes $50 million a year, from 2012 to 2015, to be divided among five hospitals that are creating a first-of-a-kind training program for APRNs, and the Senate's bill directs CMS to issue a progress report on the planning for the pilot by fiscal 2012 funding justification.

The White House is proposing to take $100 million from the Agency for Healthcare Research and Quality's budget that was supposed to pay for comparative effective research and is giving it the Centers for Disease Control and Prevention for other purposes. That $100 million was part of last year's stimulus package, and the White House justified the cut by pointing out that this year's health overhaul law provides AHRQ with a separate funding stream for CER, so the agency no longer needs all the money that stimulus provided. AHRQ is set to receive hundreds of millions of dollars from the Patient-Centered Research Outcomes Institute, therefore the administration could decrease future appropriations to offset other initiatives without affecting the agency's CER efforts, sources said.

CMS clarified in a call to state officials and a recent guidance letter that all of the original requirements -- including prompt pay and maintenance of effort -- that apply to the enhanced Medicaid funding under the 2009 stimulus package also apply under the extension that was enacted last month. In a separate letter HHS Secretary Kathleen Sebelius also strongly urged governors to take advantage of the funding extension.

There will be 20 percent fewer Part D plans offered next year, due to measures in the health overhaul law that set minimum enrollment levels and require plans to have "meaningful differences," according to CMS. Consumer advocates are pleased by the news, as they have tried since the beginning of the drug benefit to get CMS to weed out redundant plans that could confuse beneficiaries.

CMS will pay states 90 percent of the cost of running a program that pays hospitals and doctors to use electronic health records, and CMS gave state Medicaid directors a list of activities that qualify for that 90 percent match, which pleases Medicaid directors. They also like that CMS listed specific activities for getting state incentive programs up and running, sources say.

CMS spent $43 million in two years for drugs that are deemed "less than effective," and the HHS Office of Inspector General is urging the agency to create a list of such drugs and regularly send the list to health insurance companies. But CMS argues that FDA should be responsible for the list, and CMS should not have to regularly disseminate the list to sponsors.

HHS Secretary Kathleen Sebelius defended the cable TV advertisement featuring Andy Griffith that HHS is running prior to Medicare open enrollment, but Sen. Tom Coburn (R-OK), who tried to get HHS to yank the ad, isn't happy with the administration's response and sent another letter to the department with more demands. The administration has been touting the overhaul of health care prior to the November mid-term elections, and Republicans are trying to counter those efforts, though Sebelius argues that the Andy Griffith spot is part of an education campaign, not a political one.

NAIC: MLR Rebate Draft Reg Coming Soon

As HHS steps up its efforts to ferret out fraud with the passage of health reform, health care providers may need to worry more about Zone Program Integrity Contractors than Recovery Audit Contractors, sources say, even though RACs have received most of the attention for being "bounty hunters" paid on a contingency basis to identify improper payments made by Medicare. However, the ZPIC program has been sluggish up to now, sources say, and some of the contracts for the seven ZPICs have not been awarded so it is difficult to determine how aggressive ZPICs will be.