The Congressional Budget Office this week received industry-backed legislation to create patient-admission criteria for long-term care hospitals, and this could be the sector's last chance to avoid CMS' proposal to create much stricter admission criteria, which the American Hospital Association estimates would eliminate about 65 percent of LTCH patients. This week Wells Fargo stock analysts downgraded Kindred Healthcare and Select Medical, which operate a little more than half of the approximately 450 LTCHs, because the analysts believe their share prices don't reflect the risk of Medicare cutting long-term care hospital reimbursement rates in 2015.

Industry experts say a CMS proposed Part D rule expected within the next few weeks could address agency concerns that some preferred pharmacy networks cost Medicare more than other pharmacies. The expected Part D rule comes as a growing chorus of lawmakers is urging CMS to increase oversight of the networks and make sure they are not resulting in increased Medicare spending.

Pharmacists and some Medicare beneficiaries are pushing for more signatures on a bill that would let retail pharmacies deliver diabetic testing supplies to Medicare beneficiaries. Pharmacists have been banned from delivering those supplies since July 1, when the second stage of the Medicare durable medical equipment bidding program took effect and contracts and prices were rolled out under the national mail-order competition for diabetic supplies.

CMS proposed on Wednesday (Aug. 28) lowering by nearly $3,000 reimbursement for both Elekta's Gamma Knife brain cancer radiosurgery and Varian's competing linear accelerator (LINAC) treatment, according to an updated file to the proposed hospital outpatient pay rule. To help pay for overriding scheduled physician pay cuts, the fiscal cliff law drastically cut reimbursement for Gamma Knife by equalizing reimbursement with LINAC, then in July the agency increased reimbursement for both of the procedures to $8,576, but the new proposed price for both procedures is $5,615 for a single treatment.

CMS is not interested in partnering with states on Medicaid shared savings programs based on cost savings alone, saying the programs must improve quality and health outcomes, according to agency guidance released Friday (Aug. 30) laying out what states need to consider when designing and implementing such initiatives. The guidance doesn't prescribe a preferred model, allowing for state flexibility, and says CMS in the initial stages of such programs will support efforts that don't put providers at risk if they fail to reach shared savings targets, but provide incentives if they do.

CMS is looking to interview hospice providers on the Affordable Care Act's Hospice Quality Reporting Program, the agency announced Tuesday (Sept. 3). The agency says it is seeking input from providers to better understand the strengths, weaknesses, priorities and provider burden from the HQRP. CMS also is interested in how providers ensure the accuracy of data submitted through the program, and how the quality program has impacted patient services and outcomes. Plus, CMS says it is looking to see what it can do to improve the program and processes in the future.

A coalition of health systems is pushing for a legislative fix that would cap the penalty for "paper work type" violations of the Stark Law and expedite CMS' handling of disclosures, and a source close to the effort expects the fix to score as a money saver that potentially could help pay for Medicare physician payment reform legislation. Rep. Charles Boustany (R-LA) has jumped on the wagon and drafted a proposed bill that would cap the penalty, clear out the backlog and create an expedited disclosure process.

To cut Medicare spending, the House Ways & Means and Energy & Commerce committees intend to establish a uniform deductible for Medicare hospital (Part A) and medical (Part B) insurance, to simplify coinsurance for spending above that deductible and to cap out-of-pocket spending, a joint paper from the committees states. However, most Democrats likely view the proposals as an effort to shift costs to seniors and put Democrats in the awkward position of opposing proposals from President Obama's budget that the president had intended only as part of a larger package with tax increases, a Democratic source states.

CMS is considering changing the statement of work for Recovery Audit Contractors to include measures related to appeals overturned at the first level, and timeliness and accuracy, the agency said in response to a report from the HHS Office of Inspector General which found that CMS' performance evaluations of the RAC program -- which some hospitals say is overly aggressive -- did not look at how well the RACs were fulfilling their contracts.

The HHS Office of Inspector General in a new report criticizes CMS for not increasing the frequency of its hospice recertifications, noting the OIG recommended in 2007 that CMS recertify hospices more often as many hadn't been through the process in six years or more. The industry backs the OIG's recommendation, and one stakeholder said it's almost a disservice to hospices if CMS does not offer them more frequent feedback on how they're operating, especially in light of changes to Medicare conditions of participation requirements since 2008.

Medicare Advantage plans will be required to pay for same-sex spouses' nursing home coverage in the same facility where a spouse is living, according to CMS guidance released Aug. 29. The guidance is HHS' first memo updating policies to reflect the US v. Windsor Supreme Court case that declared part of the Defense of Marriage Act unconstitutional.

Michigan's House of Representatives on Tuesday (Sept. 3) signed off on a Medicaid expansion plan for the state, clearing the way for Gov. Rick Snyder to become the latest GOP governor to approve the ACA's Medicaid expansion. However, a state spokesperson says the bill cannot take effect until after the legislative session is over, which the state anticipates will occur the end of March.

Enroll America on Thursday (Aug. 29) announced the creation of a new toolkit for hospitals that encourages them to use presumptive eligibility to enroll individuals in Medicaid.

The Energy and Commerce health subcommittee is jumping right back into health reform oversight during Congress' first week back in session, with lawmakers announcing a Sept. 10 hearing to probe the ACA's implementation challenges and the burdens the law is putting on states and employers.

A key official with the U.S. Chamber of Commerce tells Inside Health Policy that Congress could potentially change by the end of this year the Affordable Care Act's definition of a full-time employee as one who works 30 hours per week, a provision that has been criticized by both businesses and unions and revision of which has generated bipartisan support. Lawmakers could stick the fix to define "full-time" as 40 hours per week into the upcoming continuing resolution, Chamber Senior Vice President Randy Johnson says, but other sources say Congress is still too gun-shy about opening up the ACA and any tweaks for now -- even those that carry bipartisan support -- are unlikely.

All eyes are on California as the state nears the conclusion of a months-long battle over a biosimilar substitution bill that would require a physician be notified when any biologic is dispensed, although the provision would expire in 2017. The importance of the California bill in possibly shaping legislation in other states has led to increased interest from stakeholders and sparked extensive debate on the issue.

Starting in November, WellPoint will only cover compounded drugs that contain an FDA-approved product, making the insurer the third to tweak its policy since the practice of compounding garnered nationwide attention, although the company attributes the stepped-up enforcement to Health Insurance Portability and Accountability Act changes.

A key industry attorney and Health IT Now posed differing views about FDA's role in a tri-agency regulatory strategy for health information technology, with the attorney pushing for FDA to provide clear but flexible oversight while the broad-based stakeholder group said the agency's role should be limited to medical technologies. The comments come as a federal workgroup is slated to present its final recommendations to the Office of the National Coordinator for Health Information Technology next week.