Five major hospital associations are out with a detailed
three-page letter urging lawmakers to reject proposals to cap payment for
non-emergency evaluation and management (E/M) services in the outpatient
department at the same rate as in a physician's office, saying such a move
would undermine the shift toward delivery service reform. At the same time, a
group of integrated care hospitals is floating an alternative proposal that
aims to achieve the same policy goal by requiring providers to attest they are
following certain criteria in order to receive outpatient payments, and the
proposal applies a two-year moratorium on new attestations. Sources with the
American Hospital Association and other groups that signed the three-page
letter say they are open to ideas and are considering the alternative proposal,
but one hospital source says although "attestation" is fine, the moratorium
concept is a non-starter.898 words
Consumer groups are once again pushing the Obama
administration to make several changes in the near future to the health reform
law's Summary of Benefits and Coverage document that, starting Sept. 23, must
be provided to consumers as a way to give concise information about health
insurance. Among their key gripes is the administration's plan to let insurers
temporarily use a streamlined calculator to generate information for the SBC's
"coverage examples," a policy they say should be abandoned starting January to
ensure consumers have "access to more robust estimates per the original rules,"
according to a Sept. 13 letter they sent to the CMS Center for Consumer
Information and Insurance Oversight as well as the Labor and Treasury
departments.912 words
More than half of the states now have Medicaid Recovery Audit
Contractors in place, according to CMS, which has revamped its Medicaid RAC
website to publicly list the new RACs and offer a state-by-state breakdown of
how the health law-required audits are working. An increasing number of states
have also received exemptions to delay implementing the program and extend the
look back period beyond three years, reveals the website, which CMS plans to
refresh on a monthly basis until all the state programs are up and running and
then likely will update quarterly.655 words
Children's hospitals and advocates are urging CMS to change
its proposed approach to essential health benefits by letting states use
Children's Health Insurance Program (CHIP) plans as the benchmark package for
children, according to a letter they sent to CMS. The advocates say they worry
that health insurance plans available to states as benchmarks do not meet the
needs of children.548 words
A bipartisan group founded by former Clinton White House Chief
of staff Erskine Bowles and former Sen. Al Simpson (R-WY) has set aside $25
million for a "sophisticated, national campaign to encourage policymakers to
pass meaningful debt legislation in the coming months." The two policymakers in
December 2010 riled health care stakeholders by touting a plan to cut $400
billion from Medicare, some of which they would have used to permanently repeal
the physician payment formula.386 words
A CMS official said Thursday (Sept. 13) that CMS is no longer
discussing a "blended" federal Medicaid matching rate that would ax the
existing varying federal payments in order to create a streamlined rate
encompassing existing and newly eligible Medicaid beneficiaries, but a state
Medicaid source was not assuaged, saying the agency has little control over
such decisions. The White House floated the proposal, estimated to save the
federal government about $18 billion over 10 years, last September and also
included it in the fiscal year 2013 budget request, which a White House
official recently told Inside Health Policy was the deficit reduction
plan the president referred to in his convention acceptance speech last
Thursday (September 6).414 words
A top CMS official said Wednesday (Sept. 19) that the agency will continue its effort to promote enrollment in higher quality Medicare Advantage plans by urging beneficiaries in lower-performing plans to switch to those with higher star ratings and by turning off a button on CMS' web site that allows easy plan re-enrollment. CMS' Jonathan Blum made the comments during a teleconference announcing that MA plan enrollment is expected to grow by 11 percent in FY2013 and that premiums are expected to remain stable. CMS attributes those trends to improved plan quality and aggressive bid negotiations, but others say it's largely because the brunt of the health reform law's MA cuts have yet to take effect and because a bonus-payment demonstration has so far shielded MA plans from those cuts.
488 words
Cancer patients, advocates and oncology stakeholders will visit Capitol Hill Thursday (Sept. 20) to lobby against several planned and proposed reimbursement cuts that they say would be devastating to cancer treatment. Among the issues that members of the Community Oncology Alliance and CPAN, the group's patient advocacy network, will bring up are the oncology, diagnostic and radiation cuts in CMS' proposed Medicare physician fee schedule, and a need to avert both the upcoming 27 percent physician payment cuts and budget sequestration. Advocates also will lobby lawmakers to sponsor legislation that would exclude "prompt pay" discounts from Medicare Part B's "average sales price" calculations, which affect reimbursements for drugs administered by oncologists.
604 words
Children's advocate First Focus plans to lobby for extensions
of programs in the Children's Health Insurance Program that will run out of money
before CHIP funding expires in 2015. One of these is the Express Lane
enrollment program, for which funding expires next year, says First Focus
President Bruce Lesley.477 words
The American Hospital Association held a webinar Tuesday
(Sept. 18) to discuss with hospitals the results of the organization's latest
RACTrac survey that shows claims denials from Recovery Audit Contractors increased
by 21 percent compared with the first quarter of 2012 and continue to grow. One
of the most common denials for hospitals, the group's voluntary survey found,
are medical necessity claims provided in the wrong setting. The results come as
AHA continues to raise concerns on Capitol Hill that RAC denials are forcing
hospitals to avoid admitting a patient as an inpatient for short stays, and to
instead keep them under observation, an outpatient procedure, due to concerns
about providing care in the wrong setting.611 words
The Obama administration indicated Friday that a handful of
Medicare and health reform programs are exempt from the upcoming 8.2 percent
sequestration cuts in nondefense discretionary spending, including the bonus
program for health information technology, the Pre-Existing Condition Insurance
Plan program, subsidies to help people buy insurance in the exchanges, payment
to quality improvements organizations, payments to health care trust funds and
various low-income programs.443 words
Rep. Jim McDermott (D-WA), a senior member of the Ways and
Means Committee, will unveil legislation Thursday (Sept. 13) that aims to boost
the primary care workforce by establishing a federal- and state-funded
scholarship program to cover the full cost of medical school -- including a
cost-of-living stipend -- for students who agree to practice in medically
underserved areas for at least five years. The Restoring the Doctors of Our
Country through Scholarships Act (RDOCS) would appropriate an initial $200
million a year for four years of the program, which would be used to cover 90
percent of the costs, and states would be asked to chip in 10 percent.443 words
House Energy and Commerce Republicans are circulating a memo
that criticizes the Obama administration for crafting what they call
"propaganda" rather then responding to the slew of questions from governors,
Medicaid directors and other stakeholders regarding the Medicaid expansion and
the reform law's insurance exchanges. The memo, sent out Friday (Sept. 14),
followed a House Ways and Means Committee hearing during which GOP members and
some stakeholders argued that the lack of final rules on several important
issues is impeding states from making important decisions.768 words
If he's re-elected, President Obama would give states the
flexibility they need to expand Medicaid without busting state budgets because
because more than half of the health reform law's coverage expansion is on the
backs of Medicaid, former Clinton health care aide Len Nichols said Wednesday
(Sept. 12). There is no way states will be able to expand Medicaid to the
extent that was called for in Affordable Care Act, said Nichols, who is the
director of the Center for Health Policy Research and Ethics at George Mason
University.566 words
CMS Medicaid chief Cindy Mann on Thursday (Sept. 13) strongly
suggested that the administration does not intend to allow states to expand their
Medicaid population to levels below the 138 percent threshold in the health
reform law, at least for the first three years during which the federal
government will pay 100 percent of the cost for newly eligible beneficiaries.
Mann also affirmed that CMS was in the process of drafting a proposed rule on
another key issue related to the Medicaid expansion -- if the agency would
consider a state's decision on expansion when determining reductions to the
disproportionate share hospital payments -- but she gave no indication of where
the agency would land. Another Medicaid official, however, said at a separate
event that the agency was leaning toward not treating states differently on DSH
reductions regardless of the whether a state chooses to expand its Medicaid
program.590 words
The Generic Pharmaceutical Association is working to ensure a
provision allowing FDA to fully collect user fees for generic drugs and
biosimilars is included in a final continuing resolution after the House failed
to include the measure in its bill that was on the House floor Thursday (Sept.
13). Industry officials remain hopeful that Senate lawmakers will include the
measure when the upper chamber takes up the CR next week, but some sources say
any changes to the CR at this point are unlikely.830 words
|
