Hospitals that are newly eligible for the 340B drug discount
will not receive retroactive rebates, according to HHS' website, even though
the health reform law states that the discounts take effect the beginning of
this year and drug makers had planned for back rebates. The Safety Net
Hospitals for Pharmaceutical Access (SNHPA) says HHS is reversing previous
policy, which will cost critical-access hospitals millions of dollars that they
had been counting on from the expansion of the 340B program under the health overhaul
law.
Responding to years of complaints from providers, CMS is
revamping the enrollment process for the Provider Enrollment Chain Ownership
System (PECOS) by using a private sector "tiger team" strategy to beef up
online capabilities, an agency official says. The team is focused on speeding
enrollment of legitimate providers -- currently 70 percent of new Medicare
providers use paper enrollment forms -- but the team expects that its efforts
also will make it more difficult for fraudulent providers to enroll. The tiger
team is staffed by a number of senior experts from across the agency.
CMS is delaying the announcement of contract awards for the
durable medical equipment competitive bid program because of program integrity
concerns, a CMS official said Thursday (Oct. 14). Industry officials say they
are frustrated by CMS' refusal to offer more details. The move comes as CMS
officials, White House economic advisers and congressional budget experts plan
to meet with a leading critic of the design of the Medicare competitive bidding
program for durable medical equipment on Oct. 18.
A former HCFA payment guru has offered a road map for health
reform implementation that calls for CMS to expand its least costly alternative
policy (LCA) instead of backing away from it, use its inherent reasonableness
authority to tag overvalued services, consider cost in comparative
effectiveness research and target policy experiments to treat the chronically
ill. The official, though, acknowledges that CMS' authority may be limited in
some of these areas.
Key lawmakers put CMS on notice that they will closely watch
how nursing home disclosure provisions of the health reform law are implemented
in the wake of a new Government Accountability Office report that details the
private investment takeover of nursing homes and the lack of transparency of
those firms. The lawmakers are now awaiting a second GAO report that will look
into whether the consolidation of nursing homes effects the quality of care,
and a negative finding could prompt a legislative fix, a House aide told
Inside Health Policy.
CMS will not postpone implementation of the health reform
measure requiring doctors to meet patients in-person to certify the need for
home health services, despite a push by industry for a delay and bipartisan
support for industry in Congress, a CMS official said. Aside from trying to
delay the face-to-face requirement, the National Association for Home Care and
Hospice (NAHC) is requesting flexibility on two primary aspects in an upcoming
final rule: physician identity and the time frame for seeing patients in
person.
The work that CMS is undertaking to issue a regulation on
Accountable Care Organizations (ACOs) by the end of the year has spurred a
flurry of activity from stakeholders hoping to help shape the upcoming
policies, including recent comment letters from the hospital and device
manufacturing lobbies. The health insurance trade group has hired attorneys
with expertise in ACO policy and health reform, and beneficiary advocates and
physicians also recently weighed in on the issue.
As CMS gears up to issue a proposed rule outlining the rules
for Accountable Care Organizations, the National Committee for Quality
Assurance is also asking for stakeholder input on "quality criteria" it is
proposing for ACOs. The NCQA is giving interested parties until Nov. 19 to
comment on a variety of issues.
The Senate Finance Committee's top Republican is looking at
expanding CMS' authority to hold Medicare Administrative Contractors
accountable for stopping fraud and abuse by providers, recently criticizing the
agency for not taking action against a MAC that allegedly allowed fraudulent
billing to occur. While at least one court has suggested CMS already has
authority to take criminal action against its MACs, others disagree, and Sen.
Charles Grassley (R-IA) is seeking the agency's view on the matter.
The HHS Inspector General suggests in an Oct. 12 memorandum
to CMS that Quality Improvement Organizations disclose corrective actions taken
as a result of Medicare beneficiary complaints about practitioners, even when
practitioners do not consent to disclosure. The IG memo likely meshes with CMS'
internal efforts to revise QIO disclosure policy, according to an industry
source. CMS is extensively revising the QIO manual, an agency spokesperson
says.
CMS' experiments to cut costs and improve health for Medicare
patients with multiple chronic conditions have largely failed over the past
decade, and agency officials hope that home-based primary care demonstrations
authorized by health reform will show more promise as they prepare to launch 19
more demonstrations in the next few years. Face-to-face visits with patients
appear to have led to the best results, although such an approach is also
costly, agency officials told attendees of the Advanced Medical Device
Association's annual conference earlier this month.
The Government Accountability Office says CMS' handling of
Medicare Advantage plans that were urging beneficiaries to oppose MA cuts
during the health reform debate was unprecedented and "unusual" but didn't
violate the agency's policies and procedures. CMS officials disagreed with
GAO's characterization of the activities as unusual, saying the agency had
taken similar action previously, but Republicans pounced on the findings as
evidence that the agency's effort to stop MA lobbying was out of the ordinary.
CMS canceled a meeting scheduled for Monday with an expert on
auctions about his ideas to modify the design of the agency's controversial
competitive bidding program for durable medical equipment, Washington insiders
tell Inside Health Policy. The meeting was canceled as another group
representing DME suppliers notified CMS Monday of a forthcoming report that is
expected to detail flaws in the design of the competitive bid program. The
concerns about the bidding design come as the program kick off date -- Jan. 1,
2011 -- inches closer.
States have until Dec. 31 to decide if they are going to
create a Recovery Audit Contractor program or request a waiver from the health
reform-mandated effort to audit payments to Medicaid providers, CMS recently
told state Medicaid directors, warning waivers will be difficult to secure.
With an April 1, 2011 implementation deadline fast approaching, CMS told states
it is still grappling with key "operational and policy considerations." The
agency plans to draft regulations and guidance clarifying the qualifications of
Medicaid RACs, required personnel, contract duration, RAC responsibilities,
timeframes for completion of audits and recoveries, audit look-back periods,
coordination with other contractors and law enforcement, appeals, and
contingency fee considerations.
Five Senate Democrats are calling on the chamber's leadership
to forbid the inclusion of limits on drug patent settlements in any funding
bill, a move that generic drug industry sources say signals a shift against the
proposal as lawmakers become informed on the issue. But a supporter of
restrictions on drug patent settlements contends that there still exists
substantial support for legislation to limit these types of agreements. Critics
of the agreements tried, but were unsuccessful, in restricting the settlements
as part of healthcare reform and have attempted to attach similar limits to
appropriations bills.
The Justice Department and Michigan's attorney general are
asking a federal judge to negate provisions of contracts between Blue Cross
Blue Shield of Michigan and 70 hospitals alleged to be anti-competitive and
violate anti-trust statute due to the large market share the insurer controls
in the state, and a Justice official said the department is on the lookout for
similar problems in others states. The suit comes as many questions continue to
be raised about how accountable care organizations sought by the new health
reform law will be treated under the existing anti-trust laws.
HHS To Award $335 Million To FQHCs
ORLANDO, FL -- State insurance commissioners gave final
approval last week to a model regulation on the health reform law's medical
loss ratio, after defeating or abandoning controversial proposals to alter the
draft in insurers' favor. The National Association of Insurance Commissioners
rejected insurers' calls to calculate the MLR using a nationwide instead of a
state-based formula and to adopt a national transition period. The NAIC hopes
to work closely with HHS and has suggested creation of a working group that
would address any potential adverse effects stemming from the regulation.
The Congressional Budget Office is estimating the cost of
letting hospitals receive incentive payments at each of their campuses that
install electronic health records to help lawmakers who are pushing bills to
allow multi-campus payments, a hospital source says. Industry does not agree
with the assumptions that CBO is expected to make about the extent to which
hospitals will adopt EHRs, but that difference should not greatly affect cost
estimates.
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