CMS plans to meet this month with Pioneer ACOs threatening to drop out of the high-profile demonstration to discuss their demands that the agency delay the requirement that they meet quality measures, CMS Acting Administrator Marilyn Tavenner told Inside Health Policy Tuesday (March 5). She said it's too early to say whether CMS will give the accountable care organizations what they're requesting but she did not sound optimistic, emphasizing that the measures were developed with lots of input from ACOs.262 words

CMS Acting Administrator Marilyn Tavenner said Wednesday (March 5) the agency will delay any rulemaking on stage three of meaningful use until next year, as CMS also reached out to stakeholders for advice on how new payment models affect implementation of electronic health records. CMS also unveiled Wednesday a health information technology agenda for 2013 that calls for half of doctor offices to adopt EHRs by the end of the year and for 80 percent of hospitals that already have installed EHRs to attain meaningful user status, while recognizing that these goals are aggressive.998 words

The Office of Personnel Management, in a final rule on the multi-state plans that must eventually be sold in every state exchange, maintains its policy that insurers can offer partial coverage rather than offering coverage state-wide, however insurers must provide plans for scaling up to state-wide coverage. OPM did not identify the states that multi-state plans must cover first as they phase-in to offer coverage in all exchanges over a four-year period.942 words

CMS Medicare chief Jonathan Blum said Medicare Advantage pay cuts proposed by the agency should not hurt plans that earn 4- or 5-star ratings because the bonuses and increased business that plans get as a result of the high ratings will offset the cuts. Blum told the Senate Finance panel Thursday (Feb. 28) the proposed cuts are designed in part to encourage plans with poor ratings to improve and to weed out those that do not, and he said the cuts would not be as steep if Congress were to replace the Sustainable Growth Rate formula.925 words

There appears to be growing interest among key Senate Republicans in giving the federal government full responsibility for dually eligible Medicare and Medicaid beneficiaries, a responsibility currently split between the federal government and the states. Echoing concerns expressed recently by senior Finance Committee member Charles Grassley (R-IA), Sen. Lamar Alexander (R-TN) said Tuesday (March 5) he will push Congress to shift the duals role to the federal government.646 words

As sequestration kicks in, prior planning by some hospital systems will save many in the sector from cuts they hoped would never come to pass, industry sources say. But, despite such prior planning, stakeholders still predict dire consequences across the health care industry due to the automatic cuts and worry about potentially larger future cuts as lawmakers work in the weeks ahead to stop the sequester, raise the debt limit and address an expiring continuing resolution.925 words

CMS' plans for how to draw down funds from exchange grants, demonstrations, anti-fraud programs and other agency priority efforts are still unclear after the White House Office of Management and Budget outlined the scope of sequestration cuts facing each area. Also, while Medicaid and CHIP are exempt from the sequester cuts, CMS program management cuts potentially could also affect those areas, though the specific impact also remains unclear.734 words

A newly proposed rule laying out how IRS will collect the controversial health insurance premium tax applied to most insurers starting in 2014 confirms that the fee applies to Medicaid managed care, Medicare Part D and Medicare Advantage plans, while Medigap and long-term care policies as well as government entities and certain nonprofit plans are exempted. The proposed rule, while containing few surprises as many of its parameters were dictated by statute, refueled the insurance industry's lobby for Congress to pass bipartisan legislation repealing the fee.867 words

House Ways and Means oversight subcommittee chair Charles Boustany (R-LA) indicated Tuesday (March 5) that lawmakers are eying comprehensive tax reform as a way to repeal some of the ACA's tax-related provisions that have been strongly protested by industry, including the medical device and health insurer taxes.561 words

A physician payment commission calls for Congress to phase in over 10 years a new Medicare payment approach by spending the first five years testing new models followed by five years of incorporating the successful ones into nearly all physician specialties. In the meantime, the commission proposes that lawmakers repeal the current Sustainable Growth Rate formula -- with the repeal paid for by reducing medical services -- and recalibrate fee-for-service pay.533 words

To the delight of Medicaid directors, CMS will expand the Medicaid Integrity Institute with additional training tools for state program integrity workers, including webinars and certification programs. The expansion comes as CMS continues with changes to the National Medicaid Audit Program in 2013, following some concerns that parts of the program were using far more money than they returned.455 words

Tennessee GOP Sens. Bob Corker and Lamar Alexander are pushing legislation based heavily on the original Simpson-Bowles deficit reduction proposal that would glean an estimated $689 billion in health care savings over 10 years, the largest portion -- $290 billion -- of which would come from reforming Medicare Advantage. The Fiscal Sustainability Act (S.11), which would also reform Medicaid, prohibit Medigap coverage after 2017 and further means -test Medicare, is nearly identical to Corker's "Dollar for Dollar" bill introduced last year except that the savings under the previous law were specifically targeted to offset a debt limit increase.520 words

Senate Finance Ranking Member Orrin Hatch (R-UT) and two key House Republicans are raising issues with proposed reductions to 2014 Medicare Advantage rates CMS outlined in its advanced notice and draft call letter, saying the cuts combined with ACA reductions and sequestration will reduce beneficiary access and slash the program's total enrollment.590 words

Two key Republican House lawmakers urged hospitals on Tuesday (March 5) to lobby for "structural changes" to Medicare, suggesting that doing so could alleviate the need for lawmakers to turn to more provider pay cuts to offset the cost of replacing the Sustainable Growth Rate formula. Ways and Means Subcommittee on Oversight chair Charles Boustany (R-LA) said he wants to combine premiums from Medicare Part A, B and D and use the savings from that consolidation as an SGR offset, but that was the only offset he mentioned.419 words

America's Health Insurance Plans' (AHIP) unveiled Tuesday (March 5) a 40-page report detailing wide-ranging efforts by Medicaid managed care plans to implement innovative programs that aim to improve care and reduce health care spending. The report, which industry notes comes at a time when lawmakers are looking at ways to improve care and save money, highlights plan efforts and achievements in three categories: working with community partners, addressing obesity, and caring for people with complex needs.1055 words

One of CMS' highest profile health care delivery reform initiatives is on rocky ground as most of the Pioneer ACOs are threatening to drop out of the demonstration if CMS makes them start meeting quality measures instead of merely requiring that they report the measures, according to a letter obtained by Inside Health Policy. The accountable care organizations say the quality metrics are a poor measure of performance, and their complaint could have implications for all Medicare pay systems because CMS is moving toward basing pay on how providers perform. The Pioneer ACOs were supposed to be the few shining examples of organizations that could handle outcomes-based pay.691 words

House Republican leadership as well as top Republicans on the Energy and Commerce Committee want President Obama to redirect funding from certain health reform law programs -- including the Prevention and Public Health Fund and exchanges -- toward the Pre-Existing Condition Insurance Plan program for high-risk patients so enrollment in PCIP can continue. They are upset that CMS, in a Feb. 15 memo to state-based PCIP contractors, said it was stopping enrollment in the health law's high-risk pools to ensure funding is available through this year to keep coverage for those already enrolled. In January, CMS also instituted changes in benefits for PCIP pools run by the federal government, and indicated it might require states to make the same changes later this year to save money.397 words

Diabetes Caucus co-chairs Dianna DeGette (D-CO) and Ed Whitfield (R-KY) are asking the Government Accountability Office to study whether pay cuts for retail diabetic test strips have made those supplies more difficult to find. Medicare reimbursement is set to plummet on July 1 due to the latest round of competitive bidding cuts and savings wrapped into the end-of-the-year Medicare physicians payment package.689 words

Stakeholder groups are increasingly looking at taxation of sugary beverages as a way to nudge consumers toward healthier behaviors and glean revenues that could be targeted toward health education or prevention services, or even as a way to offset the cost of Medicare physician payment reform. John Rother, president and CEO of the National Coalition on Health Care (NCHC) tells Inside Health Policy that sugar tax should be considered as a viable offset, and according to recent estimates a one-cent per ounce tax on sweetened beverages could bring in $150 billion over 10 years, which would more than cover the $138 billion cost of repealing the Sustainable Growth Rate formula used to pay physicians.793 words

HHS is seeking to delay implementing employee choice as a requirement for all small group market exchanges, or SHOP, until 2015, citing a need to transition to broader employee choice models in part because of operational challenges in implementing the requirement next year.597 words

HHS has tweaked a controversial policy that required insurers seeking to play in the federally facilitated exchange for the individual market also participate in small business (FF-SHOP) exchanges, and now says that the policy only applies to plans with a least 20 percent share of the small group market. The updated provision is part of a newly issued Notice of Benefit and Payment Parameters, which also finalized rules related to the so-called "3 R's" -- risk adjustment, risk corridors and reinsurance -- all of which are designed to protect insurers and consumers from potential impacts of the new insurance market rules.560 words

Former CMS Administrator Mark McClellan said the Brookings Institution will soon release a set of updated Medicare reform proposals and indicated they would outline a broader reform strategy that chiefly focuses on lowering beneficiary costs and improving individual health outcomes. Speaking at a National Journal forum on Medicare, McClellan said legislative reforms to Medicare must stress individualized, prevention-oriented care under an approach in which beneficiaries could share in savings when they make decisions that result in lower costs and care being used more effectively.472 words

House Energy and Commerce Committee Vice Chair Rep. Marsha Blackburn (R-TN), a longtime opponent of the health reform law, told insurance agents and brokers that the committee would push to exempt their fees from health law's medical loss ratio (MLR) provision. The National Association of Health Underwriters (NAHU), which held its Capital Conference this week, is lobbying Congress to remove brokers' fees from the MLR and to pass legislation addressing other health law provisions that could drive premium rate increases.411 words

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