Medicare beneficiary advocates have raised concerns with administration
officials that many providers in accountable care organizations (ACOs) may not
be Medicaid providers and as a result dual-eligible beneficiaries could end up
paying for Medicare "cost sharing" that is supposed to be paid for by Medicaid.
The goal of ACOs is to coordinate patient care, and beneficiary advocates say
dual eligibles are the population in greatest need of coordinated care, but
including too few Medicaid doctors in ACOs would discourage that very
population from seeking treatment within ACOs.
The Medicare Administrative Contractor (MAC)for California
recently proposed a program that laboratories worry could make it more
difficult to get Medicare to pay for molecular diagnostics, according to a
California laboratory representative, including possibly requiring clinical
trials for coverage approvals. Because California has the greatest number of
labs performing molecular diagnostic services, local coverage policies in that
state have a broader effect.
The American Medical Association sent a letter Wednesday
(Sept. 29) asking House and Senate lawmakers for a 13-month physician pay
"patch" that would block Medicare payment reductions to doctors in 2011, a move
sources say signals AMA's acknowledgment that a permanent repeal of CMS'
sustainable growth rate formula used to pay physicians is unlikely to
materialize in the near term. The letter was signed by all of the state medical
societies and 65 national medical societies.
Providers urged CMS to not rely on claims data to measure
their performance as the agency moves toward a system, required by the health
reform law, that pays providers based both on the cost and quality of care they
provide. Instead, they told the agency at a Sept. 24 meeting that it should use
real "quality data."
CMS officials confirmed Thursday afternoon that all brand-name
drug makers have signed contracts with CMS to provide a 50 percent discount for
scripts provided in the Part D coverage gap during 2011. Deputy CMS
Administrator Jonathan Blum said, however, that some companies that provide
repackaging and relabeling of drugs have decided not to sign the agreement.
Blum told Inside Health Policy that top clinical experts at the agency
have advised that these contracts were not necessary since patients will still
have access to all branded products next year.
Rep. Pete Stark (D-CA), chair of the House Ways and Means
health subcommittee, is urging CMS to consider recommendations by auction
experts to revamp the competitive bidding program for durable medical
equipment. CMS is supposed to announce the winning bidders of that program by
early next week, and it's not clear whether Stark's request will delay the
announcement.
Antitrust attorneys gathered earlier this month to discuss
the challenges posed by the formation of accountable care organizations and the
general consensus among the lawyers was that, if ACOs save money and improve
quality for patients, the Federal Trade Commission and the HHS Inspector General
won't prosecute. America's Health Insurance Plans used the discussion to make
specific recommendations to CMS and the FTC in advance of an all-day meeting
the agencies are sponsoring Oct. 5.
The Obama administration touted improvements in the Medicare
Advantage and prescription drug programs, citing a slight drop in 2011 MA
premiums, and trumpeted increased oversight that resulted in seven plans from
three plan sponsors dropping out of the program, while hundreds more improved
bids and plan offerings and will remain in the Medicare managed care program.
CMS announced the manufacturers who have signed contracts to
provide a 50-percent discount for branded drugs provided in the prescription
drug coverage gap, even as stakeholders continue to have questions about the
program. Although the Sept. 1, 2010 deadline for manufacturers to sign
agreements to provide the discounts for branded drugs in the Part D coverage
gap has come and gone, stakeholders have questions about how certain newly
approved FDA drugs will be treated under the program.
Providers who participate in fee-for-service Medicare gave a
failing grade to the enrollment activities of the various companies who serve as
CMS contractors, according to a survey of 18,000 Part B respondents.
Rick Gilfillan, the former president and CEO of Geisinger
Health Plan and head of CMS' value-based purchasing program, has been tapped as
acting director of the Center for Medicare/Medicaid Innovation, responsible for
key elements of the health reform law. The appointment was applauded by key
stakeholders, who pointed to him as a leader in delivery system innovations.
CMS on Monday unveiled a proposed rule implementing parts of
the health reform law that strengthens the agency's enforcement abilities and
expands its authority to prevent fraud and waste in Medicare, Medicaid and
CHIP. The new rule is focused on moving the agency away from reacting to fraud and
waste to working with the Office of the Inspector General to use screening and
enrollment moratoria to prevent fraud and waste.
A proposed rule aimed at creating a more open process for
determining whether states may conduct demonstration programs envisioned in the
health care overhaul law was unveiled Thursday (Sept. 16) by CMS. The agency in
the past has been secretive about denials of 1115 waiver programs, and the new
proposed regulation is designed to align incentives in the Medicare and
Medicaid programs, according to a CMS official.
Large bipartisan groups of lawmakers in the Senate and the
House are urging CMS to increase Medicare payments for anesthesia services, but
so far the agency appears to be resisting the pressure, according to
stakeholders. Medicare payment for anesthesia services represents 33 percent of
commercial insurance payment rates, the lawmakers said, compared with about 80
percent for other physician services, and anesthesiologists say changes that
CMS is proposing to the Physician Fee Schedule will reduce payments even
further.
Home health providers are urging CMS to delay implementing
the new health care law's requirement that physicians see patients in-person before
certifying the need for home health, an industry source says. Industry wants
more time to work out a more lenient approach, but the Medicare Payment
Advisory Commission believes the CMS proposed rule to implement the law is
already too lenient.
Patient advocates worry that HHS' decision not to
specifically define "essential health benefits" in its interim final rule on
the so-called Patients Bill of Rights could leave patients vulnerable to insurance
limits on critical care and are urging the agency to take steps to ensure a
broad set of benefits is covered.
OIG Threatens Fines For Late Drug Pricing Data
CMS informed state officials Tuesday that it no longer plans
to "recapture" the revenue states collect from certain Medicaid rebates, bowing
to state Medicaid directors who said the agency's plans would have violated
"both the letter and the apparent intent" of the health reform law. The federal
government will not claim rebates that exceed the new federal minimum, CMS said
in a memo to state Medicaid directors.
Democrats easily blocked
a GOP attempt to use the Congressional Review Act to repeal the HHS' regulation
defining a "grandfathered" commercial health plan under the health reform law.
GOP lawmakers, including Sen. Mike Enzi (R-WY) who authored the resolution of
disapproval, argued that the regulation was overly burdensome and violated
President Barack Obama's oft-repeated mantra that families may keep their
coverage if they like it. Democrats and the administration countered that
dismantling the rule would create "confusion and uncertainty" for employers,
workers and families.
The House on Sept. 22 approved bipartisan legislation
expanding the HHS Office of Inspector General's ability to ban corporate
executives from the Medicare program if their companies have been convicted of
fraud, authority the OIG recently requested from Capitol Hill. The move came as
the House Energy and Commerce Committee held a hearing on additional proposals
to give HHS fraud-fighting tools beyond those in health reform, including
allowing CMS to use private insurance data mining techniques that identify
potential scams before payment is made.
Cost
profiles of Medicare physicians are "substantially" more reliable than profiles
of commercial physicians, according to a report commissioned by the Medicare
Payment Advisory Commission. A RAND researcher who worked on the study that the
MedPAC report was modeled after said, however, that resource use profiling of
physicians in the Medicare program is only slightly better than in the private
sector.
|
|
