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Medical Industry Reimbursement News

New Medicare ACO Model Announced

October 15th, 2014

The Centers for Medicare & Medicaid Services (CMS) has announced the availability of a new model for Accountable Care Organizations (ACO) participating in the Medicare Shared Savings Program (MSSP). The new ACO Investment Model is a pre-paid shared savings model that encourages new ACOs to form in rural and underserved areas and current MSSP ACOs to transition to arrangements with greater financial risk. To participate, existing ACOs can only include a hospital if the hospital has 100 or fewer beds or is a critical access hospital. Eligibility is targeted to ACOs that joined the MSSP in 2012, 2013 and 2014, and to new ACOs joining the Shared Savings Program in 2016. The application deadline for organizations that started the program in 2012 or 2013 will be December 1, 2014. CMS expects applications to be available in summer 2015 for ACOs that started in the program in 2014 or will start in 2016.

For more on the new model, go to http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-10-15.html

2015 Medicare Premiums and Deductibles Announced

October 10th, 2014

The Centers for Medicare & Medicaid Services (CMS) has announced the premiums and deductible for calendar year (CY) 2015. The Medicare Part A deductible for inpatient hospital, skilled nursing facility and home health services will increase by $44 to $1,260.The daily coinsurance amounts will be $315 for days 61-90 of hospitalization in a benefit period; $630 for lifetime reserve days; and $157.50 for days 21-100 of extended care services in a skilled nursing facility in a benefit period. The monthly Part A premium, paid by just 1% of beneficiaries who have fewer than 40 quarters of Medicare-covered employment, will decline by $19 to $407. The base Part B monthly premium and annual deductible for physician and hospital outpatient services, certain home health services, durable medical equipment and other items will be unchanged at $104.90 and $147, respectively.

More information is available at http://www.ofr.gov/OFRUpload/OFRData/2014-24257_PI.pdf

Changes to CoPs for HHA Proposed

October 7th, 2014

The Centers for Medicare & Medicaid Services (CMS) has proposed the first update to the Medicare and Medicaid Conditions of Participation (CoPs) for home health agencies (HHAs) since 1989. The proposed rule would update data transmission requirements for the Outcomes and Assessment Information Set (OASIS) to meet current federal standards; focus the patient assessment requirement on each patient’s physical, mental, emotional and psychosocial condition; expand patient rights requirements; and formalize communication and care coordination structures. In addition, the rule would require each HHA to maintain a quality assessment and performance improvement program based on OASIS and other data, and a program to prevent and control infections and communicable diseases; and require additional supervision and training when an agency suspects that home health aide skills are insufficient.

The proposed rule is available at https://www.federalregister.gov/articles/2014/10/09.

OIG Proposes Revisions to Safe Harbors

October 2nd, 2014

On October 2, 2014, the Department of Health and Human Services Office of Inspector General (OIG) published proposed rules to add new safe harbors to the federal Anti-Kickback Statute (AKS). The OIG’s proposed rules would also codify certain revisions made to the federal Civil Monetary Penalty Law (CMP Law) by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the Patient Protection and Affordable Care Act (ACA), as amended by the Health Care and Education Reconciliation Act of 2010.The proposed rule makes a technical correction to the AKS’s referral services safe harbor and also proposes new AKS safe harbors that would protect- pharmacy cost-sharing waivers for financially needy Medicare Part D participants; emergency ambulance service cost-sharing waivers when the services are furnished by state- or municipality- owned providers; certain remuneration between federally qualified health centers and Medicare Advantage organizations; discounts by manufacturers on drugs provided under the Medicare Covered Gap Discount Program; and certain free or discounted local transportation. In addition, the OIG would change regulatory definitions as they apply to gainsharing arrangements under the CMP Law to narrow the statute’s application.

The proposed rule is available at https://www.federalregister.gov/articles/2014/10/03/2014-23182/medicare-and-state-health-care-programs-fraud-and-abuse-revisions-to-safe-harbors-under-the

IPPS Payment Rule Correction Notice Published

October 1st, 2014

The Centers for Medicare & Medicaid Services (CMS) has published a correction notice to the fiscal year (FY) 2015 inpatient and long-term care hospital prospective payment system final rule. The notice includes a number of technical corrections to the calculation of hospital operating and capital rates, as well as estimated financial impacts. The notice also includes a table of the final FY 2015 readmission payment adjustment factors for hospitals under the Hospital Readmissions Reduction Program (HRRP). These payment adjustment factors will be applied to hospital discharges on or after October 1, and reflect hospital performance on the program. CMS indicates the technical corrections to payments raised estimated FY 2015 readmissions penalties by $4 million, to $428 million. CMS also states that there was a technical error in estimating Hospital-Acquired Condition Reduction Program penalties in the FY 2015 inpatient PPS final rule. In the correction notice, CMS raises its estimate of FY 2015 HAC penalties from $369 million to $373 million. However, the correction notice does not include the final list of hospitals that will receive FY 2015 HAC penalties.

More information is available at http://www.ofr.gov/OFRUpload/OFRData/2014-23630_PI.pdf.

PCORI to Fund New Research Projects

September 30th, 2014

On September 30, the Patient-Centered Outcomes Research Institute (PCORI) announced it is providing $102 million to fund 46 new research projects, including $20 million to compare the effectiveness of obesity treatment options for underserved adults in primary care settings, and $15 million for a comprehensive study of transitional care services to prevent hospital readmissions and improve outcomes for at-risk patients.

For more on the funding announcement, visit www.pcori.org.

HHS Announces Grants to Prevent Chronic Diseases

September 25th, 2014

Health and Human Services (HHS) Secretary Sylvia M. Burwell announced nearly $212 million in grant awards to support programs aimed at preventing chronic diseases such as heart disease, stroke and diabetes.  A total of 193 awards are being made to states, large and small cities, and counties, tribes and tribal organizations, and national and community organizations, with a special focus on populations hardest hit by chronic diseases. The goals of the grant funding are to reduce rates of death and disability due to tobacco use, reduce obesity prevalence, and reduce rates of death and disability due to diabetes, heart disease, and stroke.

For state-by-state lists of funding awards, visit http://www.cdc.gov/chronicdisease/about/2014-foa-awards.htm.

CMS Announces Medicare Advantage Premiums

September 18th, 2014

On September 18, the Centers for Medicare & Medicaid Services (CMS) announced that the average Medicare Advantage (MA) premium submitted by health plans for 2015 would increase by $2.94, to $33.90 per month. However, CMS estimates the actual 2015 MA average premium may increase by only $1.30, as more beneficiaries elect to enroll in lower cost plans. The vast majority of MA enrollees will experience little or no premium increase for next year, with 61% of beneficiaries not experiencing any increase. According to CMS, enrollment is projected to increase to a new all-time high.

The press release can be found at http://cms.hhs.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-09-18.html

Preview of Quality Data and HCAHPS Star Rating Available

September 15th, 2014

Hospitals can preview and validate their quality data through October 14th. The data are scheduled to be added to the Hospital Compare website in December.  Hospitals can also preview how their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data would appear in an HCAHPS star rating system which will be added to Hospital Compare in April 2015. In addition, they can provide feedback to the Centers for Medicare & Medicaid Services (CMS) on how to improve the star rating system. Hospitals may access their preview reports at the QualityNet portal.

For more information, go to http://www.hcahpsonline.org/home.aspx, and for assistance accessing reports, contact HospitalCompare@hsag.com

CDC Issues Enterovirus D68 Guidance

September 15th, 2014

The Centers for Disease Control and Prevention (CDC) has issued recommendations for clinical care, laboratory testing, infection control, and reporting for enterovirus D68. Hospitals in Missouri and Illinois have seen more children than usual with severe respiratory illness caused by the virus, which was first isolated in California in 1962 but has been rarely reported in the U.S. It primarily causes respiratory illness, although the full spectrum of disease remains unclear. There are no vaccines or specific treatments for the virus, and clinical care is supportive. Prevention tips include washing hands often with soap and water.

For more on the recommendations, visit http://emergency.cdc.gov/HAN/han00369.asp