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Archive for May, 2012

Nursing Home Dementia Care Initiative Announced

Wednesday, May 30th, 2012

The Centers for Medicare & Medicaid Services (CMS) has announced the Partnership to Improve Dementia Care, an initiative to prevent inappropriate use of antipsychotic medications for nursing home patients with dementia. The initiative partners include federal and state agencies, nursing homes and other health care providers, advocacy groups and caregivers. Among other actions, the agency plans to offer training for nursing homes and state and federal surveyors; begin posting facility-specific data on antipsychotic drug use to Nursing Home Compare in July; and emphasize non-pharmacological alternatives such as consistent staff assignments and increased exercise or other activities.

The press release can be accessed at http://www.cms.gov/apps/media/press_releases.asp.

New Guidance on Documentation Requirements for PCIP Issued

Friday, May 25th, 2012

The Centers for Medicare & Medicaid Services (CMS) has issues a new guidance for the federally-administered Pre-existing Condition Insurance Plan (PCIP). According to CMS, the Plan will no longer accept documentation from a health care provider as proof of a pre-existing condition for new applications submitted on or after May 1. CMS said it also has ended a broker referral program that helped people with pre-existing conditions connect to PCIP coverage. The Affordable Care Act (ACA) established the PCIP program to provide affordable health insurance coverage to uninsured people with pre-existing conditions until health insurance exchanges become available in 2014.

More information is available at http://cciio.cms.gov/resources/files/pcip-pl-05-25-12.pdf.

FAQ on Insurance Exchange Approval Process Posted

Friday, May 25th, 2012

The Centers for Medicare & Medicaid Services (CMS) has posted Frequently Asked Questions (FAQ) regarding the approval process for health insurance exchanges, which was established on May 16 in its draft blueprint for approval of state-based and partnership exchanges. According to the FAQ, states seeking to operate a state-based exchange or electing to participate in a partnership exchange for plan year 2014 must submit a complete “exchange blueprint” by November 16, 2012, which includes an “exchange model declaration letter” from the governor and an application describing readiness to perform exchange activities and functions. States pursuing a federally facilitated exchange need not submit a blueprint application, but CMS recommends that they submit a model declaration letter to help ensure alignment with the federally facilitated exchange.

The FAQ can be viewed at http://cciio.cms.gov/resources/factsheets/hie-draft-blueprint-states.html

Regulations Reduction Final Rules Issued

Friday, May 18th, 2012

On May 9, Health and Human Services (HHS) Secretary Kathleen Sebelius announced significant steps to reduce unnecessary, obsolete or burdensome regulations on hospitals and health care providers. The first rule revises the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). The second, the Medicare Regulatory Reform rule, will produce savings of $200 million in the first year by promoting efficiency. This rule eliminates duplicative, overlapping and outdated regulatory requirements for health care providers.

Among other changes, the final rules will:

  • Increase flexibility for hospitals by allowing one governing body to oversee multiple hospitals in a single health system;
  • Let CAHs partner with other providers so they can be more efficient and ensure the safe and timely delivery of care to their patients;
  • Require that all eligible candidates, including advanced practice registered nurses and physician assistants, be reviewed by medical staff for potential appointment to the hospital medical staff and then be granted all of the privileges, rights, and responsibilities accorded to appointed medical staff members; and
  • Eliminate obsolete regulations, including outmoded infection control instructions for ambulatory surgical centers; outdated Medicaid qualification standards for physical and occupational therapists; and duplicative requirements for governing bodies of organ procurement organizations.

View the Medicare CoPs final rule at http://www.gpo.gov/fdsys/pkg/FR-2012-05-16/pdf/2012-11548.pdf  and the Medicare Regulatory Reform final rule at http://www.gpo.gov/fdsys/pkg/FR-2012-05-16/pdf/2012-11543.pdf For additional information on the Hospital and other CoPs, visit the Conditions for Coverage & Conditions of Participation at http://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/index.html?redirect=/CFCsAndCoPs/01_Overview.aspwebsite.

CMS to Cover TAVR Procedure

Tuesday, May 1st, 2012

On May 1, the Centers for Medicare & Medicaid Services (CMS) issued a national coverage decision for transcatheter aortic valve replacement (TAVR) under coverage with evidence development (CED) for Medicare patients under certain conditions. This new procedure allows doctors to replace a patient’s aortic valve through a small opening in the leg. This is a less invasive procedure that gives patients who cannot undergo open heart surgery a new way to have their damaged heart valve repaired.

The decision can be found at this link.