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Archive for January, 2013

Round 2 of DME Competitive Bidding Announced

Thursday, January 31st, 2013

The Centers for Medicare & Medicaid Services (CMS) have announced the expansion of the Medicare competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). Medicare beneficiaries in 91 major metropolitan areas will save an average of 45% for certain DMEPOS items scheduled to begin on July 1, 2013. These products will include oxygen equipment; wheelchairs and scooters; enteral nutrients; continuous positive airway pressure devices and respiratory assist devices; hospital beds; walkers; negative pressure wound therapy pumps; and support surfaces such as mattresses

The press release can be found at this link.

Bundled Payment Initiative Announced

Thursday, January 31st, 2013

On January 31, the Centers for Medicare & Medicaid Services (CMS) announced that over 500 organizations will begin participating in the Bundled Payments for Care Improvement initiative. The initiative will test how bundling payments for episodes of care can result in more coordinated care for beneficiaries and lower costs for Medicare.

The Bundled Payments for Care Improvement initiative includes four models of bundling payments, varying by the types of health care providers involved and the services included in the bundle.  Depending on the model type, CMS will bundle payments for services beneficiaries receive during an episode of care, encouraging hospitals, physicians, post-acute facilities, and other providers as applicable to work together to improve health outcomes and lower costs. Organizations of providers participating in the initiative will agree to provide CMS a discount from expected payments for the episode of care. The provider partners will also work together to reduce readmissions, duplicative care, and complications to lower costs through improvement.

For further information, go to: http://innovation.cms.gov/initiatives/bundled-payments

Proposed Rules Issued by CMS and IRS Regarding ACA Exemptions

Wednesday, January 30th, 2013

The Treasury Department and Internal Revenue Service (IRS), as well as the Centers for Medicare & Medicaid Services (CMS), have issued two sets of proposed regulations. The regulations explain the shared responsibility provision and lay out the eligibility rules for receiving an exemption, and the process by which individuals can receive certificates of exemption for not maintaining minimum essential coverage under the Affordable Care Act (ACA). Both agencies’ proposed regulations include rules that will ease implementation and help to ensure that the payment applies only to the limited group of taxpayers who choose to spend a substantial period of time without coverage despite having ready access to affordable coverage. CMS will accept comments until March 18. Comments on the IRS rule are due by May 2.

The CMS proposed rule can be viewed at http://ofr.gov/OFRUpload/OFRData/2013-02139_PI.pdf.

The IRS rule is available at http://ofr.gov/OFRUpload/OFRData/2013-02141_PI.pdf.

States Receive Grants to Support Health Insurance Marketplaces

Thursday, January 17th, 2013

Health and Human Services (HHS) Secretary Kathleen Sebelius has announced $1.5 billion in new Exchange Establishment Grants to California, Delaware, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, and Vermont to ensure these states have the resources necessary to build a health insurance marketplace that meets the needs of their residents.

Because of the Affordable Care Act (ACA), consumers and small businesses will have access to marketplaces starting in 2014. The marketplaces are one-stop shops that will provide access to quality, affordable private health insurance choices similar to those offered to members of Congress. Consumers in every state will be able to buy insurance from qualified health plans directly through these marketplaces and may be eligible for tax credits to help pay for their health insurance. These marketplaces promote competition among insurance providers and offer consumers more choices.

Delaware, Iowa, Michigan, Minnesota, North Carolina, and Vermont received awards for Level One Exchange Establishment Grants, which are one-year grants that states will use to build marketplaces. California, Kentucky, Massachusetts, New York, and Oregon received Level Two Exchange Establishment Grants. Level Two grants are multi-year awards to states to further develop their marketplaces.

A total of 49 states, the District of Columbia, and four territories have received grants to plan their marketplaces, and 34 states and the District of Columbia have received grants to build their marketplaces.

For a detailed breakdown of marketplace grant awards made to states, including summaries of how states plan on using the awards announced today, visit: http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html

MedPAC Makes Recommendations

Sunday, January 13th, 2013

The Medicare Payment Advisory Commission (MedPAC) unanimously approved a final recommendation to increase inpatient and outpatient hospital payments by 1% in 2014. MedPAC Chair Glenn Hackbarth clarified that the 1% update should occur despite recent provisions in the American Taxpayer Relief Act that result in a negative update.  MedPAC also voted to eliminate the update for ambulatory surgical centers and require them to submit cost data, and voted not to increase the outpatient dialysis bundled payment rate in 2014.

MedPAC also recommended no marketbasket update for inpatient rehabilitation facilities, long-term care hospitals and home health providers in 2014. The commission also restated its prior recommendation for a two-year rebasing of the home health (HH) payment system starting in 2013, rather than the four-year rebasing starting in 2014 mandated by the Affordable Care Act (ACA). In addition, the Commission approved 2014 recommendations for skilled nursing facilities last month, which call for no marketbasket update and rebasing the SNF prospective payment system to better align payments with costs, which would result in an estimated 4% payment reduction in the first year. The commission projects 2013 Medicare margins of 11.8% for HH, 11%-14% for SNFs, 8.5% for IRFs and 5.9% for LTCHs.

For more details, visit http://www.medpac.gov

CMS Names 106 New Medicare ACOs

Thursday, January 10th, 2013

The Centers for Medicare & Medicaid Services (CMS) has announced the formation of 106 new accountable care organizations (ACOs) which will participate in the Affordable Care Act’s (ACAs) Medicare Shared Savings Program (MSSP). Fifteen of the groups will participate in the program’s Advance Payment Model, which provides advance payment of expected shared savings to rural and physician-based ACOs that would benefit from additional start-up resources. MSSP participants agree to be held accountable for improving the health and experience of care for Medicare fee-for-service beneficiaries while reducing the rate of growth in health care spending. To date, more than 250 organizations have formed Medicare ACOs, which are expected to serve more than 4 million beneficiaries. According to CMS, about half of the ACOs are physician-led organizations serving fewer than 10,000 beneficiaries, and about 20% include community health centers, rural health centers and critical access hospitals that serve low-income and rural communities.

For further details, visit this link.

Fiscal Cliff Legislation Passed by Congress

Wednesday, January 2nd, 2013

On January 1, Congress passed legislation to avert parts of the “fiscal cliff”. The bill includes a 12-month Medicare physician payment fix, which will be paid for in part by implementing a documentation and coding offset and extending current Medicaid disproportionate share hospital (DSH) reductions for an additional year. Physicians’ Medicare payments were scheduled to decrease by nearly 27% on January 1st. In addition, the bill extends a number of health care provisions, including ambulance add-on payments; the low-volume adjustment add-on; and the Medicare-dependent hospital program. The bill also delays by two months the sequester contained in the Budget Control Act of 2011, including the 2% Medicare sequester.

The legislation can be found by going to http://www.gpo.gov/fdsys/pkg/BILLS-112hr8eas/pdf/BILLS-112hr8eas.pdf