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Archive for May, 2013

Estimates of Insurance Marketplace Options Issued by White House

Friday, May 31st, 2013

The White House has issued early estimates of the number of health plans which will be available in Health Insurance Marketplaces when enrollment begins in October. According to the memorandum published by the White House, more than 120 insurers have applied to offer qualified health plans in the Marketplaces, which will be run by the Department of Health and Human Services (HHS).

The memorandum can be viewed at http://www.whitehouse.gov/sites/default/files/docs/competition_memo_5-30-13.pdf.

New MedPAC Member Named

Friday, May 31st, 2013

The Government Accountability Office (GAO) has announced the appointment of one new member and the reappointment of five existing members to the Medicare Payment Advisory Commission (MedPAC).

The newly appointed member is Jon B. Christianson, PhD, Professor in the Division of Health Policy and Management of the School of Public Health at the University of Minnesota in Minneapolis. His term will expire in April, 2016.

The reappointed members, whose terms will also expire in April, 2016, are Scott Armstrong, President and Chief Executive Officer of Group Health Cooperative; Katherine Baicker, PhD, Professor of Health Economics in the Department of Health Policy and Management at the Harvard School of Public Health; Herb B. Kuhn, President and CEO, Missouri Hospital Association; Mary Naylor, PhD, RN, Marian S. Ware Professor in Gerontology and Director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing; and Cori Uccello, FSA, Senior Health Fellow of the American Academy of Actuaries.

For more information, go to http://www.gao.gov/press/medpac_appointments30may2013.html

Final Rule for SHOP Released

Friday, May 31st, 2013

The Centers for Medicare & Medicaid Services (CMS) has released a rule finalizing requirements for the Small Business Health Option Program (SHOP) which means that eligible small employers will be able to evaluate participating health plans and determine if they qualify for a tax credit to help fund the coverage. Beginning October 1, small employers will be able to choose from a range of SHOP coverage options for their employees beginning in January 2014. The rule takes effect July 1.

The rule is available in the Federal Register at https://www.federalregister.gov/articles/2013/06/04/2013-13149/patient-protection-and-affordable-care-act-establishment-of-exchanges-and-qualified-health-plans

Medicare Trustees Annual Report Released

Friday, May 31st, 2013

The Medicare Trustees have projected that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2026, two years beyond what was projected in last year’s report.

A number of factors have contributed to the improved outlook, including lower-than-expected Part A spending in 2012, and lower projected Medicare Advantage program costs. Recent data from the Medicare Advantage program indicate that certain provisions of the Affordable Care Act (ACA) will help reduce the growth of spending in this program by more than was previously projected. Partially offsetting these lower spending projections are somewhat lower projected levels of tax revenue.

Medicare spending per beneficiary has grown quite slowly over the past few years and is projected to continue growing slowly over the next several years.  From 2010 to 2012, Medicare spending per beneficiary grew at 1.7 percent annually, more slowly than the average rate of growth in the Consumer Price Index, and substantially more slowly than the per capita rate of growth in the economy.

The report is available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2013.pdf.

Round Two of Health Care Innovation Grants Announced

Friday, May 17th, 2013

The Centers for Medicare & Medicaid Services (CMS) has announced that it will award up to $1 billion in funding in round two of the Health Care Innovation Awards which is an Affordable Care Act (ACA) initiative to test new payment and service delivery models. The second round of awards will focus on models to rapidly reduce Medicare, Medicaid and Children’s Health Insurance Program (CHIP) costs in the outpatient and post-acute settings; improve care for populations with specialized needs; test approaches for specific types of providers to transform financial and clinical models; and improve the health of populations.

For more information, go to this link.


CMS Releases Hospital Charge Data

Wednesday, May 8th, 2013

On May 8, Health and Human Services (HHS) Secretary Kathleen Sebelius announced a three-part initiative that gives consumers information on what hospitals charge. The newly released data shows significant variation across the country and within communities in what hospitals charge for common inpatient services.  In addition, HHS made approximately $87 million available to states to enhance their rate review programs and further health care pricing transparency.

The data posted on CMS’s website include information comparing the charges for services that may be provided during the 100 most common Medicare inpatient stays.  Hospitals determine what they will charge for items and services provided to patients and these charges are the amount the hospital generally bills for an item or service.

To make these data useful to consumers, HHS is also providing funding to data centers to collect, analyze, and publish health pricing and medical claims reimbursement data.  The data centers’ work helps consumers better understand the comparative price of procedures in a given region or for a specific health insurer or service setting. Businesses and consumers alike can use these data to drive decision-making and reward cost-effective provision of care.

The data can be viewed at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html.

Proposed FY 2014 SNF Rule Released

Friday, May 3rd, 2013

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule increasing Medicare fiscal year (FY) 2014 payment rates for skilled nursing facilities (SNF) by 1.4%. The proposed increase is based on a 2.3% market basket increase, minus a 0.4 percentage point productivity adjustment required by law and a 0.5 percentage point adjustment to account for the difference between the actual and projected market basket for FY 2012. The rule also would revise and rebase the market basket beginning in FY 2014 to reflect FY 2010 cost data, add five cost categories and revise several price proxies. CMS also proposes a more specific Minimum Data Set (MDS) reporting process to capture distinct calendar days of therapy.

The proposed rule is available at https://www.federalregister.gov/articles/2013/05/06/2013-10558/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities

Proposed FY 2014 IRF Rule Issued

Friday, May 3rd, 2013

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule increasing fiscal year 2014 Medicare payments for inpatient rehabilitation facilities (IRF) by 2%. The net increase includes a market basket update of 2.5%, minus a 0.4% productivity adjustment and 0.3 percentage point reduction mandated by the Affordable Care Act (ACA), plus a 0.2% increase due to proposed outlier payment changes.  The rule would also modify the process used to assess IRF compliance with the 60% Rule which requires 60% of an IRF’s cases for the prior 12-month compliance period to fall within 13 qualifying conditions. The proposed rule would require new, more specific codes for the patient’s condition, severity of illness, and anatomical location of illness.

The rule will can be accessed at https://www.federalregister.gov/articles/2013/05/08 with comments accepted through July 1.

PCORI Approves New Awards for CER Projects

Wednesday, May 1st, 2013

The Patient-Centered Outcomes Research Institute (PCORI) has approved 51 new awards, totaling $88.6 million over three years, to fund patient-centered comparative clinical effectiveness research (CER) projects under the first four areas of its National Priorities for Research and Research Agenda. This brings the total that PCORI has awarded for projects addressing these priorities to $129.3 million. PCORI also has committed another $30 million in funding for a series of pilot projects.

The projects include studies of how to best care for people with kidney disease, certain cancers, obesity, asthma, diabetes, and various mental health conditions. Other projects will explore ways to support patient decision-making, reduce specific health disparities, and improve health care delivery systems. The awards are part of PCORI’s second cycle of primary research funding, and were selected from among more than 400 completed applications.

Details on the approved awards, including the project name, primary investigator, research institution, and associated PCORI priority area, are provided on the PCORI website, www.pcori.org.