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Archive for September, 2013

Champions for Coverage Recognized by HHS Secretary

Monday, September 30th, 2013

On September 30, Health and Human Services (HHS) Secretary Kathleen Sebelius recognized more than 900 Champions for Coverage nationwide. These organizations and businesses have volunteered to help Americans without affordable insurance learn more about and get coverage through the Health Insurance Marketplace. The Champions for Coverage include national and local businesses and organizations that use publicly available materials from the Centers for Medicare & Medicaid Services (CMS) to help members of their communities understand their new options through the Marketplace.

For more information and a list of the Champions for Coverage, visit http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-09-30.html

Proposed Rule for Basic Health Program Published

Wednesday, September 25th, 2013

The Centers for Medicare & Medicaid Services (CMS) has published a proposed rule establishing standards for the Basic Health Program as part of the Affordable Care Act (ACA). States may choose to offer the program to low-income citizens and lawfully present non-citizens who do not qualify for Medicaid, the Children’s Health Insurance Program (CHIP) or other minimum essential coverage offered through a health insurance exchange. According to CMS, the rule proposes a framework for program eligibility and enrollment, benefits, delivery of health care services, transfer of funds to participating states, and state administration and federal oversight. Benefits must include at least the 10 essential health benefits specified in the ACA, and monthly premium and cost sharing for eligible individuals may not exceed what they would pay if eligible to enroll in the exchange’s silver plan. States operating a Basic Health Program will receive federal funding equal to 95% of the premium tax credits and cost sharing reductions that these individuals would receive if they were eligible to enroll in the Marketplace.

The proposed rule can be accessed in the Federal Register at https://www.federalregister.gov/articles/2013/09/25/2013-23292/basic-health-program-state-administration-of-basic-health-programs-eligibility-and-enrollment-in

FDA Issues Final Guidance on Oversight of Mobile Medical Apps

Monday, September 23rd, 2013

The Food and Drug Administration (FDA) has issued final guidance on the regulatory oversight of mobile medical applications. The final guidance focuses FDA oversight on software applications that are used as an accessory to a regulated medical device or which transform a mobile platform into a regulated medical device. According to the FDA, mobile medical apps that undergo review will be assessed using the same regulatory standards and risk-based approach that the agency applies to other medical devices.

The guidance can be viewed at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm369431.htm.

Census Bureau Reveals 15.4% of U.S. Residents Uninsured

Tuesday, September 17th, 2013

The U.S. Census Bureau announced that in 2012, the percentage of U.S. residents without health insurance coverage declined to 15.4% from 15.7% in 2011. The Bureau also reported that the proportion of people covered by Medicare rose from 15.2 % in 2011 to 15.7% in 2012. Currently, there are 48.9 million Medicare beneficiaries.

The press release can be found by going to http://www.census.gov/newsroom/releases/archives/income_wealth/cb13-165.html

Data Services Hub Now Available

Tuesday, September 10th, 2013

The Centers for Medicare & Medicaid Services (CMS) has built a tool called the Data Services Hub (The Hub) that will help verify information used to determine eligibility for enrollment in qualified health plans and insurance affordability programs beginning October 1. The Hub will provide one connection to the common federal data sources needed to verify consumer application information for income, citizenship, immigration status, and access to minimum essential coverage through health insurance marketplaces, or exchanges. The Hub was specifically designed to minimize security risk by developing a system that does not retain or store personally identifiable information.

A fact sheet can be viewed at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-09-11.html?DLPage=1&DLSort=0&DLSortDir=descending

IRS Issues Proposed Rules on Coverage Reporting Requirements

Friday, September 6th, 2013

The Internal Revenue Service (IRS) has issued proposed rules implementing the Affordable Care Act’s (ACA) information reporting requirements for minimum essential coverage and for large employers subject to the law’s shared responsibility provisions. The ACA requires insurers, self-insuring employers and others that provide health coverage to provide a list of covered individuals and the months they were covered. It also requires employers that have more than 50 full-time workers to provide information about the coverage offered to each, by month, including the cost of self-only coverage.

The proposed rule can be accessed at http://www.gpo.gov/fdsys/pkg/FR-2013-09-09/pdf/2013-21783.pdf.

New Guidance on Physician Orders and Certification Issued

Friday, September 6th, 2013

The Centers for Medicare & Medicaid Services (CMS) has issued guidance that interprets its new requirements for admission and medical review criteria for hospital inpatient services. The guidance clarifies the types of practitioners who may furnish orders for inpatient services and the types of information that must be included in those orders. In addition, the physician certification, which includes the practitioner order, is considered along with other documentation in the medical record as evidence that hospital inpatient services were reasonable and necessary. The following guidance applies to all inpatient hospital and critical access hospital (CAH) services unless otherwise specified.

More information can be viewed at http://www.cms.gov/Center/Provider-Type/Hospital-Center.html?redirect=/center/hospital.asp.

Cardiac Treatment Times Reduced

Wednesday, September 4th, 2013

According to a study published in the September 5th New England Journal of Medicine, hospital “door-to-balloon” times for heart attack patients undergoing primary percutaneous coronary intervention declined to an average of 67 minutes from 83 minutes between 2005 and 2009. However, in-hospital and 30-day mortality for these patients remained virtually unchanged.  Study data suggests that further efforts to reduce door-to-balloon time may not reduce mortality. Clinical guidelines recommend a door-to-balloon time of 90 minutes or less.

The study can be viewed at http://www.nejm.org/doi/full/10.1056/NEJMoa1208200?query=featured_home.

New Marketplace Documents Available

Tuesday, September 3rd, 2013

The Centers for Medicare & Medicaid Services (CMS) has made available two new documents that will answer questions health care providers and patients may have about the Health Insurance Marketplace where individuals and small businesses may purchase health coverage beginning October 1.

The new documents, entitled “10 Things Providers Need to Know” and “10 Things to Tell Your Patients” about the Health Insurance Marketplace, are available at http://marketplace.cms.gov/.