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Archive for December, 2015

DMEPOS Prior Authorization Rule Finalized

Wednesday, December 30th, 2015

On December 30, the Centers for Medicare & Medicaid Services (CMS) has issued a final rule establishing a prior authorization process for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) that are frequently subject to unnecessary utilization. The process will not create new clinical documentation requirements, but will try to ensure that existing documentation, coverage and coding requirements are met before items are furnished to beneficiaries and claims submitted for payment. The final rule has created a Master List of 135 DMEPOS items that are potentially subject to prior authorization because they have an average purchase fee of at least $1,000; or an average rental fee of at least $100. These items have also been the subject of certain reports by the Department of Health and Human Services Office of the Inspector General, Government Accountability Office, or Comprehensive Error Rate Testing Program

The final rule can be found at https://www.gpo.gov/fdsys/pkg/FR-2015-12-30/pdf/2015-32506.pdf

Medical Device Tax Suspended for Two Years

Friday, December 18th, 2015

On December 18, President Obama signed into law the $1.8 trillion Consolidated Appropriations Act of 2016, which included a two year suspension of the medical device excise tax. Originally passed as part of the funding for the Affordable Care Act, the medical device excise tax was set at 2.3% of the sales price of taxable medical devices and assessed on sales beginning in January of 2013.  The Congressional Budget Office estimated that the tax would raise up to $29.1 billion over the course of a decade.

The Consolidated Appropriations Act of 2016 can found at https://www.congress.gov/bill/114th-congress/house-bill/2029/text

New MACPAC Members Named

Tuesday, December 15th, 2015

The Government Accountability Office has named seven new members to the Medicaid and CHIP Payment and Access Commission (MACPAC). They are Brian Burwell, vice president of community living systems for Truven Health Analytics; Toby Douglas, a senior advisor for consulting firm Sellers Dorsey; Leanna George, the parent of a Medicaid/CHIP enrollee; Kit Gorton, M.D., president of public plans at Tufts Health Plan; Stacey Lampkin, a principal with Mercer Government Human Services Consulting; Penny Thompson, a consultant; and Alan Weil, editor-in-chief of Health Affairs. Commissioner Sara Rosenbaum, chair of the health policy department at George Washington University School of Public Health, will serve as MACPAC chair.

The press release can be found by visiting http://www.gao.gov/press/macpac_appointments_2016.html

CDC Reports States that Adult Cholesterol Levels Improving

Friday, December 4th, 2015

According to a new report by the Centers for Disease Control and Prevention (CDC), the share of U.S. adults with high cholesterol has declined 3.3 percentage points between 2007 and 2014 to 11%. However, the agency estimates that about half of adults who should take cholesterol-lowering medications or make diet and exercise changes to lower their cholesterol do not. Carla Mercado, a scientist in the CDC’s Division for Heart Disease and Stroke Prevention stated that nearly 800,000 people die in the U.S. each year from cardiovascular diseases – that’s one in every three deaths – and high cholesterol continues to be a major risk factor.

For further details, go to http://www.cdc.gov/nchs/data/databriefs/db226.htm