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Archive for June, 2016

HHS Releases Proposed Rule on Medicare Appeals Process

Thursday, June 23rd, 2016

The Department of Health & Human Services (HHS) has released a proposed rule that would make changes to the procedures for Administrative Law Judge (ALJ) appeals of payment and coverage determinations for items and services provided to Medicare beneficiaries, in addition to other Medicare appeals. Specifically, the proposed rule would allow attorney adjudicators to hear appeals in lieu of ALJs in some cases, and allow the HHS Departmental Appeals Board to designate certain decisions as precedential.

The proposed rule can be found at https://federalregister.gov/a/2016-15192

Nine New Members Named to Health IT Advisory Committees

Thursday, June 23rd, 2016

Health and Human Services Secretary (HHS) Sylvia Burwell has named nine new members to the committees that advise her on health information technology standards and policy. Appointed to the HIT Standards Committee were: Terrence O’Malley, M.D., geriatrician at Massachusetts General Hospital – technical expertise/long-term care representative; Rajesh Dash, M.D., professor of pathology at Duke University School of Medicine – ancillary health care worker representative; Kay Eron, general manager for heath IT and medical devices at Intel – purchaser/employer representative; Peter Johnson, retired chief information officer – technical expertise representative; Kyle Meadors, president of Drummond Group – technical expertise/HIT representative; Andrey Ostrovsky, M.D., CEO of Care at Hand – technical expertise/small innovative provider representative; Wanmei Ou, director of precision medicine product strategy at Oracle – technical expertise/HIT representative; and Larry Wolf, principal at Strategic Health Network – technical expertise representative. Named to the HIT Policy Committee was: Aaron Miri, chief information officer and vice president of government relations at Imprivata – privacy and security representative.

The press release can be found at http://www.hhs.gov/about/news/2016/06/23/new-members-named-to-serve-on-federal-health-information-technology-policy-and-standards-committees.html

Final Rule Issued for Laboratory Tests Payment System

Friday, June 17th, 2016

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule revising the Medicare payment system for clinical diagnostic laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS). Based on the final rule, CMS will implement the new approach to setting CLFS payment rates on January 1, 2018, a one-year delay from the date the agency originally proposed. Also, CMS will use the national provider identifier to apply the statutory requirements to determine whether a laboratory is considered an applicable laboratory.

The final rule can be found by going to https://federalregister.gov/a/2016-14531

MedPAC Issues June Report to Congress

Thursday, June 16th, 2016

The Medicare Payment Advisory Commission (MedPAC) has released its June report to Congress, which reports on issues affecting the Medicare program. The June report also recommends prototype designs for a unified prospective payment system for skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals. Currently, the prototype would be designed to pay for post-acute care services based on a patient’s clinical characteristics rather than the site of service. The report also recommends reducing dispensing and supplying fees for Medicare Part B drugs to rates similar to other payers, and giving isolated rural hospitals the option to convert to an outpatient-only model. In addition, the Commission recommends changes to the Part D program to lower program costs and protect beneficiaries with high costs. Also included in the report is an analysis of Medicare telehealth services, including use of telehealth in Medicare Advantage plans. The Commission recommends expanding the use of waivers in Center for Medicare & Medicaid Innovation programs to include a broader range of telehealth services.

The report can be found at http://medpac.gov/documents/reports/june-2016-report-to-the-congress-medicare-and-the-health-care-delivery-system.pdf

CMS Announces $10 million in Grants

Friday, June 10th, 2016

On June 10, the Centers for Medicare & Medicaid Services (CMS) launched the second round of the Support and Alignment Networks under the Transforming Clinical Practice Initiative (TCPI). This opportunity will provide up to $10 million over the next three years to leverage primary and specialist care transformation work and learning that will catalyze the adoption of Alternative Payment Models on a large scale. The Support and Alignment Networks represents a significant enhancement to the TCPI network expertise and will help clinicians prepare for the proposed new Quality Payment Program. Eligible applicants include health care delivery systems and plans that provide quality improvement support to a large number of clinicians. CMS expects to award up to five grants of $500,000 to $2.5 million through cooperative agreements.

The fact sheet can be found at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-10.html

GAO Report Recommends Steps to Reduce Medicare Appeals

Thursday, June 9th, 2016

On June 9, the Government Accountability Office (GAO) issued a report that stated that the Department of Health and Human Services (HHS) should take certain steps to reduce the number of Medicare appeals and strengthen oversight of the Medicare fee-for-service appeals process. The report, which was requested by leaders of the Senate Finance Committee, examines trends in appeals for fiscal years 2010 through 2014, data HHS uses to monitor the appeals process, and HHS efforts to reduce the number of appeals filed and backlogged. It concludes by stating that without more reliable and consistent information, HHS will continue to lack the ability to identify issues and policies contributing to the appeals backlog, as well as measure the funds tied up in the appeals process.

The report can be found at http://www.gao.gov/products/GAO-16-366

CMS Provides Additional Information on Two-midnight Review

Monday, June 6th, 2016

The Centers for Medicare & Medicaid Services (CMS) has provided additional information on its temporary pause of Quality Improvement Organization (QIO) claim audits under the two-midnight inpatient admissions policy. During the pause, which began May 4, CMS will improve standardization around the QIO review process. This will include retraining the QIOs on the two-midnight policy, a re-review of claims denied by the QIOs, and any needed provider outreach and education. CMS advises hospitals to work with their QIOs to determine whether denied claims have been re-reviewed prior to appealing a claim denial. If a denied claim has been appealed, and upon re-review the QIO determines it was denied inappropriately, the QIO will share its re-review findings with the appeals adjudicators to be taken into consideration during the appeal process. CMS anticipates that QIOs will resume audit activities within 60-90 days, but will formally advise stakeholders once the pause is lifted.

For further details, go to http://qioprogram.org/temporary-pause-qio-short-stay-reviews

Final Rule for Medicare Shared Savings Program ACOs Released

Monday, June 6th, 2016

On June 6, the Centers for Medicare & Medicaid Services (CMS) released a final rule that makes technical changes to the way financial targets are calculated for accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). CMS will account for differences in regional health care spending when updating ACOs’ financial targets, rather than considering only an ACO’s historical financial performance. CMS will phase in the new methodology to allow ACOs time to adjust over several performance periods.

The final rule can be viewed at https://federalregister.gov/a/2016-13651

MedPAC Appointments Announced

Monday, June 6th, 2016

The Government Accountability Office (GAO) has announced the appointment of five new members to the Medicare Payment Advisory Commission (MedPAC). They are Amy Bricker, vice president of supply chain strategy for Express Scripts Inc.; Brian DeBusk, CEO of DeRoyal Industries; Paul Ginsburg, Leonard Schaeffer chair in health policy studies at the Brookings Institution and professor of health policy at the University of Southern California; Bruce Pyenson, principal and consulting actuary at Milliman Inc.; and Pat Wang, CEO of provider-sponsored health plan Healthfirst.  Jon Christianson, professor of health policy and management at the University of Minnesota’s School of Public Health, has been reappointed to the commission and will continue to serve as vice chair.

The announcement can be found by visiting http://www.gao.gov/press/medpac_appointments2016jun.htm?utm_medium=email&utm_source=govdelivery