Feds Move to Help Americans Get Pre-Existing Condition Insurance

HHS last week announced new steps to reduce premiums and make it easier for Americans to enroll in the Pre-Existing Condition Insurance Plan. Premiums for the Federally-administered Pre-Existing Condition Insurance Plan will drop as much as 40 percent in 18 States, and eligibility standards will be eased in 23 States and the District of Columbia.  Click here for details.


Where’s the Federal Money Now?

With earmarked congressional appropriations on hold for now, the funding for specific projects is in federal grants.  The government will issue more than $80 billion in health care grants this year.  To help rural hospitals take advantage of these funds, Strategic Health Care’s Grant Division is rolling out a new Rural Hospital Grants Collaborative for rural hospitals with 60 or fewer (staffed or licensed) beds.   Collaborative participants will get professional grant writing services and development expertise at a deeply discounted rate.  If you’re interested in learning more, Strategic Health Care is sponsoring two national webinars:

To register for the webinar on Wednesday, June 29th at 1 pm EDT, click here:www.meetme.net/shc1

To register for the webinar on Thursday, June 30th at 11 am EDT, click here:www.meetme.net/shc2


Final Rule Stops Medicaid Payments for Preventable Health Care-Acquired Conditions

CMS last week released a final rule prohibiting federal Medicaid payments to states for certain preventable health care-acquired conditions. The rule is effective July 1, 2011, but states have the option to delay implementation for a year. The rule is based on Medicare’s list of preventable conditions – adjusted for differences in the Medicare and Medicaid populations. It applies to wrong site, procedure or patient surgeries in inpatient and outpatient settings, and allows states to expand these additional preventable conditions and settings with CMS approval. Click here to see the 122-page rule.


Updated FMAP Rates Released

HHS last week released updated state-by-state federal match rates  (FMAP) for state Medicaid programs for the period Jan. 1 through June 30.  Last year’s Medicaid assistance bill provided that during the six-month extension of the FMAP increases, the amount of those increases would decline to 3.2 percent from Jan. 1 through March 31 and to 1.2 percent from April 1 through June 30.  The HHS announcement lists each state’s new FMAP increase and unemployment adjustment for the first and second quarters of fiscal year 2011 (Jan. 1 through March 30 and April 1 through June 30).  The update is attached here.


Blue Dogs Ask Berwick for Home Health Relief

A group of House Democrats last week asked CMS to alter a paperwork requirement that they said unfairly burdens home health agencies. Members of the anti-deficit Blue Dog Coalition said that a final rule requiring face-to-face meetings and other changes extends beyond the original intent of the law. The documentation of the face-to-face meeting must be certified separately from an initial need for care form, and this additional paperwork is the part of the rule the Blue Dogs addressed in their letter to CMS, which you can read here.


Medicaid Block Grant Program Would Hit States Unevenly: New Report

How would state Medicaid programs fair under the House-passed budget? According to a new report from fiscal year 2012 to 2021, some states would see a reduction in total (federal and state) Medicaid funding of more than 30 percent, and others would face reductions of less than 10 percent, the analysis said. For example, total Medicaid funding for Massachusetts would be reduced by 1.6 percent, compared with 32.1 percent in Texas. The analysis from Avalere is attached here.


How Does Your State Stack Up on Quality?

The Agency for Healthcare Research and Quality last week released State Snapshots of health care quality and disparities data. The snapshots provide summary measures of quality by type of care (preventive, acute and chronic), care setting (home health, hospital, nursing home and ambulatory), and clinical area (cancer, diabetes, heart disease, maternal and child health and respiratory diseases), and compare each state to others in its region and the nation. Click here to compare your state.


New Reg Would Release Substantial Medicare Data

CMS last week issued a proposed rule regarding the release and use of Medicare claims data to qualified entities to measure the performance of hospitals, physicians and others, while still protecting patient privacy. Beginning in 2012, the ACA requires HHS to provide standardized extracts of Medicare Parts A, B and D claims data to qualified entities on request. Click here to review the 93-page proposal.


Radiological Errors More Common Than Expected:  PA State Study

Despite quality improvement efforts, the prevalence of these errors in other disciplines, namely, radiology services, may be more common than generally expected and reported in the literature. 652 events specifically related to wrong-procedure or test (50%), wrong-patient (30%), wrong-side (15%), and wrong-site (5%) radiology errors. Predominant testing modalitie reported to the Authority included radiography (45%), computed tomography (CT) scan (18%), mammography (15%), magnetic resonance imaging (MRI) (6%), and ultrasound (5%). Click here to read the full report.
Please don’t hesitate to call us with questions.

Paul Lee
Senior Partner
Washington, DC