This Week: New Exchange Regs; Deal on Budget Deficit; IPAB Attack

HHS is expected to announce today its proposed regs governing state insurance exchanges.  How much flexibility will the feds give the states?  What kind of requirements will states have to vet the providers and insurers that participate on the exchange?  We will know shortly.  In the meantime, Speaker Boehner now says he can only back a smaller debt reduction package…regardless, any deal will likely impact Medicare and Medicaid, so we’re waiting to see exactly where those cuts will be made.  The House GOP holds two hearings this week on IPAB, with most Republicans wanting to eliminate it with a small group of Democrats in agreement.  It had been the Obama Administration’s key catalyst to reigning in government health care spending.

New CMS Demos Address Difficult Dual Eligibles Issues

CMS last week initiated new demonstration projects (click here for overview) to help states redesign programs for dual eligibles that they hope will improve care and reduce costs. They will test a capitated model and a managed fee-for-service model.  Click here for details.  They will also have a demo designed to keep nursing home patients from being unnecessarily admitted to a hospital.  Click here.  CMS is also establishing a resource center to states to help them manage high-need, high cost patients.  Click here.

State Medicaid Cuts Hit Providers Across Nation
As many state budget years begin across the country, hospitals, physicians, nursing homes and other care providers are feeling the pinch of significant budget cuts.  It seems few escaped the axe. Click here and here to read summaries.

Cuts in Medicaid come just as a new study shows that expanding low income adults’ access to Medicaid substantially increases health care use, reduces financial strain on covered individuals, and improves their self-reported health and well-being. Click here to read more.

IRS Issues Community Health Assessment Regs – With Penalties 

Tax-exempt hospital systems will be required to meet new community health needs assessment standards for each hospital facility in their system or be subject to separate $50,000 fines.  The IRS is looking for comments on proposed regulations it issued last week that are required under the Affordable Care Act.  Click here to review the 28-pages.

Will Berwick Fight for Senate Confirmation?

A good article in the Washington Post outlines CMS Administrator Don Berwick’s likelihood of leaving office at the end of this year.  Should he fight for confirmation?  His advisors are telling him NO.  Click here to read.

New CMS Demo for Certain Hospital Labs

Hospitals that have laboratories that perform complex diagnostic test are eligible for a new CMS demonstration project announced last week.   The two-year Medicare demo will pay laboratories separately for certain complex diagnostic laboratory tests that are conducted using specimens obtained from individuals while they are hospital inpatients, and for which payment would otherwise be bundled into the hospital inpatient payments.  Click here to review the announcement.

GAO: Hard to Get Docs for Poor Kids

Physicians participating in Medicaid and CHIP are generally more willing to accept privately insured children as new patients than Medicaid and CHIP children. For example, about 79 percent are accepting all privately insured children as new patients, compared to about 47 percent for children in Medicaid and CHIP.  Click here to see the 62-page report.

New Trend?  Maine First to Use “Captives” for Health Coverage

In looking for ways to reduce their health costs, employers in Maine are taking advantage of new legislation allowing employers to band together and offer health insurance through so-called captives, insurance companies that are allowed to finance and leverage risk without having to buy additional insurance to cover that risk.  Read more.

JAMA Study Slams Critical Access Hospitals

According to a new study in JAMA out last week, compared with non-CAHs, CAHs had fewer clinical capabilities, worse measured processes of care, and higher mortality rates for patients with AMI, CHF, or pneumonia.  Click here to review the study.

Inspector General Hits Power Wheelchair Payments

An HHS OIG report out last week said 9 percent of power wheelchair claims in early 2007 were considered medically unnecessary, and 52 percent lacked sufficient documentation to determine medical necessity.  Click here to read the 55-page report.

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