WEEKLY E-BULLETIN


Significant Changes Made in CMMI’s Bundled Payments Demo

CMS’ Innovation Center has made some major changes to its Bundled Payments demonstration program. Because of the changes, the submission deadline has been extended a few weeks. The application process will now be online. Click here for the details.  Organizations that submitted their Letters of Intent have been receiving their comprehensive Medicare data sets, including information on all providers in their market. Our bundled payment team of experts is ready to provide you some help – click here to review our services.

CMS Wants 10-Year Lookback for Overpayments

In proposed regulations, CMS wants a 10-year period in which the agency can reopen Medicare overpayment cases that are disclosed to it. The current lookback period is about 4 years. CMS says 10 years is a better policy for a variety of reasons, but some providers are already talking about the hardship it creates with record keeping, particularly for smaller providers, i.e. solo and small physician groups. Click here to see the regs; the look back provision is on page 6 of 9 pages. CMS is taking comments until April 16.

Senators Concerned About Veteran’s Health Care Access

The leaders of the Senate Veterans’ Affairs panel last week raised serious concerns that the administration is not requesting enough funding in fiscal 2013 on meantl health care for veterans and is not working fast enough to tackle a backlog of disability claims. The panel’s chairwoman, Patty Murray (D-WA) told Veterans Affairs Secretary Eric Shinseki that she is worried the 5 percent increase President Obama requested in his budget for meant health care funding is not enough. Click here for her testimony that outlines where she believes VA health care is falling short.

HRSA Announces New TeleHealth Grant

$3.5 million is being made available for telehealth grants, according to an announcment last week from the Health Resources Services Administration at HHS. The submission deadline is April 13. Click here for an executive summary. Email Gwen.Mathews@shcare.net who heads SHC’s grants division, if you want some help or just to discuss it in more detail.

Experts Share Health Reform Recommendations with Senate

Where does Congress get its ideas for change? Sometimes from the experts.  In a meeting largely void of partisan rancor last week, the Senate Budget Committee took a closer look from three experts on recommendations to “fix” the health care system going forward.  Dr. David Cutler, a Harvard professor and Institute of Medicine member, offered a series of recommendations. Click here.  Dr. Len Nichols, a professor at George Mason University, raises serious concerns about Medicare premium support models – click here.  And James Capretta, a fellow at the Ethics and Public Policy Center, said the current reform law will force hundreds or thousands of providers out of business b the end of the decade – mostly because of the compounding impact of the productivity adjustment. Click here.

GAO Wants More Nursing Home Oversight

The GAO was out with a new report last week saying that CMS should improve oversight of the system to monitor the quality standards in nursing homes. CMS has commissioned three studies to evaluate the Quality Indicator Survey (QIS) process, but it does not routinely monitor the extent to which the objectives established for the QIS are being met, according to the report. Click here for a copy of the 28-page report.


AMA Says CMS Proposal Could Harm Patients Rx Needs

The American Medical Association wants CMS to change a provision in its 2013 Part C and D Payment Policies that allows Medicare drug plans to deny drug coverage to patients when they suspect prescription misuse. The AMA sent a letter Friday to CMS saying the policy could prevent patients from receiving coverage for medications prescribed to them by their physician. Much of the focus is on hydrocodone and oxycodone. Click here for a copy of the AMA’s 3-page letter.

State Exchanges Subsidy Cost Growth Blasted

The projected rising costs of the health insurance exchanges subsidies is raising questions in Congress. The Chairman of the Ways and Means Committee, Dave Camp (R-MI), sent a letter late last week to the Treasury Secretary asking why the costs were now projected at $111 billion through 2021 rather than the $11 billion claimed by the Administration in April 2011. Click here for the Camp letter to Secretary Geithner.

GOP Budget Leaders Say White House Ignoring Medicare Budget Plan Requirement 

In another congressional letter to the president, House Budget Committee Chairman Paul Ryan and top Senate Budget Committee Republican Jeff Sessions accuse him of ignoring a legal requirement to propose a plan for cutting Medicare spending if general revenues will account for more than 45 percent of the program’s spending. Click here for the letter.


CMS Announces Texting Initiative to Increase CHIP Enrollment

CMS said last week that it will partner with Text4Baby, a free national health texting service, to promote enrollment in both Medicaid and the Children’s Health Insurance Program (CHIP) and provide pregnant women and new mothers free text messages on important health care issues. Click here for the announcement.

House Gets Closer to Full IPAB Repeal

The House Energy and Commerce Subcommittee on Health approved legislation (H.R. 452) to repeal ACA’s Independent Payment Advisory Board (IPAB) on last Wednesday. The subcommittee vote was 17-5, with two Democrats, ranking member Frank Pallone and Edolphus Towns, voting with Republicans to send the bill to the full committee. The full House will likely vote on repeal this month.  A new coalition is rallying against IPAB through grassroots campaigns. Click here to read about coalition repeal efforts

New Medical Residency Accreditation Program Announced

The Accreditation Council for Graduate Medical Education (ACGME) last week announced major changes in how the nation’s medical residency programs will be accredited in the years ahead. Click here for their announcement.

New Hampshire First to Get Federal Long-Term-Care in the Home Funding

CMS announced late last week that New Hampshire will be the first state to get new health reform dollars to encourage state Medicaid programs to provide long-term care for beneficiaries in their homes. The agency is awarding New Hampshire $26.5 million dollars over three years from the Affordable Care Act’s $3 billion Balancing Incentives Program. It targets states that currently spend less than 50 percent of their long-term care dollars on home and community-based care. Click here for more.


Medicare Fraud Bust Nails Dallas Doc for $375 Million

In one of the largest ever Medicare fraud busts, a Dallas physician, his office manager and five home health agency owners were arrested on charges related to their alleged participation in a nearly $375 million health care fraud scheme involving fraudulent claims for home health services. Click here for the story. Also last week, one of the nation’s largest providers of hospice care agreed to pay $25 million to settle a Medicare fraud case initiated after a former company nurse in Milwaukee filed a whistle-blower suit. Click here for that story.

CMS Hosts Strong Start Webinar Wednesday

CMS is hosting a webinar Wednesday, March 7 at 3 p.m. EST that will discuss how applicants can work with States and the role of States in the Strong Start funding opportunity. A series of follow up webinars will provide more in-depth information about other aspects of this initiative. $42 million is being made available to divide between successful applicants. To sign up for this webinar, click here.


State Mandated Health Benefits Not Too Costly Under Reform: New Study

According to a new report out last week, covering state-mandated health benefits that exceed the new package of essential services required by the federal health law won’t stretch state budgets as much as first thought. That’s because most states have benefit packages that already cover a wide array of services, from prescription drugs to chiropractors. Click here for the study from National Institute for Health Care Reform.