WEEKLY E-BULLETIN


Hospitals Should Get 1% (Not 2.9%) Increase in 2013: MedPAC

The agency that advises Congress on Medicare issued its formal payment recommendations last week. Here’s a summary:

  • Hospital inpatient and outpatient PPS update: 1%.
    • Under current law, the marketbasket update is expected to be 2.9%.  MedPAC says if Congress makes it 1%, the difference should be used to recover past overpayments caused by documentation and coding changes.
  • Repeal SGR. Over ten years, freeze primary care physician payments.  For all others docs, reduce payments by 5.9% for three years followed by a freeze.  Direct HHS to identify overpriced fee-schedule services and reduce their relative value units accordingly.
  • Update ASCs and hospice by 0.5%.
  • Update outpatient dialysis by 1%.
  • Eliminate the 2013 update for skilled nursing facilities, LTCHs, and inpatient rehab.
  • HHS should conduct medical reviews on home health agencies in counties with aberrant utilization.

Click here for MedPAC’s 4-page summary of recommendations.  Click here for the very good 443-page complete report.  Congress is NOT required to implement MedPAC recommendations, however, if past behavior is a guide then Congress often takes MedPAC’s advice and HHS does the same.

The recent slowdown in Medicare spending may be the new normal, according to a report last week in the New England Journal of Medicine.  Click here to read.

New CMS Project Focuses on Reducing Hospital Readmits from Nursing Facilities

CMS last week announced a new program (and $128 million to back it up) designed to reduce avoidable hospital readmissions from nursing homes. Through this initiative, CMS will partner with eligible, independent, non-nursing facility organizations (referred to as “enhanced care & coordination providers”) to implement evidence-based interventions that reduce avoidable hospitalizations. Eligible organizations can include physician practices, care management organizations, and other public and not-for-profit entities.  Click here for details.  Strategic Health Care is prepared to help  you with your application.  Contact SHC’s Gwen Mathews (gwen.mathews@shcare.net) for more information.

New CMS Rules Finalize Changes to Medicaid

CMS on Friday released new final rules governing Medicaid.  One of the major changes from draft rules is that States will be able to chose whether an exchange will enroll people in Medicaid or whether to leave that power exclusively in the hands of the state Medicaid agency.  Additionally, the rule reflects the statutory minimum Medicaid income eligibility level of 133 percent of the Federal Poverty Level across the country for most non-disabled adults under age 65; eliminates obsolete eligibility categories and collapses other categories into four primary groups: children, pregnant women, parents, and the new adult group; and it modernizes eligibility verification rules to rely primarily on electronic data sources. Click here for a copy of the 268 pages of rules.


HHS Issues Regs to ‘Reduce Uncertainty’ in Insurance Market Under Exchanges

HHS will establish programs designed to eliminate incentives for health insurers to avoid covering people with health problems if states do not set up their own programs in health insurance exchanges, under a final rule issued late last week. Click here for a copy of the 127-page rule.  The regulations establish  standards related to reinsurance, risk corridors and risk adjustment.

If you’re still trying to get your arms around the massive federal Exchange regulations issued March 12, this article in Health Affairs does a pretty good job of simplifying the issues. Click here.

CBO Releases Analysis of Obama’s FY13 Budget Proposal

The Congressional Budget Office last week released a detailed report on the impact of the Obama Administration’s FY13 proposed budget.  It would reduce Medicare spending by $276 billion over 10 years and cut Medicaid spending by $66 billion over the same time period.  While it is very unlikely that Congress will approve that budget this year (the Senate has already said it won’t produce a budget plan of its own), the CBO report is expected to give some support to those who would like to see further budget reductions this year. Click here to see the 3-pages of Medicare and Medicaid provisions. The CBO also released an updated report on the costs associated with the insurance provisions of the Affordable Care Act. Click here for the 12-page summary.

More States Turn to Provider Taxes: CRS

Between February 2009 and July 2010, 10 states and D.C. implemented 28 different provider taxes, including 15 new provider taxes and 13 increases to existing provider taxes, according to a new report from the Congressional Research Service.  States are more likely to impose or increase provider taxes during economic downturns to generate additional revenue to finance Medicaid, the report said. Click here for the report.


Emergency Psych Demo to Award $75 Million in 11 States and D.C.

11 States and D.C. will participate in a Medicaid Emergency Psychiatric Demonstration, according to an announcement from CMS last week.  It is designed to test whether Medicaid beneficiaries who are experiencing a psychiatric emergency get more immediate, appropriate care when institutions for mental diseases receive Medicaid reimbursement. This demonstration will provide up to $75 million in federal Medicaid matching funds over three years to Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, and West Virginia and D.C. Click here for more.

RACs Authorized to Request More Medical Records

Medicare’s fee-for-service Recovery Audit Program announced changes last week that will allow RACs to increase the number of medical records requests they can make of hospitals and nursing homes. Click here for the 2-pages of details.


Supreme Court Won’t Televise Affordable Care Act Proceedings Next Week

For those of you hard core Affordable Care Act buffs, the Supreme Court announced Friday that it will not televise the oral arguments on the repeal effort scheduled for March 26, 27 and 28.  However, it will post the audio recordings. Click here for details from the Supreme Court. 14% of the public believes the Supreme Court has already overturned the health reform law, according to a poll from the the Kaiser Foundation, click here. Another 28% are unsure.

Administration Seeks Public Comments on Proposed Contraception Reg 

The Obama administration announced late Friday it is seeking public comments on a draft of a proposed rule on preventive health services including proposed contraception coverage that has been the source of controversy since the administration issued “guidance” on the topic earlier this year. The notice announces the intention of the departments of Health and Human Services, Labor, and the Treasury to propose amendments to regulations regarding certain preventive health services and gives the public 90 days to comment. Click here for the announcement.

Senate Medicare Reform Bill Would Enroll All Seniors into Federal Employees Plan

Four U.S. Senators last week introduced a plan, the Congressional Health Care for Seniors Act, S.2196, that would enroll all seniors into the same health care plan as their Member of Congress and other federal employees – the Federal Employees Health Benefits Plan. In 2010, federal employees could choose from among the 250 plans participating in FEHBP, including 20 nationwide plans.  Senators Paul (KY), Graham (SC), DeMint (SC) and Lee (UT), all conservative Republicans, say their bill would save more than $1trillion. Click here for more.

Second Major Medicare Fraud Bust in Two Weeks

A Miami-area resident pleaded guilty last week for his role in a fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, announced the Department of Justice, the FBI and the HHS. Click here for the story.