WEEKLY E-BULLETIN


Senate Leader Considers Stark Law Reform

In an effort to ease physician-referral restrictions, Senate Finance Committee Chair Orrin Hatch (R-UT) last week released stakeholders’ suggestions for Stark law reform. Hatch said the restrictions make it difficult for providers to undertake delivery-system reforms, and he said the need to lift restrictions was made greater when Congress reformed the physician pay system under MACRA, which aims to move physicians to alternative pay models. Stark law prohibits physicians from referring Medicare patients for certain services to entities in which those same doctors have a financial relationship which has contributed to the blame for doctors overusing services. The paper states that many providers are reluctant to move toward alternative payment models because they worry about “devastating penalties” from the Stark law. Click here for more from the Finance Committee and here for the white paper.

196 Group Practices Selected for New Oncology Care Model

Nearly 200 physician group practices and 17 health insurance companies have been selected by CMS to participate in a care delivery model that supports and encourages higher quality and more coordinated cancer care. The Medicare arm of the Oncology Care Model includes more than 3,200 oncologists and will cover approximately 155,000 Medicare beneficiaries nationwide. The Oncology Care Model begins on July 1, 2016 and runs through June 30, 2021. Click here to see who was selected.

CMS Proposes Further Cuts to Home Health Payments

CMS expects that Medicare home health agencies will see pay in 2017 reduced by about 1 percent — about $180 million — as a result of the policies in the proposed pay rule the agency released last week. The agency’s proposal would complete the last year of a four-year phased adjustment to the payment system. Additionally, the rule would update the quality reporting program for home health to include four measures that would help determine 2018 payments as requested by the IMPACT Act. Click here for the rule and here for the CMS fact sheet.

CMS’ Part B Demo Is Likely To Be Implemented with Adjustments

The Senate Finance Committee held a hearing last week on the controversial Medicare Part B drug pay demonstration. CMS’ #2 Patrick Conway testified that CMS is “evaluating the public comments now and intends to take those comments into account in the finalized rule.” Members of both parties questioned the nearly nationwide scope of the proposed Part B drug model. The lawmakers also expressed concerns that people living in rural areas might lose access to medicines, with doctors finding it difficult to afford to provide certain drugs under the plan. To view the hearing or to read the testimony, click here.

UnitedHealthCare Sues Renal Dialysis Company for Fraudulent Billing

A lawsuit filed last week by UnitedHealthCare accuses American Renal Associates, a public company that operates nearly 200 dialysis clinics across the country, of fraudulently billing millions of dollars since the beginning of the year. UnitedHealthCare is trying to recoup that money. Click here for the story.

HHS Proposes Changes to the Medicare Appeals Process

HHS last week proposed reforms to how it hears appeals of payment and coverage determinations affecting beneficiaries, including allowing the HHS Departmental Appeals Board to designate certain decisions as precedent-setting. HHS estimates that these changes, along with funding increases and legislative proposals included in the President’s fiscal 2017 budget, could help eliminate the backlog of appeals by fiscal 2021. The American Hospital Association has expressed its disappointment stating that they “are skeptical that these proposals will do more than scratch the surface.” Click here for the proposed rule, here for the HHS blog post describing the change, and here for the AHA statement.

House Likely to Vote Today on Mental Health Bill

The House is set to vote on legislation intended to improve the nation’s mental health care system. The Helping Families in Mental Health Crisis Act of 2015 (HR 2646) has been under development for more than a year and is scheduled for a vote today. The bill will be similar to the language the committee previously adopted. There will likely be a technical correction to a provision that would provide grants to states and Indian tribes to support the development of mental health services delivered through video consultations or other forms of telemedicine. Click here to view the bill and summary.

Number of Infants Born with Zika on the Rise in the US

While funding for Zika has stalled in Congress, seven infants have been born with Zika-related birth defects on the U.S. mainland, up from four two weeks ago, according to new CDC data. Five pregnancies have ended because of Zika-related birth defects, the CDC data also shows. The CDC started reporting pregnancy statistics two weeks ago. Click here for the CDC data.

HHS Will Use Innovation Center and BARDA to Accelerate a Zika Vaccine

HHS has announced that it will use its Center for Innovation in Advanced Development and Manufacturing in Baltimore to accelerate work on a Zika vaccine in partnership with Emergent BioSolutions. HHS’s Biomedical Advanced Research and Development Authority (BARDA) will provide nearly $18 million to Emergent over the next 30 months, with the possibility of another $4 million for additional work. Emergent is tasked with developing and manufacturing a vaccines for a first-in-human clinical trials. Click here for the announcement.

Here’s the Latest on What’s Killing Us in the USA

Heart disease is the leading cause of death in the country, but a handful of other common killers aren’t far behind, according to new 2014 mortality numbers out from the CDC. Cancer, chronic lower respiratory disease, accidents, and stroke rounded out the top five causes of death. Click here for the CDC report.

  • Click here for the latest on how state’s are acting to reign in opioids.

ACA Plans Generally Cover Substance Abuse Treatment Affordable Care Act exchange plans do cover treatment for alcohol and opioid-use disorders but it’s not always clear which services are covered or how much they cost, according to a report released last week. The analysis found that medications for alcohol-use disorders are covered more frequently and have lower associated out-of-pocket costs compared to those for opioid-use disorders. Researchers focused on plans in six cities: Albuquerque; Chicago; Kansas City.; Los Angeles; Manchester, N.H.; and Memphis.. Click here for the report.

Doctors are Less Satisfied and Burned Out by EHRs

Most doctors who use electronic health records and order entry software tend to be less satisfied with how much time they spend on clerical tasks and are at higher risk of burnout than others, according to a new study released by the Mayo Clinic. For doctors, burnout has been linked to decreased quality of care and medical errors. The researchers looked at survey responses collected in 2014 from U.S. doctors in all specialties. Almost 36,000 doctors were invited to participate and 6,880 responded, including 6,560 who were in active practice. Click here for more.

More Than 11 Million Enrolled in Obamacare Now

About 11.1 million people were enrolled in Obamacare plans at the end of March, a drop from the 12.7 million people who signed up during the latest enrollment period, according to new HHS data.? Enrollment numbers usually drop after open enrollment – which ended Jan. 31 this year – because not everyone will pay their premium. Enrollment numbers are expected to drop throughout the year. Click here for details from HHS.

IRS Says Some Wellness Incentives Are Taxable

An IRS memorandum clarifies that some wellness program incentives or rewards are taxable for employees. The IRS detailed three scenarios in which wellness incentives were deemed taxable as income.? Click here for details.

House Committee Subpoenas Reinsurance Documents from HHS

The House Energy & Commerce Committee last week subpoenaed HHS Secretary Sylvia Burwell for all documents and communications regarding the agency’s decision to prioritize insurers over the U.S. Treasury when allocating funding through the Affordable Care Act’s reinsurance program. Over the last several months, the Committee has been investigating how the Administration is handling the ACA’s reinsurance program. Click here for more from the Energy and Commerce Committee and here to view the subpoena.