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Tag Archive | "CMS"

Rep. Allyson Schwartz Proposal to Repeal SGR

Rep. Allyson Schwartz (D-PA) has proposed to repeal the SGR and freeze the current Medicare physician payment rates through 2012. She proposes to provide primary care physicians with a 2.5 percent annual rate increase and specialists with a 0.5 percent increase from 2013-2016. Her proposal calls on CMS to test and evaluate physician payment models and identify at least four models from which physicians could select to be paid beginning in 2016. If physicians elected to remain in the fee-for-service system, reimbursement rates would decrease annually to encourage providers to move away from the FFS system.

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President to Nominate Marilyn Tavenner as CMS Administrator

Later today, the President is expected to nominate Marilyn Tavenner to succeed CMS Administrator Donald Berwick when his recess appointment expires on December 31, 2011. Marilyn Tavenner currently serves as the Principal Deputy Administrator and Chief Operating Officer of CMS. She will serve as Acting Administrator of CMS during her confirmation process.

Marilyn Tavenner was Secretary of the Virginia Health and Human Resources Department during Governor Tim Kaine’s (D) administration from 2006-2010. Previously, she was a nurse and an executive at the Hospital Corporation of America. She was Chairwoman of the Virginia Hospital Association and a trustee at the American Hospital Association.

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Republican Governors Outline Policy Options for Medicaid Reform

The Republican Governors Public Policy Committee issued a report in response to a request from House Energy and Commerce Committee Chairman Fred Upton that includes the following policy options for Medicaid reform:

  • Repeal the Affordable Care Act and replace it with market-based reforms;
  • Allow states to define an outcome-based program operating agreement with CMS (program would include a limited number of measures and eliminate federal review process for Medicaid programs);
  • Enable states to measure accountability through measures of quality, cost, access and customer satisfaction;
  • Repeal maintenance of effort requirements; Entrust the state with responsibility for program integrity;
  • Require the federal government to assume the cost of uncompensated care for illegal aliens;
  • Allow states to pilot programs to reduce the occurrence of cost-shifting between the state and federal programs;
  • Permit a state (if it can demonstrate budget neutrality) to use state or local funds to pay for Medicaid services of system improvements that are not currently “matchable;”
  • Encourage states to develop innovative programs to reduce chronic illnesses, emergency room visits, and hospitalizations;
  • Provide states with the ability to implement bundling projects;
  • Allow states to use only one managed care organization (rather than at least two as currently required by CMS);
  • Amend ACA’s eligibility definition to reverse the use of MAGI;
  • Allow states to contract with private firms to streamline eligibility determination;
  • Provide states with flexibility to design benefit structures;
  • Eliminate benefit mandates that exceed private insurance market benchmark or benchmark equivalent;
  • Permit states to divide Medicaid into different parts; and
  • Engage in shared savings arrangements for dual eligible beneficiaries.

The report will serve as the basis for the Committee’s Health Care Summit in Washington in October.

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HHS Outlines Regulatory Review

Earlier this year, President Obama issued an Executive Order directing Department and Agency heads to submit a plan for retrospective review of regulations that may be obsolete or burdensome to businesses. Federal Departments submitted preliminary plans in the spring and just this week issued their final plans.

HHS’s plan notes that the goal of the retrospective review of the regulations is to improve patient care and outcomes and reduce system costs by removing obsolete or burdensome requirements.  The Centers for Medicare and Medicaid Services will publish a rule in September related to this regulatory review and estimates that the changes outlined in the plan will result in savings of $600 million annually and $3 billion over five years.

HHS plans to revisit regulations a number of issues including the following:

  • Use of telemedicine to increase access to improve the ability of rural and critical access hospitals to provide care more broadly and reduce provider burden by removing credentialing requirements;
  • Increase use of electronic reports and submissions at the FDA and the Administration for Children and Families;
  • Align reporting for electronic prescribing requirements and the EHR incentive program in Medicare;
  • Improve pre-market review for medical devices;
  • Reduce certain burdens imposed by the FDA’s medical device regulations;
  • Continue to review the FDA’s Good Manufacturing Practices regulations for foods and drugs and establish preventive controls for food facilities, as well as accommodate advances in technology relating to pharmaceuticals;
  • Revise and update labeling regulations for food and drugs at the FDA;
  • Develop a CMS work plan to better align Medicare and Medicaid; and
  • Review quality reporting requirements.

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CMS Announces New ACO Initiatives

Earlier this year, CMS release regulations on one of the signature health care reform proposals – the Accountable Care Organization. Perhaps to the Agency’s surprise, hospitals and physicians, who would be eligible to develop an ACO, have outlined numerous concerns with the proposal. Recognizing various concerns, on May 17, the CMS Center for Medicare and Medicaid Innovation announced three initiatives that would encourage doctors, hospitals, and other health care providers to become an Accountable Care Organization (ACO).

CMS is accepting applications for a Pioneer ACO Model, which is designed for organizations that already have an ACO or significant care coordination processes. The model is intended to work in conjunction with private payers to achieve cost savings and improve outcomes. Organizations interested in applying to the Pioneer ACO Model must submit a letter of intent on or before June 30, 2011. Applications must be received on or before August 19, 2011. In addition, the Agency requests comments on whether it should offer an Advanced Payment ACO Initiative that would allow certain ACOs participating in the Medicare Shared Savings Program access to a portion of their shared savings up front to help make the necessary investment critical to a successful ACO. Comments are due to CMS by June 17, 2011. Finally, CMS will host Accelerated Development Learning Sessions that will detail for providers the ways in which they can improve care delivery and develop an action plan for better coordinating care. The first of four learning sessions will be held in Minneapolis, Minnesota from June 20-22.

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Update on ACO Regulations

CMS officials continue to report that the ACO Proposed Rule will be released “very soon.”  CMS Deputy Administrator Marilyn Tavenner has signaled that CMS will issue the regulations by the end of March.

CMS officals of of late have alluded to regulations that provide the opportunity for lots of different providers to participate and signaled to stakeholders that they should expect to see cutting edge ideas for ACOs.   We understand that CMS intends to issue a solicitation for ”Pioneer Pilot Projects” shortly after the ACO Proposed Rule is released.

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Capital Thinking Podcast

Newly-elected Republicans have moved quickly to attempt a repeal of the health care reform legislation. Last week, the Senate voted on an amendment to the Federal Aviation Administration reauthorization bill that would have repealed the Affordable Care Act. The effort failed by a vote of 47-51. Senators voted along party lines with all Republicans voting for the repeal and all Democrats along with Independent Sen. Bernie Sanders voting against it. Sens. Joe Lieberman, an Independent, and Mark Warner, a Democrat, did not vote. This vote comes two weeks after the House successfully voted to repeal ACA. The Senate approved by a wide margin an amendment to eliminate the 1099 reporting requirement mandated by the Affordable Care Act. This followed the introduction of three separate bills to repeal the unpopular provision. The health care reform law requires that all businesses issue Form 1099 to vendors from which they purchase $600 or more of goods annually and file the information report with the Internal Revenue Service. The requirement is effective for payments made after December 31, 2011, and was included in health care reform as a revenue raising provision. The timing for repeal of the 1099 reporting requirement in the House is unclear; however, on February 17, the House Ways and Means Committee plans to mark up legislation to repeal the 1099 reporting requirement.

On January 31, a Federal judge in Florida issued a ruling declaring the entire health reform law – and the individual mandate, in particular – unconstitutional under the Commerce Clause and therefore “void.” The judge dismissed a separate claim challenging the legality of the Medicaid expansion. According to U.S. District Court Judge Roger Vinson, “Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void. This has been a difficult decision to reach, and I am aware that it will have indeterminable implications.” The Obama Administration has signaled that it will appeal the decision, and most experts believe that the case will be heard by the Supreme Court in the next couple of years.

On Thursday, CMS Administrator Don Berwick will make his debut on the Hill in appearing before the House Ways and Means Committee at a hearing examining the Affordable Care Act’s impact on Medicare beneficiaries. Richard Foster, Chief Actuary at the Centers for Medicare and Medicaid Services, will also testify at the hearing. During the week of February 14, Department of Health and Human Services Secretary Sebelius and White House Office of Management and Budget Director Jack Lew are scheduled to testify before the Committee about the President’s Fiscal Year 2012 Budget proposal.

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HHS Reorganization

Secretary Kathleen Sebelius has announced a reorganization of the Department of Health and Human Services (HHS) in order to enhance efficiencies including health information technology, contracting and staff support. The Office of Consumer Information and Insurance Oversight (OCIIO) will be moved to the Center for Medicare and Medicaid Services (CMS) under the charge of current Deputy Administrator Marilyn Tavenner. OCIIO Director Jay Angoff will move to the office of the Secretary, advising on health reform implementation issues. The move could be considered an effort to shield OCIIO from defunding efforts by Congressional Republicans, but the Administration touts improved coordination between important health reform elements including interaction between the Medicaid and the exchanges.

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Richard Gilfillan named Acting Director of CMI

CMS Administrator Don Berwick named Richard Gilfillan as Acting Director of the Center for Medicare and Medicaid Innovation (CMI). According to the announcement, Dr. Gilfillan is a physician, who ran the Geisinger Health Plan in Pennsylvania from 2005 to 2009. Administrator Berwick noted that Dr. Gilfillan is experienced in developing accountable care organizations, patient-centered medical homes, and bundled payment systems

The Affordable Care Act (ACA) calls for the establishment of the Center no later than January 1, 2011. Through the CMI, the Department of Health and Human Services (HHS) Secretary will select models to be tested where there is evidence that the model addresses a defined population for which there are deficits in care. The law requires the Secretary to focus on models that are expected to reduce costs while preserving or enhancing the quality of care. The Secretary is directed to give preference to models that also improve the coordination, quality and efficiency of health care services.

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CMS Proposed Rule on Provider and Supplier Enrollment

CMS released the Proposed Rule: “Medicare, Medicaid, and Children’s Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers.” The Proposed Rule will be published in the September 23 Federal Register.

The Affordable Care Act made statutory changes to the Medicare and Medicaid programs and CHIP to enhance provider and supplier enrollment and to reduce fraud, waste, and abuse.

The Proposed Rule will have implications for both new and existing providers and suppliers. For example, the Proposed Rule would establish new screening procedures for newly enrolling providers and suppliers beginning on March 23, 2011. The new procedures would apply to current Medicare, Medicaid, and CHIP providers beginning on March 23, 2012.

Comments on the Proposed Rule are due to the Agency by November 16, 2010 at 5:00 pm.

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