CMS Issues Final Rule Re: Hospital-Specific Limitation

 

In the December 3, 2014 Federal Register (79 Fed. Reg. 71679), the Centers for Medicare & Medicaid Services (CMS) issued a final rule authorizing a service-specific basis for defining the uninsured, for the purpose of determining the hospital-specific limitation on disproportionate share hospital (DSH) payments. Under section 1923(g) of the Social Security Act, DSH payments to hospitals are limited to the uncompensated costs of providing hospital services to individuals who are Medicaid eligible or have no health insurance (or other source of third party coverage) for the services furnished during the year. [More]

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CMS Proposes Changes in Medicare ACO Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published proposed rules in the December 8, 2014 Federal Register on accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) under section 3022 of the Affordable Care Act (ACA). Under the MSSP, Medicare providers and suppliers that participate in a qualifying ACO receive traditional Medicare Part A and Part B fee-for-service payments, the ACO drives collaboration, and the ACO has an opportunity to earn “shared savings” bonus payments for each ACO “performance period” if it achieves MSSP savings targets and performance standards under quality measures for that period. [More]

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GAO Issues Report on Transparency of CMS Websites for Consumers

 

The U.S. Government Accountability Office (GAO) released a report on November 18, 2014 entitled, “Health Care Transparency: Actions Needed to Improve Cost and Quality Information for Consumers.” GAO found that five Centers for Medicare and Medicaid Services (CMS) websites launched over 12 years – Nursing Home Compare (1998), Dialysis Compare (2001), Home Health Compare (2005), Hospital Compare (2005), and Physician Compare (2010) – do not use language consumers understand, do not present data in ways meaningful to consumers, and do not help consumers collect information they need to make informed, value-based decisions about their care. While the CMS websites can motivate providers to improve quality of care, research shows that providers and consumers look at data differently. [More]

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HHS OIG Releases Work Plan for Federal Fiscal Year 2015

 

As the new Federal Fiscal Year began on October 1, 2014, a work plan was released that outlines the engagements planned throughout the year. The Office of Inspector General (OIG) was created was created “to protect the integrity of US Department of Health and Human Services (HHS) programs and operations and the well-being of beneficiaries by detecting and preventing fraud, waste, and abuse; identifying opportunities to improve program economy, efficiency, and effectiveness; and holding accountable those who do not meet program requirements or who violate Federal health care laws.” [More]

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CMS Launches $840 Million Quality Improvement Initiative

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) issued two funding opportunity announcements on the Transforming Clinical Practices Initiative (TCPI) on October 23, 2014. The two announcements describe opportunities for applicants to compete for up to $840 million in federal funding under cooperative agreements with CMS over a May 1, 2015 - April 30, 2019 performance period. Applicants may seek funding under cooperative agreements as Practice Transformation Networks (PTNs) or as Support and Alignment Networks (SANs). [More]

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CMS Issues Proposed Notice to Establish Methodology to Determine Federal Payments Under BHP in 2016

 

The Centers for Medicare & Medicaid Services (CMS) published in the October 23, 2014 Federal Register a proposed Notice (79 Fed. Reg. 63363) which would establish the methodology the agency intends to utilize to determine federal payments under the Basic Health Program (BHP) in 2016. Pursuant to Section 1331 of the Affordable Care Act (ACA), states can elect to operate a BHP, which would provide affordable health coverage to individuals under age 65 with household incomes between 133% and 200% of the federal poverty level who are not otherwise eligible for Medicaid, CHIP, or affordable employer-sponsored coverage. [More]

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HHS-ONC Releases Health IT Progress Report

 

The U.S. Department of Health and Human Services (HHS), Office of the National Coordinator for Health Information Technology (ONC) has released an October 2014 report to Congress which describes progress toward the development of a nationwide system for the electronic use and exchange of health information. The report shows that, as of June 2014, 75 percent (over 403,000) of the nation’s eligible health professionals and 92 percent (over 4,500) of eligible hospitals had received Medicare or Medicaid incentive payments for the adoption and meaningful use of certified electronic health record (EHR) technology authorized under the American Recovery and Reinvestment Act of 2009 (ARRA). [More]

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UCLA Publishes Study on Hospital Service Utilization in Demonstration Program

 

The UCLA Center for Health Policy Research published a landmark study on October 17, 2014 entitled, “Increased Service Use Following Medicaid Expansion Is Mostly Temporary: Evidence from California’s Low-Income Health Program.” UCLA analyzed hospital emergency room (ER) use, hospital inpatient admissions, and other hospital outpatient department (OPD) service utilization for individuals who were enrolled in 2011-2013 in the Low-Income Health Program (LIHP) under California’s innovative “Bridge to Reform” Medicaid demonstration waiver. UCLA sorted 182,443 LIHP enrollees in eight counties into four distinct groups based on expected “pent-up demand” in each group (the 69,095 in the highest group had the least access to county funded indigent care before enrolling in LIHP), controlled for other differences such as demographic variables using regression models, and tracked service utilization from the July 1 – September 30, 2011 quarter through the April 1 – June 30, 2013 quarter. [More]

 

HHS Report Updates ACA Impact on Medicaid Enrollments

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), released on October 17, 2014 a report showing that 26 jurisdictions (25 states and the District of Columbia) which implemented Medicaid expansion under the Affordable Care Act (ACA) by August 2014 saw on average a 22.09 percent increase in Medicaid/CHIP enrollments for August 2014, as compared to their average monthly enrollments in a July – September 2013 baseline period. [More]

 

CMS Releases Pioneer ACO Performance Data

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) released data on October 8, 2014 showing the quality of care and financial performance of accountable care organizations (ACOs) over the first two years of its Medicare Pioneer ACO program. For year two, the program achieved $96 million in net aggregate Medicare savings along with substantial improvements in 28 out of 33 quality of care metrics across four major quality of care domains. [More]

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