Medicare Audit Improvement Act introduced in Senate   05/22/2013
Sens. Mark Pryor (D-AR) and Roy Blunt (R-MO) today introduced a Senate companion to the Medicare Audit Improvement Act (S. 1012/H.R. 1250), legislation strongly supported by the AHA to improve the Recovery Audit Contractor program and other Medicare audit programs. AHA applauded the action and encouraged quick passage by Congress. “Hospitals are inundated with multiple auditing programs (Recovery Audit Contractors, Medicare Administrative Contractors and Comprehensive Error Rate Testing Contractors),” said AHA Executive Vice President Rick Pollack. “These duplicative audits, unmanageable medical record requests and inappropriate payment denials are overwhelming hospitals and diverting resources from patient care. According to an AHA survey, when hospitals decide to commit the time and resources necessary to fight RAC denials in the Medicare appeals process, they are successful at overturning the RAC denial 72% of the time. This legislation provides much needed guidance for auditors while keeping them out of making medical decisions that should be between patients and their physicians. It also will improve recovery auditor transparency and allow denied inpatient claims to be billed as outpatient claims when appropriate.” Reps. Sam Graves (R-MO) and Adam Schiff (D-CA) introduced the bill in the House.
Senate committee approves drug compounding, 'track and trace' bill   05/22/2013
The Senate Health, Education, Labor and Pensions Committee today approved legislation to improve the safety of compounded drugs by clarifying the oversight responsibilities of state and federal authorities. The legislation distinguishes between traditional compounding pharmacies and “compounding manufacturers,” which make sterile products without or in advance of a prescription and sell them across state lines. Traditional compounding would continue to be regulated primarily by state pharmacy boards, while compounding manufacturers would be regulated by the Food and Drug Administration. Health systems that engage in sterile compounding would be considered traditional compounders, regulated by the states as they are now, even if they ship interstate for dispensing within their system. The approved bill (S. 959) incorporates “track and trace” legislation (S. 957) to increase the safety and security of the nation’s drug distribution system by requiring interoperable, electronic unit-level product tracing within 10 years. According to a report released by the committee today, large-scale drug compounders continue to pose a serious risk to public health since last year’s fungal meningitis outbreak involving the New England Compounding Center.
NGA task force to focus on state health care delivery, payment reforms   05/22/2013
The National Governors Association yesterday named a task force to focus on state innovations that require the redesign of health care delivery and payment systems with the objectives of improving quality and controlling costs. Through the sharing of state experiences and best practices, the Health Care Sustainability Task Force will work to identify areas where federal legislative or regulatory action is necessary to reduce barriers and further support state initiatives. Oregon Gov. John Kitzhaber and Tennessee Gov. Bill Haslam will co-chair the task force, whose members include Alabama Gov. Robert Bentley, Arkansas Gov. Mike Beebe, California Gov. Jerry Brown, New Mexico Gov. Susana Martinez, New York Gov. Andrew Cuomo, South Dakota Gov. Dennis Daugaard, Utah Gov. Gary Herbert and Vermont Gov. Peter Shumlin. Maryland Gov. Martin O’Malley and Nevada Gov. Brian Sandoval will serve as ex-officio members.
CMS to host webinar on second round of innovation grants   05/22/2013
The Centers for Medicare & Medicaid Services will host an informational webinar May 28 for potential applicants in round two of the Health Care Innovation Awards, which will provide up to $1 billion in funding to test new payment and service delivery models. All applicants for round two, announced last week, must submit by June 28 a non-binding letter of intent to apply. Health care providers and health systems are eligible. To register for the 90-minute webinar, click here.
CMS approves Virginia dual-eligible demonstration   05/22/2013
Virginia is the sixth state to partner with the Centers for Medicare & Medicaid Services in the Financial Alignment Demonstration to test a new capitated payment and integrated care model for patients enrolled in both Medicare and Medicaid, Gov. Bob McDonnell announced yesterday. Under the Commonwealth Coordinated Care initiative, Virginia and CMS will enter into a contract with health plans to coordinate the delivery of primary, preventive, acute, behavioral and long-term services and supports for more than 78,000 enrollees, including older adults and people with disabilities, who live in designated regions of the state. The initiative will begin in January and continue through 2017.