CMS adopts operating rules for electronic fund transfers, remittance advice    08/07/2012
The Centers for Medicare & Medicaid Services today released an interim final rule adopting operating rules for electronic transfer of health care funds and remittance advice under the Health Insurance Portability and Accountability Act. As recommended by the AHA, the rule adopts operating rules developed by the Council for Affordable Quality Healthcare's Committee on Operating Rules for Information Exchange, which link the remittance advice with the fund transfer so health care providers can match the transactions when they arrive separately. The interim final rule takes effect Aug. 10 with comments accepted for 60 days. Health plans and other HIPAA-covered entities, including hospitals, must comply with the operating rules by Jan. 1, 2014. When combined with an earlier rule adopting federal standards for electronic fund transfer and remittance advice, CMS estimates the operating rules will save between $2.7 billion and $9 billion in administrative costs over 10 years by reducing manual administrative processes for physicians, hospitals and health plans.
CMS Official: States can opt in and then out of Medicaid expansion   08/07/2012
States may choose to adopt the Patient Protection and Affordable Care Act's Medicaid expansion and later decide to drop it, a Centers for Medicare & Medicaid Services official told state legislators yesterday. "Our key message to states is that there's a lot to think through and there's no deadline by which states have to make that determination," said Cindy Mann, director of CMS' Center for Medicaid and CHIP Services, recapping her talk with state officials at a National Conference of State Legislatures summit in Chicago. "We expect and encourage states to look at what their choices are and what their options are. In that regard, we made it clear that the expansion for low-income adults is voluntary with states. That means a state can decide when to come in, if to come in and also, if a state does adopt the expansion and determines at a later time, for whatever reason, that it does not want to maintain the expansion, it could also decide, because it's a voluntary program, to drop the expansion. And we talked about the fact that all other aspects of the law remain intact, including the very favorable federal match rate that's available, and that states need to think through both the costs and the benefits of moving forward." In June, the U.S. Supreme Court ruled the ACA's Medicaid expansion constitutional, but said that the federal government could not withhold all existing Medicaid funds from a state that refuses to participate in the Medicaid expansion.
Report identifies successful governance practices in large health systems   08/07/2012
A new study by the Commonwealth Center for Governance Studies identifies effective governance practices at large nonprofit health systems, and steps that boards and CEOs can take to improve their organization's governance and performance. The authors, led by University of Kentucky College of Public Health Associate Dean Lawrence Prybil, recommend that boards review their roles and responsibilities in the context of recent and anticipated changes in the health care environment and communities they serve; re-examine their agendas and practices to devote more time and energy to strategic deliberations; and review their evaluation processes to ensure they consistently generate action and improve their effectiveness. The report also advises boards to charge a standing committee to oversee system-wide community benefit policies/programs and population health priorities; develop better methods and practices to be accountable to the community; and more clearly define their role in quality and patient safety. In addition, the report calls for boards to make leadership succession planning a system-wide strategic priority, and appraise the boardroom culture for ways to make it healthier and more effective. The report is available from the AHA's Center for Healthcare Governance at www.americangovernance.com/gov-booklet.