AHA criticizes OIG proposal to remove, reevaluate certain CAHs' status   08/15/2013
The AHA today took issue with a new report from the Department of Health and Human Services’ Office of Inspector General that recommends dramatic changes to the critical access hospital program. Specifically, the report recommends that the Centers for Medicare & Medicaid Services seek legislative authority to remove the permanent exemption from the distance requirement for “necessary provider” CAHs and revise the CAH Conditions of Participation to include alternative location-related requirements, claiming that 64% of the nation’s 1,329 CAHs would not meet the current location requirements if required to re-enroll in Medicare. It also recommends that CMS periodically reassess CAHs for compliance with all location-related requirements, and apply its uniform definition of “mountainous terrain” to all CAHs. Joanna Hiatt Kim, AHA vice president of payment policy, said, “The OIG’s recommendation that CMS seek legislative authority to remove and reevaluate certain CAHs’ special Medicare status is completely inappropriate and demonstrates an unfortunate lack of understanding of how health care is delivered in rural America. If the recommendation were implemented, many of these facilities may be forced to close and patients could lose their access to essential medical services.”
Groups urge CMS to comply with ACA coverage provision   08/15/2013
The AHA, Federation of American Hospitals, and Association of American Medical Colleges today urged the Centers for Medicare & Medicaid Services to require qualified health plans to provide health coverage for a full three-month grace period for nonpayment of premiums by people who qualify for advance payment of premium tax credits, as mandated by the Patient Protection and Affordable Care Act. A recent CMS final rule required QHPs only to pay all appropriate claims for services provided during the first month of the grace period. “The effect of this policy is to allow QHPs to retroactively terminate coverage for the second two months of the grace period,” the organizations wrote. “This shifts the burden related to patient protections during most of the grace period from QHPs to health care providers…Without payment for covered services, there is only an illusion of continued coverage during the 90-day grace period, not the actual continued coverage required by law.” CMS “promulgated this final policy without any indication of such a possibility in the proposed rule,” the letter notes. “Thus, affected stakeholders had no meaningful opportunity to comment.”
CMS extends application deadline for IPF quality reporting program   08/15/2013
Inpatient psychiatric facilities will have until Aug. 23 at 11:59 Pacific Time to submit their Notice of Participation in the IPF quality reporting program due to submission challenges with the online application, the Centers for Medicare & Medicaid Services announced today. The original deadline was Aug. 15. This new deadline is the same as the measure submission deadline for the program. IPFs and distinct-part psychiatric units in acute care hospitals are eligible to participate in the IPF quality reporting program. Participating facilities must submit the Notice of Participation and required measures by Aug. 23 to receive a full payment update in FY 2014. Questions about the data submission process should be directed to CMS contractor Telligen at (888) 961-6425 or IPF-PCHQRSupport@telligen.org.
HHS awards $67 million for insurance exchange navigators   08/15/2013
The Department of Health and Human Services today awarded 105 grants totaling $67 million for “navigators” to provide in-person assistance to individuals and small businesses enrolling in health coverage through Federally-facilitated and State Partnership Marketplaces, also known as exchanges, beginning Oct. 1. The navigators are expected to provide unbiased information in a culturally competent manner to consumers about health insurance, the new Health Insurance Marketplaces, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program. They must become certified by completing 20-30 hours of training and renew their certification yearly. To view the grantees, click here.
Study: About half of individually insured could receive tax credits next year   08/15/2013
An estimated 48% of Americans who currently buy health insurance through the individual market would be eligible for tax credits to offset the cost of coverage purchased through the Health Insurance Marketplace, or exchanges, according to a new analysis by the Kaiser Family Foundation. These people would receive an average subsidy of nearly $2,700 next year, which would reduce the premium for the second-lowest-cost silver plan by an average 32%, the study estimates. "Tax subsidies are an essential part of the equation for many people who buy insurance through the new marketplaces next year," said KFF President and CEO Drew Altman said. "They will help make coverage more affordable for low- and middle-income people."
AHA, health groups join HHS Champions for Coverage initiative   08/15/2013
AHA, the American Medical Association, and other physician and hospital groups have joined the Champions for Coverage initiative to help spread the word about the Health Insurance Marketplace, also known as exchanges, that will begin enrolling individuals and small businesses in health coverage Oct. 1. The Department of Health and Human Services launched the initiative earlier this month. Participants help promote the marketplace at HealthCare.gov and CuidadoDeSalud.gov and the Consumer Call Center at (800) 318-2596 to members, customers and partners. For more information or to apply to participate, visit marketplace.cms.gov/help-us/champion.html.