AHA urges CMS to delay certain inpatient admission and review criteria   09/18/2013
AHA today urged the Centers for Medicare & Medicaid Services to delay at least until January certain inpatient admission and review criteria included in the inpatient prospective payment system final rule. “The AHA recognizes that the creation of the two-midnight presumption, along with several directives in the rule which, if set forth clearly and precisely in guidance to providers and contractors, could be helpful in reducing some number of appeals of Part A claims denials,” wrote Linda Fishman, AHA senior vice president of public policy analysis and development. “These elements should be implemented on Oct. 1. However, other elements of this policy need significant further guidance and provider education from CMS and additional time for hospitals, physicians and review contractors to operationalize.” The AHA letter recommends specific inpatient admission scenarios for CMS to address in its guidance, adding, “We continue to believe that the 0.2% reduction to the PPS market basket update was unjustified and ask that CMS work with us to develop a payment solution to address those intense, inpatient-level services provided by hospitals to Medicare beneficiaries that are reasonable and necessary but do not appear on the inpatient-only list and are not expected to span two midnights.” 
CMS: Health spending to grow average 5.8% annually through 2022   09/18/2013
National health spending is expected to grow an average 5.8% annually from 2012-2022, the Centers for Medicare & Medicaid Services reported today in Health Affairs. While CMS projects health care spending growth will remain less than 4% this year, it expects improving economic conditions, expanded health coverage under the Patient Protection and Affordable Care Act, and an aging population to drive faster projected growth in 2014 and beyond. According to the report, spending for hospital care grew an estimated 4.9% in 2012, its third straight year below 5%. CMS expects spending for hospital care to slow to 4.1% in 2013, largely due to a 2% reduction in Medicare spending under sequestration, then increase 4.7% in 2014, 5.6% in 2015 and an average 6.4% per year in 2016-2022. The agency projects the health care share of gross domestic product will rise from 17.9% in 2011 to 19.9% by 2022. CMS notes that although projected growth of overall health spending is faster than in the previous few years, it is still slower than the growth experienced in most years since 1990.
CMS issues FQHC prospective payment system proposed rule   09/18/2013
The Centers for Medicare & Medicaid Services today issued a proposed rule to establish a prospective payment system for Federally Qualified Health Centers under Medicare Part B beginning Oct. 1, 2014, as required by the Patient Protection and Affordable Care Act. The proposed rule also would make changes to the Clinical Laboratory Improvement Amendments regulations giving CMS more discretion in enforcing proficiency testing referral rules. In addition, the rule would allow rural health clinics to contract with non-physician practitioners. According to CMS, Medicare payments to FQHCs would increase about 30% for services furnished to Medicare beneficiaries in medically underserved areas. Medicare would pay the centers a single encounter rate per beneficiary per day for all services provided, which would be adjusted for geographic variation in costs and the higher costs associated with patients who are new or receiving an initial comprehensive Medicare exam or annual wellness visit. Medicare currently pays FQHCs based on reasonable costs, subject to payment limits. The ACA requires the Medicare PPS to account for the type, intensity and duration of services provided, without payment limits. The centers would transition to the new payment system throughout FY 2015. The proposed rule will be published in the Sept. 23 Federal Register with comments accepted through Nov.18.
Agencies coordinating fraud prevention for Health Insurance Marketplace   09/18/2013
The departments of Justice and Health and Human Services and Federal Trade Commission today announced a coordinated effort to prevent consumer fraud and privacy violations in the Health Insurance Marketplace. Among other actions, the Marketplace Call Center will serve as a resource and referral to FTC for consumer fraud concerns, with staff trained to refer consumer threats and complaints. The initiative also will connect consumers to FTC’s Complaint Assistant through HealthCare.gov; develop a system for routing complaints through the FTC’s Consumer Sentinel Network for analysis and referral as appropriate; establish a rapid response mechanism for addressing privacy or cybersecurity threats; and ramp up public education to empower consumers and assisters to know the facts and avoid scams. “We have strong security safeguards in the Marketplace to protect people’s personal information against fraud and we will work with our partners to aggressively prosecute bad actors, just as we have been doing in Medicare, Medicaid and the Children’s Health Insurance Program,” said HHS Secretary Kathleen Sebelius. 
Deadline for posting revised HIPAA privacy notice approaching   09/18/2013
Sept. 23 is the deadline for hospitals and other entities covered by the Health Insurance Portability and Accountability Act to post updated privacy notices under the HITECH Act of 2009. A final rule implementing the HITECH Act’s HIPAA provisions introduced new content requirements for the privacy notice. HIPAA-covered entities with a direct treatment relationship with patients must prominently post the revised notice on their website by Sept. 23 and make the revised notice available to patients upon their request on or after that date. The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology and Office for Civil Rights have developed model notices that may serve as a guide for hospitals and health plans updating their notices to meet the new requirements.
Hospitals urged to verify Leapfrog safety data by Oct. 7   09/18/2013
About 2,500 general acute-care hospitals slated to receive safety scores from the Leapfrog Group can confidentially preview their scores and underlying data online starting tomorrow, and should report any errors in the data to Leapfrog by Oct. 7. CEOs at affected hospitals should receive a letter from Leapfrog soon with log-in information. Reviewers will see the hospital’s score on individual measures, not its overall grade, which may change based on Leapfrog’s cut off point for the data. Leapfrog excludes from its hospital safety scorecard critical access hospitals, specialty hospitals, federal hospitals, mental health facilities, freestanding children's hospitals, hospitals in Maryland and U.S. territories, and those with fewer than nine process measure scores or three outcome scores. For more information, contact Leapfrog at scorehelp@leapfroggroup.org.