Proposed settlement would clarify Medicare maintenance coverage   10/24/2012
The Centers for Medicare & Medicaid Services has reached a proposed settlement agreement with the Center for Medicare Advocacy in a 2011 federal class action lawsuit alleging that CMS wrongfully denies continued Medicare coverage of skilled services when a beneficiary's condition is chronic or not improving. Under the proposed agreement, which must still be approved by the court, the Medicare Benefit Policy Manual would be revised to clarify that skilled nursing facility, home health and outpatient therapy coverage of therapy or nursing services "does not turn on the presence or absence of a beneficiary's potential for improvement… but rather on the beneficiary's need for skilled care." The revisions also would clarify that an inpatient rehabilitation facility claim "could never be denied because a patient could not be expected to achieve complete independence in the domain of self-care" or "could not be expected to return to his or her prior level of functioning." Among other actions, CMS would conduct a campaign to educate providers, contractors and others about the new maintenance coverage standards.
FDA posts revised lists of providers who received NECC products   10/24/2012
The Food and Drug Administration last night posted revised lists of health care providers who received products shipped from the New England Compounding Center on or after May 21, which are believed to be of greatest risk of contamination in relation to a multistate outbreak of fungal meningitis. FDA said it cannot vouch for the accuracy of the new lists, which continue to be based on NECC data but are "the best information we have available at this time." The agency last week confirmed the presence of fungus in unopened vials from one of three lots of injectable epidural steroid medication recalled by NECC on Sept. 26. Testing continues on the other two lots and on other NECC injectable medications included in an Oct. 6 recall of all NECC products. FDA recommends that providers follow up with patients who were administered injectable products, ophthalmic drugs that are injectable or used in conjunction with eye surgery, and cardioplegic solution purchased from or produced by NECC and shipped on or after May 21. It also advises providers to secure and then return all remaining products to NECC. The Centers for Disease Control and Prevention last night issued updated guidance for monitoring certain asymptomatic patients.
Report looks at impact of health insurance rate reviews   10/24/2012
About one in five requests for rate increases in the small and individual health insurance markets in 2011 were denied, lowered or withdrawn during state review, according to a new report from the Kaiser Family Foundation. On average, approved rate increases were 1.4 percentage points lower than insurers initially requested. Beginning Sept. 1, 2011, insurers requesting rate increases of 10% or more were subject to rate review programs under the Patient Protection and Affordable Care Act. While many states had rate review programs in place before the ACA, the report found that 2011 rate requests above the 10% threshold were more likely to be denied, modified or withdrawn after the provision took effect.
Reminder: Members-only webinar Monday on bundled payment research   10/24/2012
AHA members are invited to attend a free Oct. 29 webinar on findings from a new study on Medicare bundled payment sponsored by the AHA and Association of American Medical Colleges. The webinar, from 2-3:30 p.m. Eastern Time, will discuss key implications for policy makers and health care providers, and answer questions from the audience. To register for the event, visit