CMS issues draft parameters for certain ACA provisions beginning in 2014   11/30/2012
The Centers for Medicare & Medicaid Services today issued a proposed rule further detailing parameters for several Patient Protection and Affordable Care Act provisions beginning in 2014. These include the ACA's risk adjustment, reinsurance, and risk corridors provisions, including calculation of reinsurance contributions to be paid by self-insured employer plans; user fees to be paid by health plans for participating in a federally facilitated insurance exchange; processing of cost-sharing reductions and advance payments of the premium tax credit to plans to avoid access barriers for low-income enrollees; implementing provisions for a federally facilitated Small Business Health Option Program; and changes to the medical loss ratio requirements including treatment of community service expenses for tax-exempt plans. The proposed rule will be published in the Dec. 7 Federal Register with comments accepted through Dec. 31. Also today, the Office of Personnel Management issued a proposed rule outlining the Multi-State Plan Program. The ACA directs OPM to contract with private health insurers to offer at least two multi-state plans on each state insurance exchange. The rule will be published in the Dec. 5 Federal Register with comments accepted for 30 days.
CMS contractor to host Dec. 6 webinar on IPF quality reporting   11/30/2012
The Centers for Medicare & Medicaid Services' support contractor for the Inpatient Psychiatric Facility Quality Reporting Program on Dec. 6 will host the first in a series of training webinars for participants in the program. The presentation will be followed by a question-and-answer session. Slides for the webinar will be posted prior to the event. For more information and to register, visit
ISMP issues safety guidelines for sterile compounding   11/30/2012
The Institute for Safe Medication Practices yesterday issued guidelines for safe preparation of sterile compounds. The guidelines were developed at an October 2011 ISMP summit that reviewed current methods used to prepare compounded sterile products and sought to identify and standardize critical quality control practices. To register for a free ISMP symposium Dec. 3 on the new guidelines, go to
AMA: 70% of health insurance markets 'highly concentrated'   11/30/2012
Most U.S. health insurance markets are highly concentrated, according to a report released this week by the American Medical Association. Examining market share and concentration levels for health maintenance organizations, preferred provider organizations and point-of-service plans in 385 metropolitan areas, the study found 70% of the markets are rated "highly concentrated" based on 2010 Horizontal Merger Guidelines issued by the U.S. Department of Justice and Federal Trade Commission. In 89% of the areas, at least one insurer held a commercial market share of 30% or more. "In sum, the majority of health insurance markets in the United States are highly concentrated," the report states. "Coupled with the concomitant large increases in premiums, insurer profitability, lower scope of benefits and high barriers to entry, this strongly suggests that health insurers are exercising market power in many parts of the country and in turn causing competitive harm to consumers and providers of care."
Report looks at state efforts to establish insurance exchanges   11/30/2012
The Kaiser Family Foundation has issued an updated report on state decisions and efforts to establish health insurance exchanges under the Patient Protection and Affordable Care Act. To date, 18 states have indicated they will run their own exchanges; six have opted for a partnership exchange; 17 states will default to a federal exchange; and 10 states remain undecided, according to the report. States that choose to run their own exchanges face a Dec. 14 deadline to submit a blueprint for their exchange to the federal government, and those opting for a partnership exchange must submit a blueprint by Feb. 15, 2013.