AHA, hospitals seek expedited proceedings in challenge of CMS RAC policy   12/13/2012
The AHA and hospital system co-plaintiffs today urged a federal court to expedite proceedings in their lawsuit challenging the Department of Health and Human Service's refusal to reimburse hospitals for reasonable and necessary care that recovery audit contractors later decide could have been provided in an outpatient setting. "[R]esolving this matter at an accelerated pace is essential," the request for an expedited status conference states. "Each day that [the Centers for Medicare & Medicaid Services] enforces the policy…hospitals lose hundreds of thousands of Medicare reimbursement dollars for medically necessary items and services they have provided." The request asks the trial court to immediately accelerate the schedule for future proceedings in the case, including any motions and pleadings from the government, to resolve the claims quickly on summary judgment. "Plaintiffs stand ready to brief [the court] on the merits - more than ready, in fact," the request states. "They have lodged [as an attachment] a proposed motion for summary judgment." The lawsuit seeks to overrule CMS' nonpayment policy, which AHA and the hospitals say "has shunted providers into an endless loop" of payment denials by contractors who know they will later be overturned on appeal.
House panel holds hearing on ACA exchanges, Medicaid expansion   12/13/2012
Fifteen states to date have chosen to operate their own insurance exchange beginning in 2014, while four have chosen to operate a partnership exchange and seven to participate in a federally facilitated exchange, Centers for Medicare & Medicaid Services officials told the House Energy and Commerce Subcommittee on Health today at a hearing on implementing the Patient Protection and Affordable Care Act's insurance exchanges and Medicaid expansion. States that choose to run their own exchanges must submit a blueprint for their exchange to the Department of Health and Human Services by Dec. 14, while those opting to operate an exchange in partnership with HHS must submit a blueprint by Feb. 15, 2013. Witnesses from the state health departments of Louisiana, Wisconsin, Pennsylvania, Maryland and Arkansas also participated in the hearing and offered testimony regarding both the insurance exchanges and the Medicaid expansion.
Senate committee updated on CMS dual-eligible initiatives   12/13/2012
The Senate Finance Committee today held a hearing on progress to improve and integrate care for the more than 9 million Americans enrolled in both the Medicare and Medicaid programs. Melanie Bella, who directs the Centers for Medicare & Medicaid Services office created for that purpose by the Patient Protection and Affordable Care Act, described how the agency is partnering with states to test payment and service delivery models through the Financial Alignment Initiative, and with hospitals and other organizations to reduce preventable hospitalizations among nursing facility residents. Other witnesses included state officials from Arizona, Washington and Ohio.
AHA: Smarter, not more, regulation needed   12/13/2012
Smarter regulations that put patients first by promoting high-quality and efficient health care are needed, AHA President and CEO Rich Umbdenstock notes in an AHA advertorial today in the Wall Street Journal. "Unnecessary or poorly targeted regulations don't help patients - but cost providers and our communities. They also obstruct the innovation and connections needed to make our fragmented health care system more patient-focused…Building a better health care system means eliminating outdated rules and regulations and ensuring that new ones are coordinated, efficient and effective." For more, visit www.aha.org/smartregs.
CMS approves OH Medicaid-Medicare project   12/13/2012
Ohio is the third state to partner with the Centers for Medicare & Medicaid Services in the Financial Alignment Demonstration to test a new capitated payment and integrated care model for patients enrolled in both Medicare and Medicaid, the agency announced yesterday. Part of a CMS demonstration announced last year, the project will contract with five managed care plans that will oversee and be accountable for the delivery of covered Medicare and Medicaid services for dual enrollees in seven regions of the state. About 115,000 beneficiaries will be able to opt in to the program beginning in September 2013. John Palmer, public affairs director for the Ohio Hospital Association, said OHA "continues to have reservations about the Medicaid managed care plans' ability to truly manage the health care of their enrollees, as well as how this intense and fast realignment of Medicaid recipients from fee-for-service to managed care will affect Ohio's Upper Payment Limits programs. We look forward to continue collaborating with state officials on the refinement of these vital health care programs and to help ensure it benefits patients first."