House set to vote on fiscal cliff 'Plan B'   12/20/2012
The U.S. House of Representatives is poised to vote tonight on legislation to avert some of the effects of the so-called "fiscal cliff." The package, dubbed "Plan B" by House Speaker John Boehner (R-Ohio), would prevent tax rates from increasing on those earning less than $1 million a year while also delaying parts of the sequester set to kick in early next year, but not the 2% Medicare sequester. The delay would be funded in part by cutting health care spending. Specifically, the package would reduce the Medicaid provider assessment rate from 6% to 5.5% beginning June 1, 2013, repeal the Medicaid and Children's Health Insurance Program maintenance-of-effort rules under the Patient Protection and Affordable Care Act, and reduce Medicaid state disproportionate share hospital allotments for fiscal year 2022. It also would repeal unlimited funding for exchange grants under the ACA, eliminate the Prevention and Public Health Fund, and defund the ACA's Consumer Operated and Oriented Plan program. "The impending budget crisis is real, and we need to work together to provide financial certainty to our economy," said AHA President and CEO Rich Umbdenstock. "But today's proposal by the House would negatively impact all patients, especially the nation's most vulnerable - children, the poor, elderly and the disabled." Senate Democrats have said they will not take up the bill, and the White House has issued a veto threat.
AHA, others urge Senate to reauthorize CHGME program   12/20/2012
The AHA and three other organizations today urged Senate leaders to pass legislation that would reauthorize the Children's Hospitals Graduate Medical Education program, which provides funding to help freestanding children's hospitals train pediatric residents. "The CHGME program is an investment in the health care of every child in this country, and an investment in the future of the nation," the groups wrote to senate leaders. "In these challenging times, passage of CHGME reauthorization legislation before the end of the year will signal Congress's continued bipartisan, bicameral support of this critically important program." The American Academy of Pediatrics, Association of American Medical Colleges and Children's Hospital Association also signed the letter. The U.S. House of Representatives yesterday approved by voice vote S. 1440, which reauthorizes both the CHGME program and the Prematurity Research Expansion and Education for Mothers who deliver Infants Early Reauthorization Act. The PREEMIE Act reauthorizes funding for the prevention of preterm births.
AHA weighs in on EHB proposed rule   12/20/2012
The AHA today expressed concerns that the Centers for Medicare & Medicaid Services' proposed rule implementing the Patient Protection and Affordable Care Act's provisions relating to essential health benefits, actuarial value and accreditation "may have granted states and health plans too much flexibility, undermining the ACA's goal of extending meaningful and affordable coverage" to the uninsured or underinsured. "The definition of EHB is the cornerstone for determining whether the health coverage offered and purchased is truly meaningful - that is, ensuring the ability to respond to individuals' needs with coverage of services grounded in clinical, evidence-based guidelines," wrote Linda Fishman, AHA senior vice president for public policy analysis and development, in comments to the agency. "… While the AHA supports appropriate flexibility, we remain concerned that too much emphasis is being placed on providing flexibility and affordability rather than ensuring that coverage is meaningful." The AHA's comments are based on the EHB framework it first shared with the Institute of Medicine last year, which "looks to balance the availability of a comprehensive benefit package capable of meeting individual needs, with the need to keep the benefit package affordable by emphasizing broad coverage grounded in evidence-based clinical guidelines."
HHS grants conditional approval for three exchanges   12/20/2012
Delaware, Minnesota and Rhode Island have received conditional approval to operate health insurance exchanges beginning in 2014, the Department of Health and Human Services announced today. Delaware became the first state to receive conditional approval to operate an exchange in partnership with HHS, and Minnesota and Rhode Island received conditional approval to operate state-based exchanges. Last week, HHS granted conditional approval for state-based exchanges in Colorado, Connecticut, the District of Columbia, Kentucky, Massachusetts, Maryland, New York, Oregon and Washington state. States opting for a partnership exchange must submit a blueprint to HHS by Feb. 15, 2013. HHS said Arkansas, Illinois, Iowa and North Carolina expressed early interest in a partnership exchange.
CMS notifies physicians of pending payment cut   12/20/2012
The Centers for Medicare & Medicaid Services yesterday notified physicians that a 27% pay cut is set to take effect Jan. 1. In its notice, CMS expressed disappointment that Congress "has failed to pass a solution to eliminate the sustainable growth rate formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk," and urged Congress to prevent the cuts from going into effect. Given that electronic claims are paid no sooner than 14 days after receipt, Congress has until Jan. 14 to act to prevent the cut to physician payments before 2013 claims will be processed. CMS said it would update physicians again by Jan. 11.
CDC updates on possible spinal infections associated with NECC drugs   12/20/2012
New information from recent magnetic resonance imaging of patients exposed to contaminated methylprednisolone acetate from the New England Compounding Center in Framingham, MA, demonstrates the need for assertive clinical evaluation of these patients for the possibility of an unrecognized, localized spinal or paraspinal infection, the Centers for Disease Control and Prevention said today. "These findings demonstrate that among patients with no previous evidence of infection, and with new or worsening symptoms at or near the site of their injection, more than 50% had findings suggestive of a localized spinal or paraspinal infection, including epidural abscess, phlegmon, arachnoiditis, discitis, or vertebral osteomyelitis," the notice said. CDC recommends MRIs with contrast of the symptomatic areas in patients with new or worsening symptoms at or near their injection site following spinal or paraspinal injection of implicated MPA. The agency also recommends clinicians consider obtaining an MRI for patients with persistent but baseline symptoms because the infections can be difficult to distinguish from a patient's baseline chronic pain. Contaminated drugs from NECC have been linked to 39 deaths and more than 620 illnesses.
OIG: Free access to electronic interface would not violate anti-kickback statute   12/20/2012
A hospital's proposal to provide free access to an electronic interface to community physicians and physician practices allowing them to transmit orders and results for certain services to the hospital would not violate the federal anti-kickback statute or lead to administrative sanctions, the Department of Health and Human Services' Office of Inspector General said in an advisory opinion released yesterday. Under the proposed arrangement, the hospital would provide free access to the interface to all physicians who request it, and through a contractor, the hospital would provide support services necessary to maintain the interface. Physicians would remain responsible for all aspects of their electronic health records system that would allow them to communicate with the hospital through the interface, which would be used only to transmit orders for laboratory and diagnostic services to the hospital and receive the results. "Based on the facts certified in your request for an advisory opinion and supplemental submissions, we conclude that the Proposed Arrangement would not generate prohibited remuneration under the anti-kickback statute," OIG said. The opinion is limited to the proposed arrangement and has no application to, and cannot be relied upon by any other individual or entity, OIG noted.