House Hearing on Means to Curb Fraud Under Medicare

The House Energy and Commerce Health Subcommittee heard testimony from GAO which criticized CMS efforts to reduce health care fraud which costs Medicare $60 billion annually.  The Health Care Director said that CMS has not implemented GAO recommendations to: remove Social Security numbers from Medicare cards; require providers in high-risk areas to post surety bonds; and to integrate the CMS predictive analytics system into existing HIT systems.  Also discussed were efforts to set up smart ID card pilot programs and expanding CMS authority to prevent beneficiaries from doctor shopping to obtain large amounts of drugs.

PPACA Proposed Rules on Multi-state Plans and Pre-Existing Conditions

CMS released a 373-page proposed “Notice of Benefit and Payment Parameters for 2014” which provides further guidance on risk programs established under a final rule HHS released in March and on advance payments of premium tax credits and cost-sharing reductions.  The Office of Personnel Management also released a proposed rule “Establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges” under which at least two multistate plans will be certified to operate under health insurance exchanges in 2014.

It's Not Over Until It's Over

Despite the Supreme Court’s decision backing the constitutionality of the PPACA and its individual mandate, the Court has granted a petition by Liberty University which challenges an appeals court decision which said that the University’s suit (maintaining that the PPACA employer mandate is unconstitutional) was barred by the tax anti-injunction act (AIA).

IB on Medicaid Psychiatric Service Reimbursements

CMS released an informational bulletin which will give state Medicaid programs more flexibility in the reimbursement of facilities providing inpatient psychiatric services to individuals under age 21.  States may now directly reimburse individual practitioners or other providers of psychiatric services, provided they are part of an individual’s overall treatment plan supervised by an inpatient psychiatric facility.

CMS National Coverage Decision Topics

CMS released a list of topics that could be considered for purposes of granting national coverage decisions.  Topics include, among others: surgical procedures, diagnostic tests or procedures, imaging or radiology services, lab tests, or durable medical equipment (such as glucose monitors or wheelchairs); treatments for diseases such as cancer, heart disease, kidney disease or gastrointestinal disease; and procedures such as orthopedic or eye procedures.  The agency also released draft updated guidance on the use of coverage with evidence development (CED) for Medicare coverage decisions.

Health Legislation Recently Introduced

S. 3641 (ASTHMA), to amend the Public Health Service Act with regard to research on asthma, and for other purposes; LAUTENBERG; to the Committee on Health, Education, Labor, and Pensions, Nov. 27.

H.R. 6606 (CONTROLLED SUBSTANCES), to amend the Controlled Substances Act to provide that federal law shall not preempt state law; DEGETTE; jointly, to the committees on the Judiciary and Energy and Commerce, Nov. 27.

H.R. 6608 (ASTHMA), to amend the Public Health Service Act with regard to research on asthma, and for other purposes; MCCARTHY of New York; to the Committee on Energy and Commerce, Nov. 27.

H. CON. RES. 141 (MENTAL HEALTH), expressing the sense of Congress, efforts by mental health practitioners to change an individual’s sexual orientation and gender identity or expression are dangerous and harmful and should be prohibited from being practiced on minors; SPEIER; to the Committee on Energy and Commerce, Nov. 28.

H.R. 6611 (MEDICARE), to amend Title XVIII of the Social Security Act to promote public notification and provide incentives to reduce drug shortages, and for other purposes; CASSIDY; jointly, to the committee on Energy and Commerce and Ways and Means, Nov. 29.

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