HHS Says Federal Basic Health Plan Set for 2015

In a letter to Senator Maria Cantwell (D-WA), HHS indicated that the rules for the Federal Basic Health Plan Option (FBHPO) will be proposed this year and finalized in the first quarter of 2014. In 2015 the FBHPO will be made available to individuals ineligible for Medicaid but with incomes under 200% of the federal poverty level.

Final Rule for Increased FMAP under PPACA

CMS released a final rule which defines the methodology that states must use to apply for the increased Federal Medical Assistance Percentage (FMAP) matching rates (100% in 2014-16 for new expansions) available under the PPACA when states voluntarily decide to expand Medicaid coverage to those with incomes up to 138% of the federal poverty level. Public comments are due by June 3.

MedPAC Concerned with MA Premium Rates and SGR

The Chairman of the Medicare Payment Advisory Commission (MedPAC) sent a letter to CMS stating the panel’s concerns with the practice of the agency to incorporate potential Medicare physician payment cuts into the final payments established for Medicare Advantage (MA) plans. He said it creates uncertainty in the MA bidding process and results in insurers having to continually catch up their rates with actual physician costs. However, he also pointed out that the problem is created mainly because of the last minute actions taken by Congress to delay or mitigate the physician payment cuts resulting from the flawed sustainable growth rate (SGR) formula under current law.

IOM Report Unfavorable on Medicare Geographic Adjustments

The Institute of Medicine (IOM) released a report in which Harvard analysts said that a congressional proposal to base Medicare physician and hospital payment rates on a “geographic value index” would result in unfair payments. They concluded that such an index would likely mischaracterize the actual value of services, particularly in heavy-spending geographic regions. Congressional members from low-spending regions have suggested that a geographic adjustment is needed to appropriately compensate providers in their districts.

OIG Issues Fraud Alert Regarding PODs

The HHS Office of the Inspector General (OIG) issued a fraud alert stating that physician-owned distributorships (PODs) which market medical devices to hospitals produce “substantial fraud and abuse risk” and may be found to be in violation of anti-kickback laws. Senate Finance Committee leaders have previously expressed their concerns with PODs and asked HHS to look into the potential problems they may pose.

CMS Chronic Disease Online Data

CMS announced it will launch a so-called “Chronic Conditions Dashboard” on its website. The tool will include: summary information from the agency’s Chronic Conditions Data Warehouse; 2011 state, Hospital Referral Region and national comparison data on the prevalence of chronic conditions; and Medicare costs and utilization data for beneficiaries having chronic conditions.

Upcoming Health-Related Hearings/Markups

The House Energy and Commerce Subcommittee on Health will hold a hearing on Wednesday, April 3 at 1:00 p.m. in 2322 RHOB to discuss “Protecting America’s Sick and Chronically Ill” in connection with the recent HHS announcement to cease covering individuals under the PPACA’s Pre-Existing Condition Insurance Program (PCIP).

The Senate Health, Education, Labor and Pensions Committee will mark up legislation on April 10; the mental health legislation is intended to “help schools become safer and help people struggling with mental health problems to get the treatment that they need.”

Health Legislation Recently Introduced

H.R. 1404 (MEDICAID), to amend Title XIX of the Social Security Act to eliminate the increased federal medical assistance percentage under the state plan with respect to newly eligible mandatory individuals under Medicaid, to provide states with greater flexibility under Medicaid, and for other purposes; SALMON; to the Committee on Energy and Commerce, March 25.

December 31, 1969: | Page 1 Page 2



 -  2019

 +  2018