POLICY BRIEFINGS


PCORI Grants


It was announced that the Patient Centered Outcomes Research Institute (PCORI) board of governors has approved more than $1 billion in grants in 2014 and 2015 for comparative effectiveness research projects.


CMS to Discuss Final CY 2014 Medicare Physician Payment Rule


Although the Office of Management and Budget (OMB) is still reviewing the final Medicare physician fee schedule rule for 2014, CMS announced that two National Provider Calls will be used to discuss the rule. On December 3, the call will allow participants to discuss the phase-in of the physician value-based payment modifier; and the call on December 17 will include a CMS presentation on how eligible professionals and group practices can meet the criteria for the 2014 physician quality reporting system incentive, the 2016 Physician Quality Reporting System (PQRS) payment adjustment, program updates to the electronic health record incentive program and the physician compare program.


Final 2014 Medicare Payment Rules for HHA's and Dialysis Facilities


CMS issued final Medicare payment rules for home health agencies which will result in about a 1% reduction in 2014 payments over payments in 2013. The agency also issued a final rule stating that Medicare reimbursements for dialysis facilities will remain about the same in 2014 as in 2013. The end stage renal disease (ESRD) rule also provides for a multiyear phase-in of the American Taxpayer Relief Act’s mandate to reduce payments to account for changes in the utilization of ESRD-related drugs and biologicals.


ESRD Patients Can Get Payment Assistance


In accordance with an advisory opinion issued by the HHS Office of the Inspector General (OIG), the OIG said it would not impose Stark law anti-kickback penalties against an insurer’s payment of the costs of a patient’s treatment for end-stage renal disease as long as the payments involve Medicare-eligible patients already receiving dialysis care for ESRD.


Proposed Expansion of Coverage for CHF


CMS issued a proposed decision memorandum seeking comments on a possible expansion of Medicare coverage for cardiac rehabilitation services by including beneficiaries who have chronic heart failure (CHF). Comments are due by December 21, 2013.


FDA Approves Bird Flu Vaccine


The FDA announced that it has approved a Glaxo SmithKline H5N1 influence “bird flu” vaccine to supplement the national stockpile. The approval does not extend to commercial use of the vaccine, however.


Upcoming Health-Related Hearings and Markups


House Oversight and Government Reform Committee: will hold a field hearing titled “Obamacare Implementation: High Costs, Few Choices for Rural America.” 10 a.m., Hall County Government Center, Gainesville, Ga.; Nov. 25.

Senate Finance Committee: Executive Session markup to consider legislation to repeal the sustainable growth rate system (SGR) and to consider health care extenders; 10:00 a.m., 215 Dirksen Bldg.; Dec. 12.



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