CMS Releases New Instructions for Hospital Settlement Program

The CMS program intended to reduce the volume of hospital patient status claims pending in the appeals process, through an “administrative agreement”, was modified by the agency to make clear that the agreement is a one-time settlement offer (for 68% of the disputed amount), that the settlement request is voluntary and that payment under a completed settlement will be made within 60 days. Nonetheless, House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) sent a letter to the HHS Secretary calling for the process to be halted and stating that settling all appeals without reviewing the merits of the appeals or coming up with any plan to address the backlog hurts the integrity of Medicare and is a waste of taxpayer dollars.

IOM Promotes End of Life Program Changes

In a report released by the Institute of Medicine (IOM), Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, the institute recommends that Medicare, Medicaid and other health delivery programs be restructured to better address the needs of people nearing the end of life and reduce the current drive for the most expensive care. The IOM recommended: Government health insurers and care delivery programs as well as private health insurers should cover the provision of comprehensive care for individuals with advanced serious illness who are nearing the end of life; Professional societies and other organizations that establish quality standards should develop standards for clinician-patient communication and advance care planning that are measurable, actionable, and evidence based; and Educational institutions, credentialing bodies, accrediting boards, state regulatory agencies, and health care delivery organizations should establish the appropriate training, certification, and/or licensure requirements to strengthen the palliative care knowledge and skills of all clinicians who care for individuals with advanced serious illness who are nearing the end of life; Federal, state, and private insurance and health care delivery programs should integrate the financing of medical and social services to support the provision of quality care consistent with values, goals, and informed preferences of people with advanced serious illness nearing the end of life; and Civic leaders, public health and other governmental agencies, community-based organizations, faith-based organizations, consumer groups, health care delivery organizations, payers, employers, and professional societies should engage their constituents and provide fact-based information about care of people with advanced serious illness to encourage advance care planning and informed choice based on the needs and values of individuals.

MA Average Premiums to Increase

CMS estimated that average Medicare Advantage premiums will increase by nearly $3 in 2015 to $33.90 per month, but said that as beneficiaries shift to lower-cost plans the average cost may be somewhat less.

Health-Related Legislation Recently Introduced

S. 2804 (DISEASE RESEARCH), to amend the Public Health Service Act with regard to research on asthma, and for other purposes; GILLIBRAND; to the Committee on Health, Education, Labor and Pensions, Sept. 15.

S. 2808 (INSURANCE REGULATION), to authorize health insurance issuers to continue to offer for sale current group health insurance coverage in satisfaction of the minimum essential health insurance coverage requirement, and for other purposes; VITTER; to the Committee on Finance, Sept. 15.

H.R. 5464 (APPROPRIATIONS), making appropriations for Department of Labor, Health and Human Services and Education and related agencies for the fiscal year ending Sept. 30, 2015, and for other purposes; DELAURO; to the Committee on Appropriations, Sept. 15.

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