Senators Encourage CMS to Expand PACE Program

Senators Tom Carper (D-DE), Pat Toomey (R-PA) and eleven other Senators sent a letter to CMS which urged the agency to expand the Program of All-Inclusive Care for the Elderly (PACE) to operate in a variety of community settings, such as adult day health centers or senior centers, and to offer concurrent reviews at the federal and state level to speed up the provider application process. They maintained that current regulatory and statutory barriers have inhibited the growth and innovation of the PACE program.

PCORI Approves Effectiveness Research Projects

The Patient-Centered Outcomes Research Institute (PCORI) announced that 46 new patient-centered clinical comparative effectiveness research projects have been approved to receive a total of almost $102 million in funding. The Improving Healthcare Systems program awards include targeting for obesity and steps needed to allow for the smooth transitioning of patients from a hospital setting to their home.

CMS Reports on Medicare Overpayment Recoveries

CMS reported that four Recovery Audit Contractors (RACs) collected $3.65 billion in Medicare overpayments during FY 2013, an increase from the $2.3 billion that was collected in FY 2012, and that RACs blocked $22 million in improper payments from being made through a prepayment review demonstration program operational in 11 states.

New Safe Harbors Added to Anti-Kickback Rules

The HHS Office of Inspector General (OIG) released a proposed rule, Medicare and State Health Care Programs: Fraud and Abuse; Revisions to Safe Harbors under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements and Gainsharing, that would provide new safe harbors to the anti-kickback statute covering some Medicare Part D activities and expand the list of conduct exempted from civil monetary penalties (CMPs). Among the topics covered by the safe-harbors are: pharmacy cost-sharing waivers for impoverished Medicare Part D beneficiaries; cost-sharing waivers for emergency ambulance services offered by state or municipal-owned organizations; manufacturer discounts for drugs provided through the Medicare Coverage Gap Discount Program; and certain interactions between Medicare Advantage plans and federally qualified health centers. The CMP exemptions would include copayment reductions for some outpatient services; copayment waivers for the first order of a generic drug; and coupons, rebates or rewards programs that meet certain requirements. Comments are due by December 2, 2014.

NIH Announces BRAIN Funding

The National Institutes of Health (NIH) announced that it has approved $46 million in grant funding for 58 projects under the agency’s Brain Research through Advancing Innovative Neurotechnologies, or BRAIN, initiative. Among other areas, the grants will be used to: identify complex brain circuits with DNA barcodes; track the entire nervous system while in motion; develop laser systems to control the activity of specific cells and circuits in the brain; and build a wearable PET scanner to observe the brain while people are physically moving.

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