Administration Contests Need for Supreme Court Review of PPACA Challenge

The Department of Justice filed a brief with the Supreme Court arguing against a review by the court of the lower court decisions as to the validity of the Internal Revenue Service (IRS) regulation allowing PPACA subsidies/tax credits to be made to individuals who enroll in health insurance plans under HealthCare.gov in states that do not set up their own exchanges. The brief said the review was not ripe given that the Halbig v. Burwell decision in favor of the plaintiffs has been vacated pending an en banc appeal by the DC Circuit Court and the decision by the U.S. Court of Appeals for the Fourth Circuit in favor of the federal government was correct.

New Rules for HHA Participation in Medicare/Medicaid

CMS released a proposed rule which would require home health agencies (HHAs) to meet four new conditions in order for them to participate in the Medicare and Medicaid programs. In general, the conditions focus on the care delivered to patients, reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality care standards and eliminate unnecessary procedural requirements. Comments are due by December 8th.

Potential Delay in EHR Effective Dates

CMS said that the agency intends to issue a proposal which would delay the date certain hospitals and physicians have to meet meaningful use standards for electronic health records (EHR). The proposal would reopen the hardship exception application for such entities which have been unable to fully implement the 2014 edition of certified EHR technology due to delays in its availability, as well as to those that couldn’t meet earlier deadlines using certain flexibility options.

Changes to Nursing Home Five-Star Rating System

CMS announced that it is instituting significant changes to the Nursing Home Compare website that, beginning in January, will phase-in a new system that will increase accuracy, improve the timeliness of the data shown and allow for the calculation of quality measures for staff turnover, retention, types of staffing and the levels of different types of staffing. The changes are being made pursuant to the Improving Medicare Post-Acute Care Transformation Act (or IMPACT ACT) that will require providers to submit standardized data by 2019 to allow for the comparison of quality measures across different post-acute care settings.

Medicare Part B Premium/Deductible Unchanged in 2015

CMS gave notice that the Medicare Part B monthly premium ($104.90) and annual deductible ($147) will remain the same in 2015 as in 2014. However, for skilled nursing facilities the daily coinsurance for days 21-100 in a benefit period will be $157.50 in 2015, an increase from $152.00 in 2014.

NIH Grants for Analyzing Big Data

The National Institutes of Health (NIH) announced that $32 million of a total $656 million over six years has been granted to four universities to establish twelve centers focusing on different ways to analyze what the agency said is increasingly complex biomedical data sets. The goal is to improve the ability to predict who is at increased risk of developing diseases, such as breast cancer and heart attack, and to speed discoveries to better prevent or treat such conditions. In related news, the Agency for Healthcare Research and Quality (AHRQ) issued a report stating that just 1% of patients account for 22.7% of health care spending and that over one-half of all health costs are incurred by just 5% of all patients.

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