Health Law Misgivings?

At a National Press Club briefing, Senator Charles Schumer (D-NY) addressed the health law and the recent election results as follows: “After passing the stimulus, Democrats should have continued to propose middle class-oriented programs and built on the partial success of the stimulus, but unfortunately Democrats blew the opportunity the American people gave them. We took their mandate and put all of our focus on the wrong problem — health care reform….The plight of uninsured Americans and the hardships caused by unfair insurance company practices certainly needed to be addressed. But it wasn’t the change we were hired to make.” Going forward, he said that “We must have our presidential candidate, or  candidates, on same page….This is our most important mission during the year of 2015.” U.S. Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell also addressed the missteps of her agency in rolling out the HealthCare.gov website and the overstatement of the number of enrollees (by double counting enrollees in dental-only plans) saying the mistakes were “unacceptable” and that going forward there must be an improved “culture of increased transparency”. She admonished her staff to develop and implement means to increase “transparency, ownership and accountability”. In this connection, House Oversight and Government Reform Committee Chairman Darrell Issa (R-CA) scheduled a December 9th hearing to allow his committee to grill Marilyn Tavenner, Administrator of
the Centers for Medicare and Medicaid Services (CMS) on the shortcomings of the agency’s actions. CMS is likely to put a positive light on the progress made this year in enrolling over 462,000 individuals in the first week of the health law’s open enrollment. HHS indicated that the agency will issue monthly reports on the number of persons who have signed up for health coverage under the federal and state-run health insurance exchanges.

Hospital Meaningful Use Requirement Extended

CMS announced that hospitals, including critical access hospitals, will have until December 31, 2014 to qualify for Medicare meaningful use payment incentives and avoid the 1% penalty for failure to meet the Stage 1 and Stage 2 requirements for 2014. The Stage 3 requirements are scheduled to begin in 2017.

FMAP and CHIP Rates Set for FY 2016

HHS gave notice of the Federal Medical Assistance Percentages (FMAP) that will be applied for
FY 2016. As set by law under the PPACA for newly eligible adults, the FMAP will remain at 100% for FY 2014, 2015 and 2016 and gradually decline to 90% in 2020. For other covered individuals the percentages
range from 50-71% depending on the state. In addition, CMS said the Enhanced Federal Medical Assistance Percentages (eFMAP) for the CHIP program will be effective from FY 2016 through FY 2019.

CMS Proposes MA Star Rating Changes

CMS is asking for comments by December 17 on possible changes to the 2016 star rating system for Medicare Advantage (MA) and Part D drug plans. Proposed is the development of an integrated system for Medicare/Medicaid Plans participating in the PPACA’s capitated demonstration program for dually eligible beneficiaries. The potential adjustment for such plans would account for the additional needs of Medicare/Medicaid enrollees and would measure the performance of such plans in integrating Medicare and Medicaid benefits.

GAO Cites Improvement in CMS WFA Efforts

The Government Accountability Office (GAO) issued a report which identifies fourteen of twenty-three “best practices” that CMS has implemented to help prevent waste, fraud and abuse under Medicare Part D. The list of best practices includes: prevention, detection and monitoring; investigation and prosecution; limiting the supply of abused prescription drugs, creating pre-payment edits to deny payments for suspicious claims and conducting data analysis to identify billing anomalies or outliers. GAO also said that CMS engages with Part D plan sponsors to identify providers who might be engaged in fraud or abuse.

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