CMS to Review Health Insurer Rate Increases

The CMS Center for Consumer Information and Insurance Oversight announced that it will conduct health insurance rate reviews in seven states and four territories and partner with three states to conduct the reviews in accord with PPACA imposed regulations.  The review will apply to existing “non-grandfathered” plans which increase their annual health insurance rates by 10% or more.

IRS Issues CHNA Rule

The IRS issued notice 2011-52 which describes how charitable hospital organizations can document PPACA imposed community health needs assessments (CHNA) in written reports, make the CHNA widely available to the public and adopt an implementation strategy to meet health needs identified through the CHNA.

CMS Proposes Home Health Payment Reductions

CMS proposed a rule under which CY 2012 Medicare payments to home health agencies would decrease by 3.35%, or about $640 million.  The proposed rule would update the national standardized 60-day episode rates; the national per-visit rates; the low utilization payment amount (LUPA); and outlier payments under the Medicare prospective payment system for home health agencies.  Comments on the proposal are due by September 6th.

NGA Asks HHS for $4 Billion in Back Medicaid Payments

The National Governors Association has written to HHS Secretary Kathleen Sebelius demanding that the agency reimburse states for up to $4 billion in Medicaid payments made by states over the last 30 years, the costs of which should have been more accurately paid under Medicare.  The Social Security Administration has previously found, over the period, that numerous individuals were erroneously denied Social Security Disability Insurance which would have made them eligible for Medicare coverage, thus relieving state Medicaid programs of their payment liabilities.

Dual Eligible Payment and Nursing DEMOs

HHS announced another demonstration project under which states will be allowed to test new payment models for beneficiaries enrolled under both Medicare and Medicaid.  The demonstration project includes a capitated model under which CMS and health insurance plans enter into a three-way contract that pays plans a blended capitated rate for the full continuum of benefits provided to dual eligible enrollees.  Under a second fee-for-service model, states will be eligible for savings that result from managed fee-for-service initiatives that improve quality and reduce costs under both Medicare and Medicaid.  HHS also announced a related demonstration project under which CMS will select partner organizations who will help implement means to help reduce preventable inpatient hospitalizations for nursing facility residents.  In this connection, HHS will establish a resource center to help states deliver coordinated health care to high-need, high-cost beneficiaries, such as dual eligibles or those with chronic health conditions.

Medicare Laboratory Billing DEMO

CMS announced a two-year $100 PPACA mandated demonstration, the Treatment of Certain Complex Diagnostic Laboratory Tests Demonstration, under which laboratories that perform certain gene-related diagnostic tests on hospitalized Medicare beneficiaries may apply for direct reimbursement from Medicare rather than from the hospitals involved.  Labs must apply for a temporary code to participate by August 1st.  A report on the demonstration project will be sent to Congress after the trial period.

FDA Issues

At a House Energy and Commerce Health Subcommittee hearing last week on FDA prescription drug manufacturer user fees, Chairman Joseph Pitts said that he wants to have the fifth reauthorization of such fees enacted by the end of June next year.  During the hearing, the Director of the FDA Center for Drug Evaluation and Research defended the FDA’s drug approval system, stating that the drug approval process in the United States is faster than in Europe.  However, another witness said that the changing regulatory environment at the FDA has led to declining investments in the U.S. pharmaceutical industry, thus hampering innovation.

Recently Introduced Health Legislation

H.R. 2435 (MEDICARE), to allow individuals to choose to opt out of the Medicare Part A benefit and to allow individuals opting out of such benefit to be eligible for health savings accounts; SAM JOHNSON of Texas; to the Committee on Ways and Means, July 7.

H. RES. 339 (CHILDHOOD OBESITY AWARENESS), expressing support for designation of September as “National Childhood Obesity Awareness Month”; FUDGE; to the Committee on Energy and Commerce, July 7.

H. RES. 341 (BRAIN ANEURYSM AWARENESS), expressing support for designation of the month of September as “National Brain Aneurysm Awareness Month”; MARKEY; to the Committee on Energy and Commerce, July 7.

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