MedPAC Annual Report

In its annual report to Congress, the Medicare Payment Advisory Commission recommended that Congress: increase hospital inpatient and outpatient care payments by 1% in FY 2013; reduce over three years the payment rates for evaluation and management visits in hospital outpatient departments to the rates in free-standing physician offices; increase by 0.5% the payments for ambulatory surgical centers; increase by 1% the payments for outpatient dialysis services; increase by 0.5% the payments for hospice services; freeze payments for SNFs, LTC hospitals and Inpatient Rehabilitation Facilities; and restructure Medicare Part D drug low-income subsidy (LIS) copayments in an attempt to control the increasing cost of the benefit.  Of note, given the expiration at the end of this year of the current level of Medicare physician payments, MedPAC recommended that the SGR formula be disbanded and replaced with a ten-year statutory fee-schedule update as follows: freezing current primary care payment levels, reducing payment levels for all other services by 5.9% annually for three years, and freezing rates for the remainder of the period.  MedPAC recommended various ways to pay for the SGR repeal, such as applying an excise tax to Medigap policies and rebasing skilled-nursing facility payments.

MACPAC Annual Report

The Medicaid and CHIP Payment and Access Commission (MACPAC) also released its semiannual report to Congress, recommending: the improvement of care for Medicaid disabled persons by accelerating the advancement of targeted, efficient and innovative approaches through coordination of services; the improvement of quality measurements for Medicaid only enrollees with disabilities; that HHS ensure that its current Medicaid program integrity efforts do not place an undue burden on states or providers by eliminating existing HHS programs that are redundant, outdated or not cost-effective; and that HHS develop methods to better quantify the effectiveness of program integrity activities, including the analytic tools used to detect and deter fraud and abuse.

DEMO for Emergency Care for Low-Income Medicaid Enrollees

CMS announced that eleven states and the District of Columbia will participate in a $75 million demonstration project designed to improve emergency care for low-income patients with mental disease.  The Medicaid Emergency Psychiatric Demonstration will test whether Medicaid enrollees who are experiencing a psychiatric emergency receive better care when the institutions treating them receive Medicaid reimbursement.

Initiative to Help Dual-Eligibles Avoid Hospitalization

CMS announced a $128 million “Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents” which is designed to improve care in nursing facilities for Medicare and Medicaid dual-eligibles.  Interested organizations must submit their notice of intent to apply by April 30 to the CMS Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation.

Delay in HIPPA Enforcement

The Centers for Medicare & Medicaid Services Office of E-Health Standards and Services (OESS) announced that the agency will not initiate enforcement action until June 30th against any HIPPA covered entity that is not in compliance with certain electronic transaction standards.

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