POLICY BRIEFINGS


Medicare Shared Savings Program Participants Announced


CMS said that 27 accountable care organizations have been selected to participate in the first wave of the Medicare Shared Savings Program (MSSP).  The ACOs selected agree to be responsible for improving care for nearly 375,000 beneficiaries in 18 states through better coordination among more than 10,000 physicians, 10 hospitals and 13 smaller physician-driven organizations in both urban and rural areas.


Physician Payment Sunshine Act Implementation


Senators Grassley and Kohl have sent a letter to Acting CMS Administrator Marilyn Tavenner demanding that CMS issue final regulations to implement the Physician Payment Sunshine Act by this June.  The Act, requiring manufacturers and group purchasing organizations to disclose information about physician ownership and investment interests, includes a $150,000 fine for failing to report such gifts or a $1 million fine for knowingly not reporting such gifts.  The Senators asked CMS to respond by April 18.


FDA Issues


The FDA has issued a series of voluntary guidelines that are intended to limit the use of antibiotics in animal feed for non-medical purposes and prevent the creation of antibiotic resistant bacteria that could affect treatments for various infections in humans.  The guidance asks the farming industry to phase out the use of “medically important drugs” that accelerate animal growth; asks drug manufacturers to voluntarily remove production uses of antibiotics from FDA-approved labels; and provides draft regulations that provide veterinarians with strategies on how to authorize the use of certain drugs in animal.


Delay in ICD Compliance Date


CMS released a proposed rule that would delay the compliance date for the International Classification of Diseases, 10th Revision (ICD-10) code set from October 1, 2013 until October 1, 2014.  The rule also includes a requirement for health plans to adopt a unique health plan identifier for all HIPAA transactions.  When implemented the new code set will be applicable to all transactions subject to HIPAA, including outpatient and inpatient claims.


Medicare Coverage for LSG


CMS has invoked its coverage-with-evidence-development policy to propose coverage under Medicare for specific clinical trials for laparoscopic sleeve gastrectomy (LSG) as a bariatric surgery option for the treatment of obesity.  The procedure will be covered only under certain conditions in randomized controlled trials.  The proposal also includes a sunset provision whereby any studies must be approved within two years after publication of the final decision memorandum.



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