Administration Touts PPACA Benefits

T he Department of Health and Human Services (HHS) released an issue brief stating that 47 million women will be eligible August 1st for preventive care health services without paying out-of-pocket fees under a provision of the PPACA. However, affiliates of religious organizations that oppose contraception and abortifacients that are covered as preventive services have an extra year for their health plans to comply with the rule for these services. The latter provisions are the subject of several federal lawsuits contesting the provision and recently a federal district court judge in Colorado granted an injunction preventing HHS from enforcing the contraception mandate on a company that is not a religious organization. In another announcement, CMS said it has provided the Colorado Health Insurance Cooperative Inc. with a $69.4 million low-interest loan under PPACA CO-OP program

Senators Call for Halt to Certain Medicaid MD Payments

Responding to a GAO report finding that about 7,000 health care providers in Florida, New York and Texas who received $6.6 billion in Medicaid payments owe about $791 million in back taxes, Senator Tom Coburn (R-OK) said that “People who cheat on their taxes show a clear disregard for the law, so they might be more likely to defraud Medicaid or even harm patients.” Senators Carl Levin (D-MI), Chuck Grassley (R-IA) and others suggested that CMS “ought to prohibit health care providers with unpaid taxes from enrolling in Medicaid, allow continuous levies on health care providers’ Medicaid payments to recover unpaid taxes and authorize tax levies on Medicaid payments to managed care organizations whose doctors or other principals are tax-delinquent.”

CBO Estimates Cost of Delaying Medicare SGR Physician Payment Cuts

The Congressional Budget Office (CBO) released an analysis stating that if Congress were to continue 2012 Medicare physician payment levels into next year, rather than letting the scheduled 27% cut due to the Sustainable Growth Rate (SGR) formula go into effect, it would result in a cost of about $18.5 billion over 10 years and again trigger a 26% cut in payment levels beginning in 2014. The payment freeze would cost $11.1 billion in CY 2013 alone.

Medicare Payment Increases for Hospitals/LTCH/SNFs/ IPFs

CMS released a final rule under which payments to inpatient hospitals will increase by 2.8%, about $2 billion, in FY 2013. Medicare payments for long-term care hospitals (LTCH) are will also increase by 1.7%, about $92 million. Payments to skilled nursing facilities (SNF) will increase by 1.8% and by 1.9% for inpatient psychiatric facilities (IPF). Medicare payments could be cut by up to 2% if the BCA budget sequestration is allowed to go into effect next year.

Demo to Expand APRNs

CMS announced that it will award five hospitals in five states up to $200 million over four years under a new “Graduate Nurse Education Demonstration” that is designed to help train more advanced practice registered nurses (APRNs). Under the demonstration, about one-half of the clinical training must occur in nonhospital settings in the community and must provide APRNs with the primary care, preventive care, transitional care and chronic care management skills needed to provide effective and well-coordinated care.

New NIGMS Office of Emergency Care

The NIH announced that a new Office of Emergency Care Research is to be established under the National Institute of General Medical Sciences (NIGMS). The office will not fund grants, but identify funding sources to incorporate different elements of basic, clinical and translational emergency care research and training from existing NIH programs.

New Medicare Coverage for Platelet-Rich Plasma (PRP)

CMS announced that Medicare coverage will become available under certain clinical research studies for autologous platelet-rich plasma (PRP) gel for the treatment of diabetic, pressure and venous ulcerous wounds.

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