MEDICARE RELEASES MACRA RULE PROPOSAL
The Centers for Medicare and Medicaid Services released its proposed rule for carrying out last year’s congressional overhaul of payments for doctors, physician assistants and other providers of care routinely delivered in medical offices. The rule is intended to further tie payments for the care of more than 35 million Americans in traditional government-run Medicare to judgments about the quality of care by doctors and other providers. Medicare paid about $69 billion in 2014 for services covered by the physician fee rule, which sweeps in many related fields. CMS is trying to reach out to as many interested parties as possible. CMS launched a Quality Payment Program website which CMS is using as its central repository for all webinars and information provided to the public during the rulemaking process. The website is available here.
OKLAHOMA CONSIDERING MEDICAID EXPANSION
Oklahoma legislators are racing against the clock in an effort to agree on a budget that could expand Medicaid and spare medical providers from severe payment cuts. The Republican-led legislature and GOP Gov. Mary Fallin are working to pass a budget that will plug a $1.3 billion budget hole. Lawmakers have until May 27 to pass the budget before the session ends. The Medicaid policy reversal, put forward by sharp Obama administration critics who have opposed the 2010 health law, could expand coverage for an additional 175,000 low-income residents. Medicaid is the federal-state program for the low-income and people with disabilities. The health care law gave states the choice of whether to expand the program. Under the plan that OHCA is proposing to expand Medicaid instead of proceeding with the hospital payment cut, the state would apply for a federal waiver to cover 175,000 uninsured adults and offer them help to pay for a health plan using a subsidy under Oklahoma’s Medicaid program. The expansion would take effect by Jan. 1. Enrollees would also be allowed to have an individual health savings account that would help them pay for co-pays, deductibles and more. The plan also would prepare to shift into Medicaid children and pregnant women who could lose coverage under the Children’s Health Insurance Program after Sept. 30, 2019.
UNINSURED RATE SHOWS HISTORIC DROP, CDC STUDY FINDS
The nation’s uninsured rate fell below 10 percent for the first time in history last year, according to survey results published by the Centers for Disease Control and Prevention. The new figures, showing a 9.1 percent uninsured rate, are the latest to underscore the gains of the 2010 federal health overhaul (PL 111-148, PL 111-152). Before that law took effect, about 14.4 percent of Americans lacked health insurance, according to the same survey data. The study shows some 28.6 million Americans still go without insurance, about 16.2 million less than the tally before the law took effect. The Obama administration in February estimated that 20 million people gained coverage because of the overhaul. Among the insured, 9.1 million people gained private coverage through HealthCare.gov or the state-based exchanges, the study says. Those gains were slightly steeper among young adults, 18-24, than among older adults, and also slightly steeper among the poor and nearly poor than among wealthier Americans.
EEOC RULES CAP WELLNESS PROGRAM INCENTIVES
The U.S. Equal Employment Opportunity Commission on released two rules that largely endorse incentive provisions in employer wellness programs allowed under the 2010 health care overhaul. Genetic specialists, however, are at odds with employer groups over whether the rules penalize employees who choose not to participate in such programs. The rules also drew criticism from Congress, as one top lawmaker criticized the cap EEOC placed on allowable incentives and threatened legislative action to block them from going into effect. The health care law permitted employers, under employee wellness programs, to provide incentives based on the total cost of self-only coverage for consumers to meet health goals, such as reaching a certain body mass index or cholesterol level. The rules, which go into effect in 2017, largely amend Americans with Disabilities Act and Genetic Information Nondiscrimination Act policies to clarify the EEOC’s position on these incentives. Under the new rule, employers that run wellness programs that include medical examinations can offer incentives up to 30 percent of the cost of self-only coverage. The GINA rule caps the incentives for spouses at the same level of employees.
PROPOSED RULE INCLUDES OUTPATIENT STATUS NOTIFICATION REQUIREMENT
The Hospital Inpatient Prospective Payment System and Long Term Acute Care Hospital Proposed Rule, which the Centers for Medicare & Medicaid Services (CMS) released on April 18, includes a plan for implementing the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act. The NOTICE Act requires that critical access hospitals (CAHs) and other institutions to provide notification to individuals who are receiving observation services as outpatients for more than 24 hours. Under the proposal, CAHs and other hospitals would be required to furnish the new CMS-developed notice, known as the Medicare Outpatient Observation Notice (MOON), to affected Medicare beneficiaries or enrollees no later than 36 hours after observation services begin. The notification should indicate why the patients are receiving these services, the cost-sharing implications, and post-hospitalization eligibility for Medicare coverage for skilled nursing facility services. The MOON must be provided to patients who are entitled to Medicare benefits, regardless of whether the outpatient observation services are payable under Medicare. A final rule will be issued no later than August 1, and the NOTICE Act’s requirements take effect August 6.
CMS DELAYS STAR RATING SYSTEM FOR HOSPITAL COMPARE WEBSITE
The Centers for Medicare & Medicaid Services (CMS) has announced that the release of a new star system for rating overall quality at hospitals is being postponed until at least July. Originally scheduled for April 21, the star rating metric would be posted on the CMS Hospital Compare website and would assign hospitals a rating of one to five stars based on specific inpatient and outpatient reporting measures. The delay comes in response to concerns raised in congressional correspondence to CMS. A total of 60 senators signed the letter to CMS asking that the program be delayed because the overall ratings may not accurately take into account hospitals that treat low-income patients and patients with multiple, complex, chronic health care conditions. The letter also raises concerns that hospitals have insufficient data to replicate or evaluate CMS’ work to ensure that the methodology is accurate and fair.
CMS RELEASES 2014 PQRS EXPERIENCE REPORT
The Centers for Medicare & Medicaid Services (CMS) on April 15 released the 2014 Physician Quality Reporting System (PQRS) Experience Report, which summarizes the experiences of group practices and individual providers that participated in the PQRS program. A total of 585,037 providers within 45,723 practices successfully participated in PQRS in 2014, earning $224 million in PQRS incentive payments. The total number of PQRS participants increased by 28 percent between 2013 and 2014. Claims reporting was the most popular way to participate in PQRS in 2014, while the PQRS Group Reporting Option also saw a dramatic increase with nearly 3,000 practices registered to participate in 2014 versus 677 in 2013. Based on 2014 reporting, more than half of all providers avoided the 2 percent penalty on their 2016 charges. Providers who were unsuccessful or nonparticipants in PQRS in 2014 receive a 2 percent penalty on their 2016 claims.