MedPAC Clarifies Position on Payment Update
Late last week, the Medicare Payment Advisory Commission (“MedPAC”) reiterated its support for a 1% hospital payment update in FY 2014. The commission that advises Congress on Medicare payment issues had been considering proposals that, if adopted, would have resulted in a negative payment update for hospitals following the $11 billion in cuts used to pay for an extension of the Sustainable Growth Rate formula known as the “doc fix.” The hospital industry had expressed concern the “doc fix” legislation and the impending 2% sequestration cut would negate the expected 1% payment update. While MedPAC makes payment update recommendations to Congress, lawmakers on Capitol Hill will have the final say on any payment rate update for FY 2014. Ultimately, the payment update decision will be made by Congress.
CMS Announces Fourth Round of Community-Based Care Transitions Program Participants
On January 15, CMS announced 35 new participants in the Community-Based Care Transitions Program (“CCTP”). These 35 sites will join the 47 organizations already participating in the CCTP, bringing the total number of sites to 82. The goal of the CCTP is for the sites to work with local hospitals and other care settings to reduce readmissions for high-risk Medicare beneficiaries and to document measure savings for the Medicare program.
The CCTP was created by Section 3026 of the Affordable Care Act (“ACA”) as a five-year program. Participants in the program include acute care hospitals or an appropriate community-based organization that has partnered with at least one acute care hospital. Critical access hospitals and specialty hospitals are excluded from participation.
Participants sign two-year program agreements with CMS, with the option to renew each year for the remainder of the program based on their success. As of January 15, CMS continues to accept applications and approve participants on a rolling basis as long as the $500 million in funding remains available.
HHS Finalizes HIPAA Rule
On January 17, HHS issued a final rule that makes broad changes to HIPAA standards, as required by the 2009 Stimulus Act. The rule increases penalties to providers for noncompliance based on the level of negligence, with the maximum penalty set at $1.5 million per violation. The rule extends privacy rules beyond traditional health entities to outside contractors and subcontractors with whom those entities share health records. The changes also clarify when breaches of unsecured health information must be reported to HHS.
House to Take Up Children’s Hospitals GME Reauthorization Bill
On January 15, the chairman of the House Energy and Commerce Health Subcommittee, Rep. Joe Pitts (R-PA), introduced a bill (H.R. 297) to reauthorize the Children’s Hospitals Graduate Medical Education (“CHGME”) program. The bill provides funding to assist freestanding children’s hospitals in training pediatric residents. The CHGME program is designed to supplement pediatric hospitals that, because of their low Medicare patient volume, do not receive significant Medicare direct graduate medical education and indirect medical education payments.
Last Congress, almost identical legislation passed the House but lacked the votes to pass the Senate. The Energy and Commerce Committee is scheduled to mark up the legislation on January 22. It is expected to pass and be ready to go before the full House as early as February.
HHS Releases Proposed Rule on Medicaid, CHIP and Health Insurance Marketplaces
On January 14, HHS released a proposed rule implementing key ACA provisions relating to Medicaid and the Exchanges. This proposed rule codifies statutory eligibility provisions and lays out a structure and options for coordinating Medicaid, the Children’s Health Insurance Program (“CHIP”) and Exchange eligibility notices and appeals. It also proposes to modify existing benchmark benefits regulations for low-income adults, and codify several of the provisions included in the CHIP Reauthorization Act.
This proposed rule includes information on how consumers will receive coordinated communications on eligibility determinations and can appeal eligibility determinations. It gives states flexibility in designing benefits and determining cost sharing in the Medicaid program. The proposed rule also provides flexibility to state-based Exchanges by allowing them to opt to rely on HHS for verifying whether an individual has employer-sponsored coverage and conducting some types of appeals.
PCORI Announces Research Funding Opportunity
The Patient-Centered Outcomes Research Institute (“PCORI”) will accept applications through April 15 for up to $96 million in funding for research to help patients and caregivers make better informed health and health care decisions. Hospitals and others must submit letters of intent to apply by February 15. PCORI was created by the ACA and is authorized by Congress to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions. To apply online, click here.
Next Week
The Senate is in recess until a joint session for the inauguration at 11:30 AM on January 21. Legislative business resumes at 10 AM on January 22.
For more information, please contact John F. Williams, III at 317.977.1462 or jwilliams@hallrender.com.
Please visit the Hall Render Blog at http://blogs.hallrender.com/ for more information on topics related to health care law.
