On January 27, 2010, President Obama delivered his State of the Union address to Congress. While the economy was the overwhelming focus of the address, President Obama reaffirmed his commitment to health insurance reform. Acknowledging setbacks on this issue, he nevertheless implored Congress to “not walk away from reform.” He asked Congress to “take another
January 2010
National Practitioner Data Bank Adverse Action Reporting Final Rule
On January 28, 2010, the Health Resources and Services Administration (HRSA) published a final rule updating the regulations governing the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners. The rule implements statutory provisions requiring each state to have in effect a system of reporting disciplinary licensure actions taken…
Health Reform Efforts on Hold as Congressional Leaders Reassess Options
After devoting much of the last year to crafting comprehensive health reform legislation, the election of Republican Scott Brown in the Massachusetts special election to fill the late Senator Edward Kennedy’s seat has thrown into doubt the fate of these efforts. While just two weeks ago Democratic leaders reportedly were near agreement on a compromise…
Upcoming Congressional Hearings on President Obama’s Budget Request
On February 1, 2010, President Obama is scheduled to deliver his proposed federal budget for fiscal year 2011, which is likely to again include provisions that would, if adopted, significantly impact federal health care policies. Congressional panels already have scheduled hearings on the upcoming proposal, including Senate Finance Committee and House and Senate Budget Committee…
MedPAC Votes on 2011 Medicare Provider Update Recommendations
The Medicare Payment Advisory Commission (MedPAC) recently voted on recommendations it will make to Congress regarding Medicare payment updates for 2011. At the meeting, MedPAC voted to recommend increasing acute inpatient and outpatient prospective payment system reimbursement in 2011 by the projected rate of increase in the hospital market basket index (MBI). This rate increase…
FTC Report on Drug Company “Pay-for-Delay” Agreements
The Federal Trade Commission has released a “staff study” entitled “Pay for Delay: How Drug Company Pay-Offs Cost Consumers Billions.” The report examines agreements in patent litigation settlements in which a brand-name pharmaceutical company compensates a generic pharmaceutical company for delays in generic entry. According to the study, over the past six years, such…
CMS Transmittal Highlights Program Integrity Issues for Medicare Contractors
On January 15, 2010, CMS issued a transmittal on “Various OIG Reports that have Medical Review Implications.” The transmittal instructs Medicare contractors to take steps to strengthen program safeguards to prevent improper payment in areas identified by the HHS Office of Inspector General (OIG). Specifically, reports highlighted by CMS address negative pressure wound…
HHS/DOJ Convene National Summit on Health Care Fraud
On January 28, 2010, HHS Secretary Sebelius and Attorney General Eric Holder are hosting a “National Summit on Health Care Fraud” to discuss innovative ways to eliminate health care fraud, waste, and abuse. The summit, an invitation-only event featuring public and private-sector representatives, is an outgrowth of the Administration’s Health Care Fraud Prevention & Enforcement…
OIG Report on Documentation Requirements for DME Claims
The HHS Office of Inspector General (OIG) has issued a report entitled “Review of Medicare Payments for Selected Durable Medical Equipment Claims With the KX Modifier for Calendar Year 2006.” According to the OIG, the KX modifier – which indicates that the supplier has the required documentation on file — was not effective in ensuring…
OIG Medicaid Drug Payment Reports
The OIG has released two reports analyzing Medicaid payments for prescription drugs. The first report, ”Comparison of Medicaid Federal Upper Limit Amounts to Acquisition Costs, Medicare Payment Amounts, and Retail Prices,” concludes that the current method for setting federal upper limit (FUL) amounts results in “substantially inflated Medicaid payments for many drugs” compared to other…
GAO Issues Report on Medicare Advantage Marketing Violations
This post was written by Jacqueline B. Penrod. The Government Accountability Office has outlined the results of a study it conducted regarding how CMS has handled violations of the marketing rules applicable to Medicare Advantage Organizations (MAOs). The study found that between January 2006 and February 2009, CMS took action against 73 MAOs. …
HHS Resources on State Health IT Laws
HHS has released a number of reports regarding state health information law, business practices, and policy variations. Specifically, the following materials have been posted: Report on State Medical Record Access Laws; Report on State Law Requirements for Patient Permission to Disclose Health Information; Releasing Clinical Laboratory Test Results: Report on Survey of State Laws; Report…
CMS Announces Accreditation Organizations for Imaging Suppliers
On January 26, 2010, CMS published a notice announcing its approval of the following three national accreditation organizations to accredit suppliers seeking to furnish the technical component of advanced diagnostic imaging services under Medicare: the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission.
DMEPOS Competitive Bidding/PAOC Meeting (Feb. 23, 2010)
On February 23, 2010, CMS is hosting a Program Advisory and Oversight Committee (PAOC) meeting to discuss DMEPOS competitive bidding, including the Round 1 Rebid and upcoming rounds. CMS expects to begin registration for the meeting within the next few weeks.
Health Reform Update: Congress Returns from Break, Seeks Compromise Reform Bill
The House of Representatives has returned from its winter break to start the second session of the 111th Congress, and the Senate returns to business next week. At the top of the Congressional agenda is reconciling the differences between the separate health reform bills approved by the House and Senate late last year. While…
HIT Rules Released: HIT Standards and Definition of “Meaningful Use” and Criteria for Electronic Health Record Incentive Program
This post was written by Jacqueline B. Penrod. On January 13, 2010, the Office of the National Coordinator for Health Information Technology (ONC) published an interim final rule (the “Standards Rule”) to adopt an initial set of standards, implementation specifications, and certification criteria for health information technology. Designed to be “the first step in…
Updated OIG Fraud Alert on Telemarketing by DME Suppliers
On January 13, 2010, the OIG released an update to its March 2003 Special Fraud Alert on Telemarketing by Durable Medical Equipment Suppliers. The Special Fraud Alert focuses on section 1834(a)(17) of the Social Security Act, which prohibits suppliers of DME, except under limited circumstances, from making unsolicited telephone calls to Medicare beneficiaries regarding the …
HOPPS/ASC Correction Notice
CMS has published a notice correcting errors that appeared in the final CY 2010 rule updating the Medicare hospital outpatient prospective payment system (HOPPS) and the ambulatory surgical center (ASC) payment system. Among other technical changes, the rule corrects Medicare ambulatory surgical center (ASC) payment rates that had been based on incorrect Medicare physician…
Medicaid/CHIP Children’s Healthcare Quality Measures
CMS has published a notice soliciting comments on an initial set of children’s health care quality measures for voluntary use by state Medicaid and Children’s Health Insurance Program (CHIP) and health insurance issuers and managed care entities that contract with these programs, and providers of Medicaid and CHIP services. The notice also seeks input on how …
OIG Solicits Safe Harbor, Fraud Alert Proposals
The HHS Office of Inspector General (OIG) has published its annual solicitation of recommendations for developing new and modifying existing safe harbor provisions under the federal anti-kickback statute, as well as developing new OIG special fraud alerts. The comment deadline is March 1, 2010. A status report on the comments received in response to last…