February 2012

On February 22, 2012, President Obama signed into law H.R. 3630, the Middle Class Tax Relief and Job Creation Act, which was approved by Congress on February 17. In addition to extending a payroll tax cut through the end of the year and extending unemployment benefits, the new law includes a number of Medicare and Medicaid provisions, including a provision temporarily averting a steep cut in Medicare physician payments. The following are highlights of the health policy provisions included in H.R. 3630 and accompanying conference report (House Report 112-399).
Continue Reading President Obama Signs Payroll Tax Bill with Medicare/Medicaid Provisions

On February 16, 2012, CMS published a proposed rule to implement an ACA provision requiring enrolled providers and suppliers (and certain other enrollees) receiving Medicare funds to report and return Medicare overpayments by the later of 60 days after the date on which the overpayment was identified or, if applicable, the date any corresponding cost report is due. Although the requirement to refund an overpayment already exists in federal law, the proposed rule clarifies what constitutes “identification” of an overpayment, the mechanics of when and how an overpayment must be returned, and the period of time subject to repayment. An overview of the proposed rule follows.
Continue Reading CMS Proposed Rule on Reporting and Returning of Medicare Overpayments Under the ACA

On February 23, 2012, CMS released a proposed rule to specify the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments under the Health Information Technology for Economic and Clinical Health (HITECH) Act.  By way of…

HHS published a rule on February 27, 2012 that implements the procedural framework for submission and review of State Innovation Waiver applications under section 1332 of the ACA, effective April 27, 2012. Under the rule, states will have flexibility to apply for a State Innovation Waiver to pursue their own strategies to provide their…

On February 27, 2012, CMS published a final rule that implements an ACA provision establishing transparency and public notice procedures for experimental, pilot, and demonstration projects approved under section 1115 of the Social Security Act relating to Medicaid and the Children’s Health Insurance Program (CHIP). The rule is intended to expand publicly-available information about Medicaid…

On February 24, 2012, CMS published a notice announcing an increase to the maximum contingency fee that may be paid to Medicaid Recovery Audit Contractors (RACs) for which federal financial participation (FFP) will be available. Specifically, CMS now authorize states to pay their respective Medicaid RACs a contingency fee of up to 17.5% of the…

The Health Resources and Services Administration (HRSA) has issued a proposed rule to implement ACA provisions designed to eliminate duplicative data reporting and access requirements between the Healthcare Integrity and Protection Data Bank and the National Practitioner Data Bank. The ACA requires the Secretary to transfer all data in the Healthcare Integrity and Protection…

The ACA Consumer Oriented and Operated Plans (CO-OPs) program provides loans to encourage the creation of consumer-governed, private, nonprofit health insurance issuers. CO-Ops will offer qualified health plans to individuals and small businesses beginning January 1, 2014. On February 21, 2012, CMS announced seven organizations that were selected on a competitive basis to receive CO-OP…

The ACA established the PCIP program to provide insurance to individuals with high-risk pre-existing conditions until 2014, when insurers will be prohibited from denying coverage to individuals with a pre-existing condition. The program is open to U.S. citizens and people who reside in the U.S. legally (regardless of income) who have been without insurance coverage…

The ACA requires insurance companies to notify customers regarding the proportion of premiums spent on medical care and quality improvement. Effective in 2011, insurers were required to spend at least 80% of total premium dollars collected on medical care and quality improvement; insurers that do not meet the 80/20 MLR must pay rebates to their…

The OIG has issued a report entitled “Medicare Advantage Organizations’ Identification of Potential Fraud and Abuse.” In the report, the OIG observes that while CMS requires MA organizations to have compliance plans that include measures to detect, correct, and prevent fraud, waste, and abuse, the agency does not require MA organizations to report…

On February 14, 2012, the Obama Administration announced that the Health Care Fraud and Abuse Control Program recovered $4.1 billion in FY 2011 from anti-fraud efforts — the highest annual amount ever recovered from individuals and companies. The DOJ also opened 1,110 new criminal health care fraud investigations involving 2,561 potential defendants, and 743 defendants…

On February 15, 2012, CMS released updated information on the health status of Medicare beneficiaries under the DMEPOS competitive bidding program, reflecting beneficiary observations through November 2011. CMS reports that based on health outcomes such as deaths and emergency room visits in competitive bidding areas compared to areas not subject to bidding, “beneficiary health…

CMS has posted the 2013 Medicare Advantage (MA) and Medicare prescription drug program (Part D) Advance Notice and the draft Call Letter.  The call letter outlines applicable ACA requirements, revisions to payment methodologies, and other policy and operational process updates for Part C organizations and Part D sponsors. In addition to setting forth payment data,…

CMS has posted the November 2011 draft Medicaid drug federal upper payment limit files. CMS continues to invite comments on the draft FUL files, although a comment deadline is not specified. Note that this feedback opportunity is separate from the formal comment period associated with CMS’s February 2, 2012 proposed rule implementing ACA provisions relating…