March 2014

On April 4th, 2014, Reed Smith will host its inaugural Washington Health Care Conference at The Mayflower Renaissance Hotel in Washington, D.C. With a keynote from Dr. Norman Ornstein, this year’s conference will focus on post-acute care, bringing together leading industry professionals for a discussion on several important issues. Limited seating is still available for this complimentary program. If you are interested in registering, please email Lindsay Korenich at lkorenich@reedsmith.com.
Continue Reading Reed Smith Hosting Washington Health Care Conference: Focus on Post-Acute Care on April 4, 2014 – One Week Left to Register

The Reed Smith Health Industry Washington Watch blog (https://www.healthindustrywashingtonwatch.com) has been updated to report on recent health policy developments, including the following:

– Regulatory Developments. The Administration has issued several regulations making changes to operational policies, payment provisions, and other standards applicable to health plans and Health Insurance Exchanges under the Affordable Care Act. CMS also has issued a final rule that increases Medicare payments for low-volume hospitals. For details, see https://www.healthindustrywashingtonwatch.com/articles/regulatory-developments/hhs-developments/other-cms-developments/.

– Other CMS Developments. Recent CMS announcements have addressed: ACA insurance coverage and exchange policies; the Medicare electronic health record “Meaningful Use” hardship exception; a new “Medicare Care Choices Model” to allow certain hospice patients to seek curative care; Medicare payment for hospice enrollees’ drug expenses; an upcoming deadline for using the revised 1500 form for Medicare paper claims; Medicare Part B drug payment files; and Medicare inpatient admissions criteria. See https://www.healthindustrywashingtonwatch.com/articles/other-cms-developments-1/.

– Legislative Developments. The clock is winding down for Congress to pass Medicare physician fee schedule reform legislation before steep payment cuts are triggered, and Congressional hearings have examined health policy issues. See https://www.healthindustrywashingtonwatch.com/articles/legislative-developments/.

– Fraud & Abuse Developments. The OIG has released its Annual Report on Medicaid Fraud Control Unit Activities, along with reports on Medicare Part B drug pricing and diabetic test strip cost and compliance concerns (https://www.healthindustrywashingtonwatch.com/articles/other-oig-developments/). Medicare contractors have issued a joint open letter to physicians warning about DMEPOS Supplier “Marketing Schemes” (https://www.healthindustrywashingtonwatch.com/articles/fraud-and-abuse-developments/).

– Odds & Ends. MedPAC and MACPAC have issued reports to Congress making Medicare and Medicaid payment policy recommendations, respectively (see https://www.healthindustrywashingtonwatch.com/articles/odds-ends/).

– Health Industry Events. Upcoming CMS events will focus on HCPCS coding applications, clinical laboratory payments, and the Medicare Shared Savings Program (see https://www.healthindustrywashingtonwatch.com/articles/events/).

For details on these and other health industry developments, please visit https://www.healthindustrywashingtonwatch.com/.
Continue Reading New Postings on the Reed Smith Health Industry Washington Watch Blog

The Medicare Payment Advisory Commission (MedPAC) has released its annual report to Congress on Medicare payment policy, including payment update recommendations for all the major Medicare fee-for-service payment (FFS) systems, limited recommendations related to the Medicare Advantage (MA) program, and a status report on the Medicare Part D program. The following are highlights of the

On March 10, 2014, CMS issued a final memorandum outlining the criteria it will use to determine payment responsibility for drugs for Medicare hospice beneficiaries, effective May 1, 2014. CMS cites the statutory requirement that the hospice cover all drugs or biologicals for the palliation and management of the terminal and related conditions; these drugs

The Administration has issued numerous regulations recently that make additional changes to operational policies, payment provisions, and other standards applicable to health plans and Health Insurance Exchanges (also called Marketplaces) under the Affordable Care Act (ACA). Highlights include the following:
Continue Reading Obama Administration Continues to Update ACA Insurance Exchange and Health Plan Regulations

Recent CMS subregulatory guidance and related announcements regarding ACA insurance coverage and insurance exchange issues include the following:

The OIG has issued a report, “Comparing Average Sales Prices and Average Manufacturer Prices for Medicare Part B Drugs: An Overview of 2012,” which assesses CMS’s use of its authority to lower reimbursement for Medicare Part B drugs when a drug’s average sales prices (ASP) exceeds its average manufacturer prices (AMP) or widely available

Medicare eligible professionals and eligible hospitals that are not “meaningful users” of certified electronic health record (EHR) technology will be subject to payment adjustments under the Medicare EHR Incentive Programs beginning on October 1, 2014 for hospitals and on January 1, 2015 for eligible professionals. Eligible professionals and hospitals may be exempt from payment adjustment

The OIG has released its Medicaid Fraud Control Units Fiscal Year 2013 Annual Report, which highlights achievements from the investigations and prosecutions conducted by the 50 MFCUs along with related OIG oversight activities. In FY 2013, MFCUs nationwide reported a total of 1,341 criminal convictions in cases involving Medicaid fraud and patient abuse and

On March 18, 2014, CMS published an interim final rule with comment period that implements changes to the payment adjustment for low-volume hospitals and to the Medicare-dependent hospital (MDH) program for fiscal year 2014 in accordance with the Pathway for SGR Reform Act of 2013. The rule, which applies to discharges on October 1, 2013 through

CMS is instructing Medicare providers and suppliers that the updated version of the Medicare claim form (CMS 1500 form version 02/12) must be used for all Medicare paper claims received on and after April 1, 2014. The new form includes indicators to differentiate between ICD-9 and ICD-10 codes, identifies whether certain providers have performed an

On March 14, 2014, the Medicaid and CHIP Payment and Access Commission (MACPAC) recommended that Congress take steps to promote continuity in Medicaid coverage, such as by providing states with an option for 12-month continuous eligibility for adults and extending the current transitional medical assistance program. Among other things, the report also discusses at length

Today CMS published an interim final rule with comment period that requires qualified health plan (QHP) issuers to accept premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program, Indian tribes and organizations, and other federal and state government programs that provide premium and cost sharing support. This rulemaking was prompted

The four Durable Medical Equipment (DME) Medicare Administrative Contractor (DME MAC) medical directors have issued a joint open letter to physicians warning about “various marketing schemes” perpetrated by DME suppliers. Such methods cited by the DME MACs in a March 5, 2014 “Dear Physician” letter include unsolicited orders for medical equipment or supplies; advertisements