Health Industry Washington Watch : Washington DC Healthcare Industry Law Firm : Reed Smith : Health Industry Washington Watch : Regulations, Medicare/Medicaid, Governmental Organizations

CMS has scheduled an August 15, 2015 national provider call on new Medicare preventive services. The call will cover the following five benefits: Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse; Screening for Depression in Adults; Intensive Behavioral Therapy for Cardiovascular Disease; Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs; and Intensive Behavioral Therapy for Obesity.

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On June 13, 2012, the National Prevention Council released the “National Prevention Council Action Plan,” which outlines specific steps the Administration is taking to implement the strategic directions and priorities of the National Prevention Strategy.

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On March 28, 2012, CMS is hosting a national provider call on Medicare Preventive Services: the Initial Preventive Physical Exam (IPPE) and Annual Wellness Visit (AVW). CMS experts will discuss both the IPPE and AWV, including when to perform them, who can perform each service, who is eligible, and how to code and bill for each service, followed by a question and answer session. Registration is required. 

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As previously reported, last month HHS Secretary Kathleen Sebelius announced that certain religious employers who currently do not provide coverage for contraceptive services under their insurance plan will be required to do so beginning August 1, 2013. An exception from the mandate was provided only to non-profit religious employers that: have the inculcation of religious values as their purpose; primarily employ persons who share their religious tenets; and primarily serve persons who share their religious tenets. In response to concerns raised by religious groups that the exception would not extend to church-affiliated universities, hospitals, and other entities, the Obama Administration announced on February 10, 2012 that objecting non-profit religious employers will not have to provide contraceptive coverage or refer women to organizations that provide contraception, but the employee’s insurance company will be required to directly offer the employee contraceptive care free of charge. Details regarding this policy will be developed through rulemaking.  A notice of the policy is scheduled to be published on February 15.

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On August 3, 2011, the HHS published an interim final rule with comment period amending rules regarding coverage of certain preventive services by group health plans and health insurance coverage in the group and individual markets under the ACA. As previously reported, HHS announced earlier this month that health plans will be required to furnish certain preventive health services, including contraceptive services, for women without cost sharing under the ACA, effective for plan years beginning on or after August 1, 2012.  The August 3 rule provides the Health Resources and Services Administration (HRSA) with additional discretion to exempt certain religious employers from HRSA preventive guidelines with regard to contraceptive services. Under the rule, a religious employer is one that: (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization. HHS will be accepting comments on this definition as well as alternative definitions.   The interim final regulations are effective August 1, 2011, although comments will be accepted until September 30, 2011. 

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The Institute of Medicine recommended to the HHS Secretary that eight additional preventive services for women be added to the preventive services that health plans cover at no cost to the patient under the ACA. The eight services include:  screening for gestational diabetes; human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30; counseling on sexually-transmitted infections; counseling and screening for HIV; contraceptive methods and counseling to prevent unintended pregnancies; lactation counseling and equipment to promote breast-feeding; screening and counseling to detect and prevent interpersonal and domestic violence; and yearly well-woman preventive care visits to obtain recommended preventive services.

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CMS is hosting a provider call on July 21, 2011 to provide an overview of Medicare coverage for an Initial Preventive Physical Examination (commonly known as the "Welcome to Medicare" Visit) and the Affordable Care Act’s Annual Wellness Visit. Registration for the call will close at 1:30 pm on July 20 or when available space has been filled.

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The National Prevention, Health Promotion, and Public Health Council has released its final “National Prevention and Health Promotion Strategy,” as mandated by the ACA. The strategy identifies four “strategic directions” for improving the nation’s health: building healthy and safe community environments; expanding quality preventive services in both clinical and community settings; empowering people to make healthy choices; and eliminating health disparities. The document also makes recommendations to address seven priority areas for improving the health and wellness of the U.S. population: tobacco free living; preventing drug abuse and excessive alcohol use; healthy eating; active living; injury and violence free living; reproductive and sexual health; and mental and emotional well-being.

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On May 4, 2011, CMS published a proposed rule that would require certain Medicare and Medicaid providers and suppliers to offer all patients an annual influenza vaccination, unless medically contraindicated or unless the patient (or patient's representative or surrogate) declines vaccination. The requirement would apply to the following entities: hospitals (all types that participate in Medicare); CAHs; rural health clinics; Federally Qualified Health Centers, and end-stage renal disease facilities. These providers and suppliers have been proposed because: (1) in each setting, the patient presents before health care providers with staff licensed to provide vaccination at the time and location of the encounter; and (2) all have ready access to equipment and storage appropriate for handling, controlling, and administering vaccines. The proposed rule also would require the specified providers and suppliers to develop policies and procedures that would allow them to offer vaccinations for pandemic influenza, in case of a future pandemic influenza event for which a vaccine may be developed. CMS will accept comments on the proposal until July 5, 2011. CMS expects to adopt a final rule in the early fall of 2011 that would be in effect during the 2011-2012 influenza season.

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On April 13, 2011, the House of Representatives approved H.R. 1217, a bill to repeal the ACA’s Prevention and Public Health Fund, which is a discretionary fund for investment in prevention and public health programs. The bill now moves to the Senate, where it is unlikely to be considered. The White House also has issued a statement opposing the bill.

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On April 5, 2011, the House Energy and Commerce Committee approved a series of health policy bills, including H.R. 1217, a bill to repeal the Prevention and Public Health Fund (a discretionary fund for investment in prevention and public health programs); and H.R. 1213, a bill to repeal mandatory funding provided to states to establish American Health Benefit Exchanges under the ACA. The full House is scheduled to vote on H.R. 1217 on April 13, 2011.

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On December 28, 2010, the Obama Administration published a request for information regarding how group health plans and health insurance issuers can employ value-based insurance design in the coverage of recommended preventive services. The notice seeks information on, among other issues: specific plan design tools to incentivize patient behavior; how to identify high-value treatment settings, providers, and delivery mechanisms; and ways to ensure that patients with particular co-morbidities or other special circumstances receive the medically-appropriate level of care. Comments are due February 28, 2011.

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On December 2, 2010, HHS released “Healthy People 2020,” which sets forth new 10-year goals and objectives for national health promotion and disease prevention. The document includes a greater focus on identifying, measuring, tracking, and reducing health disparities through a “determinants of health” approach that examines the range of personal, social, economic, and environmental factors that influence health status. New topic areas for 2020 include, among others, genomics, healthcare-associated infections, and health incident preparedness.  HHS also announced a contest for technology application developers to design platform-neutral applications to provide Healthy People stakeholders (e.g., professionals and advocates) with easy access to a comprehensive suite of information resources to maximize their success in achieving Health People objectives. The application deadline is March 7, 2011. 

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