The Centers for Medicare & Medicaid Services (CMS) recently announced a proposed rule intended to improve prescription drug and health plans performance by strengthening Medicare program participation standards. The rule, which is aimed to better serve Medicare Advantage (MA) program (Part C) and Prescription Drug benefit program (Part D) beneficiaries, would clarify program requirements and improve protections for beneficiaries.
Some of the proposed changes include strengthening CMS’s qualified drug and health plan identification and approval ability; clarifying health plan requirements relating to out-of-pocket costs and cost-sharing to improve beneficiary protections from discriminatory cost-sharing; and requiring companies that offer multiple drug or health plans in the same area to provide meaningful differences between the plans, particularly with regard to premiums, out-of-pocket costs, plan types, and formulary offerings.
The rule will be published on October 22, 2009, at the Federal Register. The comment period for the proposed rule will close on December 8, 2009.
You can read CMS’s press release on this new rule by clicking here.
CMS recently issued a memorandum to Medicare Advantage Organizations and Prescription Drug Plan Sponsors to clarify several sections of the Medicare Marketing Guidelines. CMS explains that since releasing the Guidelines, it has received numerous requests for clarification. The Memorandum serves to address these requests, and CMS expects to incorporate the clarifications in the next Marketing Guidelines revision.
The American Medical Association announced yesterday that, effective immediately, it has issued a new Current Procedural Terminology (CPT) code for vaccine administration, and revised existing code 90663 to include the H1N1 vaccine. The new code, 90470, includes H1N1 immunization administration (intramuscular, intranasal), including counseling when performed. AMA reports the new code will help to simplify and make more efficient physician and health care provider reporting and reimbursement procedures, as well as reporting and tracking H1N1 immunization and counseling services.
Read the AMA’s press release here.
The Federal Trade Commission (FTC) and the Department of Justice (DOJ) announced they will consider updates to the Horizontal Merger Guidelines. Intended to reduce the uncertainty associated with enforcement of the antitrust laws in the merger area, the Guidelines outline the merger enforcement policies of the FTC and the DOJ, including describing the analytical framework and specific standards normally used by the agencies in analyzing mergers. They have not undergone significant revision since 1992. Given legal and economic developments since that time, the FTC and the DOJ believe the time is ripe to solicit public comment and hold joint public workshops to determine whether the Guidelines take into account these developments and to determine whether the Guidelines accurately reflect the current practice of merger review at the FTC and the DOJ.
The agencies will issue a set of questions about the current Guidelines and possible revisions, allowing public comment and agency original research. Afterwards, the agencies will host a series of five workshops, open to the public and the press. The workshops are scheduled to occur in Washington, D.C. on December 3, 2009, and then Chicago, New York City, San Francisco, and a final workshop again in Washington, D.C., throughout the remainder of December and in January 2010. Additional information about the date, time, and exact location of the workshops will be provided at a later date.
The FTC will post a set of questions on its web site. The agencies are particularly looking for comments from attorneys, economists, academics, consumer groups, and the business community. Given the increase in hospital mergers and medical practice acquisitions, members of the health care community should be interested in the agencies’ updates to the Guidelines.
Medicare recently issued guidance to private health plans with Medicare contracts concerning mailings to Medicare beneficiaries about current health reform legislation’s potential impact on Medicare Advantage and prescription drug benefits. CMS is concerned that certain private health plans have sent or may send to Medicare beneficiaries information that violates Medicare rules concerning such benefit information, unless the information was first submitted to CMS for review. CMS is concerned that such mailings will confuse beneficiaries and think that such information is official communication about the Medicare Advantage program. CMS asks that plan sponsors refrain from mailing similar materials until CMS has investigated whether potential violations have occurred.
The President released a memorandum to the Secretary of Health and Human Services yesterday directing HHS to make demonstration grants available within 30 days to states and health systems “for the development, implementation, and evaluation of alternatives to our current medical liability system.” The President said in the memo that the starting point for malpractice reform should begin with The Joint Commission and the Institute of Medicine’s identified goals and core commitments. These priorities include patient safety, reducing preventable injuries, fostering better communication between doctors and their patients, ensuring fair and timely compensation for injured patients, reducing the incidence of frivolous lawsuits, and reducing liability premiums. Grants will fund “demonstration projects that can test a variety of medical liability models and determine which reforms work” to achieve the identified goals.
$25 million in grants will be awarded in amounts of up to $3 million for three years for states and health systems implementing and evaluating patient safety and medical liability demonstration programs, and one-year planning grants up to $300,000 for technical assistance for states and health systems wanting to plan demonstrations. Grant decisions will be made in early 2010.
You can read The Washington Post’s report on the White House release here.
The Wisconsin Hospital Association’s (WHA) CheckPoint web site, which provides information to the public concerning hospital quality and safety of care information, has announced that new information is now available. Through the Surgical Care Improvement Project (SCIP) measures, the public can now see information that reflects hospital care practices aimed at reducing the risk of infection and blood clots after surgery. SCIP measures, which are used by hospitals throughout the United States to monitor and improve care, include the following:
- Percent of surgery patients given an antibiotic within 1 hour before surgery
- Percent of surgery patients given the right kind of antibiotic
- Percent of surgery patients whose antibiotics were stopped within 24 hours after surgery
- Percent of heart surgery patients whose blood sugar is kept under control in the days right after surgery
- Percent of surgical patients that had their hair removed using a safer method
- Percent of surgical patients that had treatments ordered to prevent a blood clot
- Percent of surgical patients that received treatment to prevent a blood clot within 24 hours before or after surgery
Hospitals voluntarily report the information contained on CheckPoint. Currently, 128 Wisconsin hospitals report to CheckPoint, and CheckPoint’s web site explains that these 128 hospitals provide care to 99% of the state’s patients. CheckPoint may be accessed by clicking here.
A new initiative by the Joint Commission will help hospitals put an end to identified practices that endanger or inhibit quality patient care. The Joint Commission announced yesterday that it has launched the Center for Transforming Healthcare, and will team up with top hospitals and healthcare systems across the country to identify the causes that harm patient care and develop solutions to eliminate those causes. The Center’s first targeted initiative will focus on hand-washing failures as a critical patient safety problem. The next challenge will focus on patient “hand-offs,” i.e., transferring patient responsibilities from one provider to another in the hospital, such as during staff changes.
Center representatives believe that its initiatives, along with the help and collaboration of some of the top hospitals and healthcare systems in the country, will lead to “the development and testing of targeted, long-lasting patient safety solutions” that can “help transform American health care into a high-reliability industry that ensures patients receive the safest, highest quality care they expect and deserve.”
For more information on the Center for Transforming Healthcare, click here.
AHA reported yesterday that the U.S. Department of Defense “published a final payment rule for critical access hospitals under TRICARE, which covers uniformed service members and their families. Effective Dec. 1, the rule adopts Medicare’s reimbursement methodology for CAHs, paying 101% of reasonable costs for inpatient and outpatient care. As recommended by the AHA, the department dropped a proposal to pay CAHs the lesser of costs or charges. Instead, the agency will place threshold limits on the cost-to-charge ratio for CAHs by using the method Medicare uses to identify outliers in the outpatient prospective payment system. TRICARE will use historical data to calculate the cost-to-charge ratios and payments. DoD said it was ‘not administratively feasible’ to make interim payments or conduct retroactive cost settlements, since TRICARE is a relatively small payer and hospitals do not file cost reports with the program.”
Wisconsin’s Medicaid program has been tasked with generating $625 million in savings over the next two years, to help battle Wisconsin’s $6.6 billion budget deficit for the 2009-2011 biennium. The Wisconsin Department of Health and Family Services convened advisory groups to help identify savings measures and ways to improve the Medicaid health care service delivery. In that effort, the Department is soliciting comments and suggestions to restructure the Medicaid managed care delivery system in southeast Wisconsin, including Milwaukee, Racine, Kenosha, Ozaukee, Washington and Waukesha counties. Comments and suggestions can be made online by clicking here through September 11, 2009.
