Health Care Reform Memo Library
A weekly update on activities in the administration
The health care reform memos are issued on a weekly basis, highlighting news from the previous week’s activities in the administration, and implications for the C-suite and various stakeholder groups. The purpose of these memos is to:
- Provide current news on various health care reform efforts
- Tease out how changes affect various stakeholder groups, including health plans, providers, life sciences companies, federal and state government, large employers, and most importantly, consumers.
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- My take
- Implementation update
- HHS requests U.S. Supreme Court to extend argument on Anti-Injunction Act on ACA challenge
- Update: essential health benefits guidance
- HHS: ACA saved $2.1 billion for Medicare prescription drug costs
- Bill to exclude brokers’ commissions in the medical loss ratio calculation introduced
- Representative introduces bill to repeal PCORI
- House votes to repeal CLASS Act
- Legislative update
- CBO projects $1.079 trillion deficit for FY12
- FDA improvements sought to address drug shortages
- CBO: war savings calculation, target for SGR fix proponents
- GOP physicians ask AARP for Medicare reform details
- Rubio seeks EHB exclusion for religious organizations
- Representatives introduce bill to increase health care access in rural areas
- Representatives introduce legislation to amend 510(k) drug review process
- State update
- State round-up
- Industry news
- Study: insurance fee cost Medicaid $38.4 billion
- HHS: Medicare Advantage premiums down 7 percent, enrollment up 10 percent
- GAO: prices for medical devices vary widely, not transparent
- Moody’s: rough year ahead for not-for-profit hospitals
- IRS releases proposed regulations for taxable medical devices
- FDA and device industry recommend $595 million in drug user fees
- Medical practices: ICD-10 Version 5010 conversion creating payment glitches
- National Quality Forum endorses resource use and costs quality measures
- Prior authorization of power mobility devices and recovery audit prepayment review demonstrations to start June 1, 2012
- CBO: federal worker benefits better than private employers
- FDA approves “first ever” drugs for cystic fibrosis, basal skin cell cancer
- Study: state nursing workload mandates reduce RN overtime slightly
- HHS OIG: data inconclusive about physicians opting out of Medicare
- My take
- Implementation update
- PCORI releases draft research agenda with five main priorities
- OMB reviewing final rules related to exchanges, Medicaid expansion, and state innovation waivers
- Constitutional challenge update: actuaries argue mandate exclusion would invalidate rest of ACA
- HHS provides essential health benefits guidance
- HHS releases proposed rule to increase rebates from drug manufacturers
- CLASS repeal vote expected
- Legislative update
- Joint Conference Committee begins talks; physician pay cuts, payroll tax continuation on agenda
- OMB reviewing proposed rule related to stage 2 meaningful use
- ICD-10 final rule unclear on penalties for noncompliance
- GAO: Medicare overpayments for Medicare Advantage plans
- ONC launches new health IT challenges
- State update
- State round-up
- Industry news
- Hospitals challenge Medicare funding cuts, impact on jobs
- Preventive health in primary care settings incomplete
- MLR requirement for student health plans challenged
- My take
- Implementation update
- States push for details of federal exchanges
- House Ways and Means passes CLASS Act repeal bill
- Hospital groups urge fix to Medicare formula preferential to Massachusetts
- PCORI research agenda release expected today
- HHS gives several religious employers another year to cover FDA-approved contraceptives
- Legislative update
- House votes against President’s request to raise federal debt limit
- Nursing home cuts proposed for 2014
- Campaign 2012 health platforms
- GOP Presidential candidate health platforms
- GOP primary process, delegate count
- State update
- Survey: all but two states expanded or maintained Medicaid eligibility last year
- State round-up
- Industry news
- OMB is reviewing proposed rule on stage 2 meaningful use
- CBO: disease management, value-based purchasing pilots did not reduce costs
- NCQA announces organizations that seek ACO accreditation
- Study: Medicare Advantage Plans that offer fitness options attract healthier enrollees
- My take
- Implementation update
- January 24: budget talks start again, SGR, payroll tax key agenda items
- Constitutional challenges update: briefs filed for, against ACA
- Update: health insurance exchanges
- GOP leaders challenge essential benefits notification by bulletin rather than as a proposed rule
- Study: elimination of individual mandate results in 25 percent premium increase
- CO-OP grant awards expected soon: CCIIO
- Legislative update
- Proposed change in DSH payment calculations helps hospitals offset costs for inadequately insured patients
- MedPAC recommendation for E&M codes: “pay based on what is done, not where”
- Medicare eligibility age increase to 67 would save $148 billion, would increase Medicaid costs $35 billion
- White House announces plan to streamline departments, desire to improve effectiveness and efficiency of government
- Staff changes in White House health policy team; core leadership worked together in Clinton administration
- State update
- Managed care option for dual eligibles proposed
- State waivers for insurance coverage rule out next week
- State round-up
- Industry news
- CMS: health care spending up 3.9 percent in 2010 to 17.9 percent of U.S. GDP
- Device industry-FDA negotiate user fees
- European downgrades impact industry costs of capital
- Hospital adverse events hurt 1 in 7 patients; most go unreported
- Part C Medicare Advantage payment accuracy for high-risk beneficiaries adjusted 1 percent
- Implementation update
- Briefs on ACA’s individual mandate and severability filed
- Administrative simplification rule released, plans required to implement in 2012
- Innovation advisors announced by the Innovation Center
- State update
- MLR waiver denials: Kansas, Oklahoma
- State round-up
- Industry news
- Health IT funding in 2011
- CMS publishes quality measures for Medicaid-eligible adults
- Study: hospital quality websites vary widely in content and impact
- FDA: biosimilar, biologic pathways separate
- New medication shortages: 267 drugs in 2011, 5th straight yearly increase
- AHRQ study questions value of medical homes, cites lack of evidence
- HHS releases Global Health Strategy
- American College of Physicians releases new ethic guidelines for doctors
- My take
- Implementation update
- Highlights of ACA implementation
- AHRQ studies how to engage consumers in comparative effectiveness research
- Pioneer ACO grants announced
- Independence at home guidelines released
- Early Retiree Reinsurance Program ends
- Legislative update
- Two month SGR fix included in pay roll tax legislation
- Military health IT funding approved but requires alignment with overall health IT standards
- Physician performance data from federal government restricted
- PolitiFact: health care ‘lie of the year’ designation third year in a row
- House Doctors Caucus requests two year SGR fix
- Data center consolidation announced
- ONC announced online resource to track EHR adoption, implementation
- Home care workers’ compensation focus of White House legislative effort
- State update
- States initiate chronic care coordination efforts, connecting public health and local providers
- CHIP enrollment bonuses awarded
- Massachusetts waiver
- Industry news
- FDA issues guidance on off label drug and device use, responds to consumer demand
- Health plans digesting MLR final rules
- False Claims Act ineffective in stemming off label marketing activity: study
- AHA requests simplification of conditions of participation
- My take
- Implementation update
- Congress approves appropriations bill to avert government shutdown; Senate passes payroll tax cut extension
- HHS issues essential health benefits bulletin
- HHS announces funding for new hospital patient safety program under CMMI
- CMS announces Pioneer ACOs recipients
- FDA investigates impact of drug promotion
- Legislative update
- Legislative overrides of the SGR
- Democrat coalition releases principles for innovation in the U.S. health care system
- Bill to extend stay of foreign-born physicians introduced
- State update
- State roundup
- Industry news
- Study: physicians concerned about future of medical practice, unintended results of ACA
- Report: FDA increasingly dependent on states for food inspection oversight
- Report: harm to medical research subjects requires government action
- AHRQ launches online resource to help providers with EHR implementation
- HHS recovers $2.9 billion in health care fraud in FY2011 using advanced analytics
- USDA provides $30 million funding for telehealth services in rural areas
- CMS announces results for a value-based purchasing for dialysis services; 30 percent miss targeted threshold for quality
- My take
- Implementation update
- CO-OPs final rule published; flexible approach for states encouraged
- HHS releases final rule making physician performance data publically available
- PCORI received 856 applications for its Pilot Projects Grants Program
- HHS awards $14 million in ACA funding to school-based health centers
- HHS to stop paying claims for the Early Retiree Reinsurance Program
- Sequester default means 2 percent cut to Medicare; perhaps more
- Status of key ACA provisions which impact Medicare provider payments
- Legislative update
- House Republicans release temporary physician pay bill; cuts to ACA funding, hospitals proposed to offset cost
- Bill to require prompt Medicaid payments introduced
- State update
- Health exchange update
- Industry news
- FDA releases user fee program for biosimilars
- HIPAA privacy and security audits coming in 2012
- Supreme Court hears case about patent protection for medical processes
- My take
- Implementation update
- HHS releases final MLR rules; 64 percent of insurers would meet MLR requirements
- House Energy and Commerce Committee votes to repeal CLASS
- HHS announces contractor to build the federal health insurance exchange
- Medicare releases competitive bidding guidance for medical equipment and supplies
- CMS announces Medicare coverage for preventive services to reduce obesity
- Legislative update
- "SGR fix" not fixed
- State update
- Survey: state revenues below pre-recession levels; Medicaid spending growth above average
- State roundup
- Industry news
- HHS announces delay to Stage 2 meaningful use
- ONC final rule finalizes processes for consequences for EHR accreditors’ misconduct
- Medicare open enrollment ends this week
- President announces $50 million in new funding to combat AIDs
- OECD: U.S. performs well on cancer care and screenings; not on hospital readmissions
- Study: Medicare disease management pilot results suboptimal
- Study: variation in use of in-office testing and correlation to billing
- My take
- Implementation update
- Insurance commissioners urge action protect agents and brokers
- Reconciling ACA Costs after CLASS is withdrawn
- Supreme Court health reform cases
- NCQA announces ACO accreditation program
- Legislative update
- Super Committee falls short; sequester next
- Berwick resigns, Tavenner steps into CMS role
- President signs Medicaid glitch fix
- Industry news
- Update: sustainable growth rate model and physician pay; temporary fix likely
- Hospitals lose ground in sequester
- HHS rate review: Pennsylvania health insurer charging excessive premiums
- Study: retail clinic use up, popular among young urbanites
- Physician notice of National Practitioner Database inquiries suspended pending rule
- My take
- Implementation update
- Supreme Court to hear health reform constitutional challenges; four major decisions anticipated
- CLASS Act repeal passes committee vote
- House unanimously approves “fix” for ACA Medicaid eligibility calculation
- Senators introduce bill to repeal ACA’s health insurer tax
- HHS announces $1 billion for “Health Care Innovation Challenge”
- CMS announces applications deadline for ACO Advance Payment Model
- HHS expands website to help small businesses compare health insurance plans
- Legislative update
- Supercommittee fails to reach agreement on package; automatic cuts likely
- Schwartz proposal to Supercommittee: fix SGR
- State update
- MLR waivers sought by Florida, Michigan
- NGA helps states prepare for health exchanges
- Industry news
- Grace period for 5010 implementation but deadline unchanged
- AMA proposes ICD-10 delay, include physicians in state exchange governance, and to support virtual medical IDs
- ONC: 100,000 primary care providers use EHRs
- CMS seeks comment on Medicaid Information Technology Architecture
- CMS clarifies rules for physician-owned hospitals
- Study: use of EHRs improves outcomes
- FDA suspends use of Avastin for breast cancer
- National Center for Quality Assurance starts ACO accreditation
- CDC hospital antibiotic tracking system
- My take
- Implementation update
- DC Circuit upholds individual mandate
- Pioneer ACO update: CMS seeks commitments by November 28
- Final rules for new insurance industry regulations – CO-OP plans, MLR – at OMB on final review
- IRS: fewer small businesses received health coverage tax credit than expected
- Senate approves “fix” for ACA Medicaid eligibility calculation
- Legislative update
- FDA warning to retailers about sale of tobacco products to minors
- Senators introduce legislation to improve programs for seniors and caregivers
- CBO pay-to-delay by drug manufacturers would save $4.8 billion
- Medicare to cover new preventive services to reduce cardiovascular disease
- State update
- State insurance commissioners want flexibility in health exchange roles
- State roundup
- Industry news
- Survey: Medicare payment cuts to nursing homes will lead to 6 percent workforce reduction
- IOM recommends new agency to regulate health IT and patient safety
- CMS survey: 72 percent perceive Medicaid to be good, 20 percent find enrollment process hard
- NFIB study: health insurance premium tax will cut up to 249,000 jobs
- AHIP elects new chairman of the board
- My take
- Implementation update
- Justice Department asks Supreme Court to delay hearing of Virginia lawsuit
- CLASS repeal bill introduced, blocked in Senate
- GAO analysis: ACA early retiree program status and funding outlook for FY 2012
- HHS provides survey standards to capture disparities information
- Legislative update
- Super Committee update: bipartisan members of Congress and commission leaders encourage bigger cuts to spending
- State update
- Governors want flexibility in health exchange set-up operations and assistance in IT implementation
- State round-up
- Industry news
- White House Executive Order to reduce drug shortages
- CMS releases final Medicare payment rules for providers
- ONC extends temporary EHR certification program to summer 2012
- AHIP: ACA annual fees on insurers will increase premiums up to 3.7 percent by 2023
- HHS OIG analysis: states, CMS missed opportunities in hospital patient safety programs, need for state-federal collaboration
- FDA approved 35 new drugs last year
- My take
- Implementation update
- Legal challenges to ACA: U.S. Supreme Court announcement soon, trade groups weigh in
- HHS announces Advanced Primary Care Practice demonstration
- Study: elimination of mandate reduces newly insured by 7.8 million and increases premiums 12.6 percent
- Legislative update
- House votes to eliminate withholding for providers
- House approves “fix” for Medicaid modification to ACA Medicaid eligibility
- Healthy People 2010 misses targets on obesity and health disparities
- State update
- Industry news
- Medicare announces premiums, deductibles, and cost-sharing amounts for Parts A, B, C, D
- FDA prescription drug user fees recommendation to Congress January 15
- GAO recommends health care costs transparency
- FTC report: industry reached 28 pay for delay settlements in 2011
- CDC launches Preventing Infections in Cancer Patients program
- CDC committee recommends HPV vaccine for boys
- White House urges community health centers to hire veterans
- My take
- Implementation update
- ACO final rule released; reaction from providers positive
- CBO: CLASS program repeal will not impact budget
- CMS offers program Innovation Advisors
- Update: Legal challenges to ACA
- Legislative update
- CMS announces new procedures to streamline hospital regulatory compliance
- Drug importation bill rejected in Senate; trade associations weigh in on safety concerns
- Industry news
- Lawmakers encourage 12-year biologics exclusivity
- House Committee examines effectiveness of FDA medical device oversight
- My take
- Implementation update
- HHS recommends suspension of the CLASS program
- Constitutional challenge update
- HHS awards $900 million to expand primary care workforce
- ACO Pioneer program participants announcement this week
- Essential health benefits update
- PCORI seeks input for research proposals
- Legislative update
- Joint Select Committee hears budget savings suggestions from legislative leaders, key stakeholders
- State update
- Industry news
- SAMHSA awards grants to behavioral providers for health IT
- Dual-eligibles plan proposed by AHIP
- Congress approves free trade legislation
- Medicare open enrollment started Saturday
- ONC, Health 2.0 launch “popHealth Tool Development Challenge”
- Senate introduces legislation to streamline FDA oversight of medical devices
- My take
- Implementation update
- IOM releases essential health benefits guidance
- Senators urge action on Sunshine Law, manufacturer kickbacks
- OIG agenda for FY12: provider reimbursement, ACA implementation priorities
- Energy and Commerce Leader asks for actuarial analysis of CLASS Program
- HHS: Medicare enrollee use of preventive benefits
- Medicare recovery auditors corrected $92 million in improper FY 2010 payments
- CMS extends deadline for Bundled Payments applications
- Constitutional challenge: circuit court update
- Legislative update
- Physicians focus on Joint Select Committee on Deficit Reduction to fix SGR, repeal IPAB
- Dems: allow Medicare to purchase drugs directly from manufacturers
- State update
- Industry news
- GAO: enrollee “doctor shopping” costs Part D $150 million
- HIT jobs initiative announced
- Survey: HIT use by physicians improves accuracy
- CMS proposal: eliminate under-performing Part C plans; additional reporting requirements for PBMs
- MedPAC to Congress: freeze primary care payments, cut specialists 17 percent
- Deadline for first wave of meaningful use grants
- Studies: dual eligibles care fragmented, changes in oversight, quality measurement required
- FDA announces efforts to encourage personalized medicine
- Senate Finance investigates fraud in home health
- FDA and CMS launch “parallel review” pilot program
- My take
- Implementation update
- Constitutional challenge update
Health insurance exchange rule comment period extended; essential health benefits expected this week - ACA funding released for primary care, chronic, lifestyle, and workplace wellness programs
- PCORI announces grants for comparative effectiveness research
- CMS launched Medicare Plan finder website
- GAO: cost impact of ACA requirements on military health
- Constitutional challenge update
- Legislative update
- Cuts to ACA funding proposed by House GOP committee
- AHA promoting increase in Medicare eligibility age in lieu of across-the-board cuts
- HHS data collection on CHIP
- State update
- Supreme Court to hear case about enrollee challenge to Medicaid payment cuts
- CMS awards $1.5 million to State Health Insurance Assistance Programs
- State implementation efforts
- Industry news
- Medical informatics new specialty recognized by ABMS
- Meaningful use update
- Kaiser survey: employer premiums increased 8 percent to 9 percent in 2011
- CMS proposes five new measures in HCAHPS program for hospitals
- Medical device outlook mixed: domestic price pressures increasing, risk contracting with providers sought
- My take
- Implementation update
- HHS announces $224 million to support home visits for at-risk families programs
- Anti-injunction act new wrinkle in constitutionality challenge to ACA -- might delay ruling on individual mandate until 2015
- CMS announces database to collect personal information for ACO participants and providers
- HHS awards rate review
- Constitutional challenge update
- Legislative update
- President Obama $3 trillion deficit reduction proposal: $320 billion cuts to Medicare and Medicaid included
- MedPAC releases plan to pay for $200 billion SGR fix
- Dual eligibles focus of cost management efforts, managed care solutions encouraged
- Trade groups ask for continuation of automatic payment updates
- State Medicaid directors ask for flexibility to accelerate managed Medicaid programs
- House approves $300 million for pediatrician training program
- State update
- Industry news
- AHA to ONC: HIE Stage Two meaningful use standards not feasible
- Insurers pool data, plan to create not-for-profit data warehouse for public use
- Report: U.S. needs to take “serious action” to protect leadership in global biomedical industry, protect jobs
- My take
- Implementation update
- ACA primary care provisions
- Constitutional challenge update: Pennsylvania District Court rules the individual mandate unconstitutional
- CMS releases final rule implementing the Medicaid RAC Program
- GOP seeks repeal of CLASS Act in ACA
- Legislative update
- President Obama proposes America’s Job Act
- Select Committee begins work, impact on health care spending considered in first meeting
- MedPAC recommendation: eliminate SGR, freeze payments to PCPs, cut payments to others 18 percent
- Senate Democrats encourage delivery system reforms to cut cost, protect system
- HHS funds community health center upgrades
- Upcoming congressional hearings
- State update
- MLR waivers, managed Medicaid
- HRSA funds Regional Telehealth Resource Center grants
- Industry news
- CCIIO: MLR rule causing health plans to reduce premium increases
- Health IT week declared
- OIG: fraudulent billing in physician practices
- CBO: removing pay-to-delay by drug manufacturers would reduce costs
- Stage Two meaningful use improves outcomes: study
- HHS: Medicare Advantage premiums will decrease 4 percent, enrollment increases by 10 percent in 2011
- President Obama signs patent reform bill; announces NIH center to promote drug development
- HHS launches public-private sector initiative to prevent heart attacks and strokes
- My take
- Implementation update
- Fourth Circuit finds it lacks jurisdiction to hear challenges to health reform law
- Affordable Care Act year one results: Medicare enrollee use of discount drugs, preventive health services
- HHS requests input about Basic Health Program serving lower income, non-Medicaid eligible enrollees
- HHS announces funding for community health centers
- Senators ask GAO to review prevention fund awards
- Legislative update
- Joint Select Committee begins work
- Senate appropriates $50 million increase to FDA FY12 budget
- Senate committee approves funding for pediatrician training program
- State update
- Health exchange update
- State-by-state scorecard on long term care posted
- MLR waiver requests
- Industry news
- AHA study: Medicare cuts could reduce health sector jobs
- AdvaMed study: ACA device tax could reduce jobs
- Senate passes major patent reform bill
- Medicare fraud task force collects $295 million in false billings
- My take
- Implementation update
- Rate reviews rules applicable to association health plans
- Rate review update
- IOM summarizes essential health benefits listening tour feedback
- GAO analysis of MLR requirement: plans adjusting business practices to comply, brokers’ commissions being cut
- AMA urges CMS to reconsider physician enrollment process
- Legislative update
- Select Committee announces first meetings
- Industry consolidation focus of committee hearing this week
- CMS finalizes MA, Part D requirements
- Nursing homes target select committee with ad campaign to fend off funding cuts
- Fraud detection emphasis increasing
- Industry news
- UnitedHealth group acquires California medical group; plans developing strategic collaboration agreements with providers
- FDA releases draft of industry user fees reauthorization
- Health care employment trends and projections: BLS outlook
- Study: EHR use increases accuracy of diagnosis, effectiveness of treatment planning
- CMS releases rule amending e-prescribing incentive program, alignment with meaningful use
- Consumer group seeks new FDA regulations on generic labeling
- AHA challenge: CMS hospital reporting requirements breach of ACA
- Central Pennsylvania urology group consolidation anti-trust settlement reached
- State news
- GOP Governors Public Policy Committee: significant flexibility for Medicaid required
- State round-up
- My take
- Implementation update
- Bundled payments program announced by CMS
- NAIC recommendation: multi-state plans must follow same rules as other plans
- Constitutional challenges: 8th Circuit Court plans to hear oral arguments
- CBO budget update: recovery slower than earlier anticipated
- Legislative update
- Key dates for Joint Select Committee on Deficit Reduction
- Transition Medicare to a voucher program: BPC recommendation to the Select Committee
- State legislators ask for flexibility in developing exchanges
- Insurance annual fee challenged by AHIP, NFIB
- CMS announces plan to streamline regulations for hospitals
- State watch
- HHS awards $137 million to states to boost prevention and public health
- GAO: PCIP costs, enrollment lower than expected in states
- State round-up
- Industry news
- CMS expands Medicare DME bidding program
- ONC seeks public comments on its plan to reduce health IT disparities
- CMS ends EHR demonstration early
- AMGA: group practices report higher operating losses
- My take
- Implementation update
- IRS releases branded prescription drug fee regulations
- Proposed guidance for summary of benefits disclosures released
- Legislative update
- OMB: FY 2013 federal agency budget requests should be at least five percent below 2011 discretionary funding
- State watch
- HHS awards grants for CHIP outreach efforts
- HHS announced ACA grants to strengthen state and local health departments
- State round-up
- Industry news
- Study: physician medical liability exposure
- Telemedicine use in rural health necessary to reduce cost: CMMI analysis
- Advanced business analytics used to identify “drug repositioning” opportunities
- OIG: drug rebates reduce Medicaid and Medicare spending
- FDA releases guidance for medical device premarket review of benefits-risk assessment
- HHS announces initiatives to improve access to physicians and health IT in rural communities
- Report: nursing homes Medicare payments reduced by $79 billion under recent regulations
- My take
- Implementation update
- Constitutional challenges: 9th, 11th Circuit Courts rule
- HHS, IRS publish proposed rules to help states establish health insurance exchange
- Legislative update
- The Joint Select Committee on Deficit Reduction: health-related interests and activity
- HHS announces $28.8 million for community health centers
- CMS seeks state applicants for Medicaid Emergency Psychiatric Demonstration
- State watch
- HHS awards $185 million to 13 states to develop health insurance exchanges
- Dual eligibles fact sheet
- State round-up
- Quality measures for Medicaid-eligible adults released
- Industry news
- Perceived adequacy of insurance coverage (Deloitte 2011 Survey of U.S. Health Consumers)
- Moody’s: nonprofit hospitals revenue growth lowest in 20 years
- EHR incentives deadlines
- Physician groups challenge reporting requirements
- Physician group demonstration results
- Study: retractions of scientific studies increasing
- ONC releases metadata guidance, part of stage 2 meaningful use
- ONC: consumer engagement a priority
- GAO report: Medicare feedback to physicians inadequate
- Lawmaker asks HHS to study costs and benefits of health IT
- CMS: two million eligible for the Medicare Low-Income Subsidy program but not enrolled
- CBO: children’s hospital GME would cost $1.57 billion
- My take
- Implementation update
- Joint Select Committee activity encouraged to be open
- FDA officials comment on biosimilar approval, oversight process
- HHS announces ACA covered preventive services for women
- Third Circuit Court dismisses challenge to ACA
- House Republicans challenge IPAB
- Industry news
- CMS releases final rules for FY 2012 Medicare payments
- HHS: average Medicare Part D premiums will be $30 in 2012
- Nursing home cuts will cost $50,000 for each facility
- State watch
- Michigan seeks MLR waiver
- GAO report: health insurance rate reviews processes vary, efforts underway in majority of states
- State round-up
- My take
- Implementation update
- Health exchange update: scenarios for planning
- CO-OP funding deadline announced
- Association health plans subject to rate review rule under ACA: NAIC
- Supreme Court petitioned to hear case challenging individual mandate
- CBO: modification to ACA Medicaid eligibility could save $3 billion
- Legislative update
- CMS actuaries: health spending to increase 5.8 percent annually through 2020
- House subcommittee approves Children’s GME program
- Proposed law would require Medigap plans to meet ACA MLR requirements
- Commonwealth Fund analysis: provider preparedness for ACOs risk-sharing low
- Industry news
- 510(k) medical device review process update: IOM report and FDA guidance
- Physician groups challenge Medicare eRx Incentive Program
- NFIB study: small employers concerned over ACA, anticipate benefits cuts
- My take
- Implementation update
- HHS publishes proposed rule on ACA CO-OPs
- Senate bills prevent early retirees from becoming Medicaid eligible
- NCOIL supports exempting agent and broker fees in new MLR rules
- IOM recommendation: coverage for contraceptives, women’s preventive services
- CMS proposes Medicare coverage for depression screening
- Legislative update
- Debt ceiling negotiations and ACA
- Senator moves to halt SSN display on Medicare cards
- State watch
- Bill to encourage generic drug use in Medicaid introduced
- OIG analysis: Medicaid EHR incentive compliance is lacking
- State round-up
- Industry news
- Bipartisan letter focuses on hospital payment cuts
- FDA proposes oversight for mobile medical applications
- Health groups form new coalition to focus on health care disparities
- Study: drug prices five years after Medicare Part D
- Bipartisan group of senators to President: stop Medicare payment cuts for imaging services
- My take
- Implementation update
- Health insurance exchange proposed rules published; comment period for 75 days
- CBO coverage projections challenged by Senator
- House bill would prevent early retirees from becoming Medicaid eligible
- Senators request flexibility with essential health benefits
- HHS announces ACA funding for school-based health centers
- Legislative update
- Repeal on ACA restriction for OTC drug reimbursement sought
- Energy and Commerce Chairman concerned about medical malpractice reform policies
- Supplemental funding for HIT usage in multi-campus hospitals sought
- NAIC committee does not endorse broker and agent exemption
- State watch
- Study: state governments to spend at least $90 billion less under ACA
- NGA: Medicaid spending target harmful to states
- State round-up
- Industry news
- Study: small group health insurance market profile
- Study: biopharmaceutical industry impact on U.S. economy
- Hospital drug shortages significant and growing problem
- FDA personnel changes announced
- My take
- Implementation update
- Federal requirements for health exchanges will be announced today
- Ohio District Court upholds the individual mandate
- Restaurant groups ask FDA for flexibility on ACA menu labeling requirements
- CMS implements clinical lab test demonstration
- CMS to conduct insurance premium rate reviews in ten states
- Legislative update
- HHS announces three new dual-eligible initiatives
- ONC coordinator: Stage 2 meaningful use delay recommended
- State watch
- Health Affairs study: Medicaid spending varies by state, volume key driver
- FY 2012 begins for states, deficits loom
- Medicaid cuts to providers
- Governors ask HHS to reimburse states for payments made due to SSA mistakes
- State round-up from last week
- Study: impact of Medicaid coverage on previously uninsured
- Industry news
- Reports examine repeal and caps to employer health insurance tax inclusions
- Surgical groups: CMS physician payment rule undervalues their work
- FDA issues draft guidance on new dietary ingredients
- CMS home health update: 3.35 percent Medicare payment cut for home health agencies in 2012
- CMS home health update: Medicaid policy changes for face-to-face requirements
- CMS value-based purchasing update for home health update
- My take
- Implementation update
- Sixth Circuit Court of Appeals to uphold the individual mandate
- CMS publishes rule on administrative simplification of electronic health transactions
- APHA report: ACA public health provisions unfunded
- CRS report: president authorized to recess-appoint IPAB members
- Legislative update
- Senators propose plan to reduce Medicare spending
- CMS proposes physician pay formula for 2012
- Hospital outpatient, ambulatory surgery center, dialysis center oversight changes: CMS proposed rules
- CMS: almost 500,000 received 50 percent drug discounts in 2011
- State watch
- Iowa health plans to sell child-only policies for six weeks
- Utah seeks to convert Medicaid contracts into ACO model
- NY law would ban health plan mail-order prescription fill
- Health information exchange allows emergency room access prescription drug history
- Minnesota shutdown over budget
- State revenues up, deficits anticipated
- Industry news
- Congress to hold hearings on FDA prescription drug user fees Thursday
- Fees for overseas drug manufacturers considered
- Avastin, Provenge to be covered by Medicare
- Hospitals launch campaign against Medicare and Medicaid cuts
- Physicians petition White House for SGR repeal
- Physicians oppose cuts for diagnostic imaging services in proposed South Korean trade agreement
- Study: declines in physician acceptance of Medicare and private coverage
- My take
- Recent studies about the potential for employer exit from health insurance as a result of ACA
- Implementation update
- HHS announces $500 million in ACA funding for “Hospital Engagement Contractors”
- CMS report: 5.5 million Medicare beneficiaries used ACA-provided prevention benefits
- Proposed bill would repeal employee health plan auto-enrollment requirement
- Provider comments on ACO advanced payment initiative
- Legislative update
- Bill to allow federal government to purchase drugs directly from manufacturers introduced
- Nurse practitioners, physician assistants, and certified nurse midwives scope of practice expansion to home care services
- Medicare and Medicaid fraud: bill would strengthen surveillance and multi-state collaboration
- State watch
- Massachusetts AG report: global payments alone will not reduce health costs
- State legislative activity
- Industry news: consumerism in health care
- Consumer view of the U.S. system: underperforming, complicated, and inefficient
- CHPA: self-care could save $5 billion annually
- Social security solvency
- Industry news: technology enabled health care
- 2011 Medicare EHR Incentive Program update
- NLM launches tool to link patient portals and EHRs to consumer health information
- Ambulatory EHR market: $3 billion
- Supreme Court strikes down prescription drug data-mining regulation
- Industry news: delivery system integration, efficiency, and effectiveness
- AMA annual meeting highlights: support for individual mandate and health plan report cards
- AAMC report: medical student enrollment trends
- Industry news: evidence-based care
- The NPC report: employers support CER
- Industry news: federal oversight, coordination, and collaboration
- GAO report: FDA should enhance its oversight of medical device recalls
- Post market surveillance: FDA
- New FDA plan to police food imports
- Industry news: health insurance transformation
- White House announces new appeals process for health plan enrollee denial of coverage
- Amended interim final rule on insurance appeals provides additional state flexibility
- Industry news: correlation of health cost containment and economic recovery
- Federal forecast for weaker recovery
- Industry news: growth and innovation
- Business analytic tool applied to HIV/AIDS
- My take
- Implementation update
- CMS announcement: end to mini-med waivers
- Republican governors, Senator Hatch ask for Medicaid “management of effort” flexibility
- Senate bill aims to repeal FSA and HSA reforms from ACA
- HHS announces the National Prevention Strategy
- GAO report: use of ARRA and ACA funding for comparative effectiveness research
- HHS announces $4 million in ACA funding to support Community Transformation Grants
- Legislative update
- Imaging focus of federal utilization review effort
- Study: Medicare enrollee responsibility for home health copayments
- Administration intensifies fraud reduction efforts
- CMS rule permits mental health centers participation in Medicare
- Democrats propose Part D legislation
- Legislation proposed to promote antibiotic development
- State watch
- Study: Medicaid prescription drug costs could be less with tight national formulary
- Managed Medicaid promoted
- OIG analysis of state 340B drug discount programs
- Commonwealth Fund study: Medicaid managed care plans administrative costs and quality of care
- Industry news
- AHA recommends delay in Stage 2 EHRs meaningful use program
- SGR options: CBO
- White House releases framework for coordination, regulation of nanotechnology
- Senators ask for industry input on how to streamline regulations to promote innovation
- Imaging over-utilization focus of MedPAC recommendation
- NAIC report: MLR options for brokers
- My take
- Implementation update
- ACO rule update
- ACA constitutional challenges update: Atlanta circuit court
- House subcommittee focuses on IPAB repeal
- IRS extends deadline for BCBS health plans to implement MLR provision
- Revisions to CLASS Act sought by House GOP
- Tax on home care devices focus of advocacy effort
- FDA report: budget cuts threaten biosimilar pathway development, generic review approval processes, and food safety
- HHS funds ACA demonstration projects for Federally Qualified Health Centers
- HHS announces $40 million in ACA funding for state chronic disease programs
- AMGA asks OMB to use lower ACO savings estimates in its budgeting process
- Legislative update
- Democratic lawmakers form Health Care Innovation Task Force
- Senate Democrats urge Administration to reject GOP Medicaid proposal
- Bipartisan effort to protect NIH funding
- Industry news
- AHRQ analysis: employee health care costs are increasing
- Medical Device Manufacturers Association encourages investment in R&D
- AdvaMed outlines recommendations to sustain leadership in the medical technology industry
- State watch
- U.S. Supreme Court to hear case to determine if hospitals can sue states over Medicaid payment rates
- Insurance exchanges: update
- OIG audits identify $61 million in improper Medicaid claims in NC, WA
- My take
- Implementation update
- Constitutional challenges: update
- Trade groups weigh in on ACO rules
- HHS releases final regulation on Medicaid payment adjustments for provider-preventable conditions
- Prescription drug excise tax calculation provided by IRS
- CMS clarifies Medicare Prescription Drug (Part D) enrollee financial responsibility for those in higher income brackets
- House Blue Dog Coalition asks CMS to simplify regulations on home health certifications
- State watch
- Medicaid cuts prominent in state FY12 budgets
- Insurance exchange oversight: update from CMS
- Legislative actions
- Industry news
- New CMS rule: Medicare data accessible
- HHS lowers premiums to encourage enrollment in Pre-Existing Condition Insurance Plan
- Antibiotic resistance, development focus of new legislation
- Hepatitis drug approved, second in recent months
- IOM recommends revisions to calculating labor costs used to determine Medicare provider payments
- FDA official defends device approval process, says European device approval process will not work in U.S.
- Energy and Commerce Health Subcommittee leaders send letter to MedPAC regarding payment cuts to diagnostic imaging services
- House approves a measure to require the FDA to use “hard science”
- HITECH update
- EHR adoption increasing: ONC
- CMS seeks comments on the Physician Quality Reporting System electronic health record measures
- ONC publishes proposed regulations for ONC-Approved Accreditors participating in the Permanent
- Certification Program for Health IT
- CMS releases Exchange/Medicaid IT Guidance 2.0
- My take
- Implementation update
- CBO, JCT address impact of funding cuts for ACA implementation
- Trade groups weigh in on ACO rules: Pioneer ACO more attractive than shared savings models proposed
- GOP Senators ask HHS to withdraw ACO rule
- MLR study: excluding agent and broker commissions reduces consumer rebates
- FDA extends menu labeling comment period
- Legislative update
- CMS Office of the Actuary analysis: Medicare Trustee Report projections too optimistic, do not account for physician payments accurately
- FY 2012 budget votes in Senate
- Regulatory overhaul proposed by OMB
- House panel recommends FDA 2012 budget cut
- House Appropriations Committee trims $1.3 billion from President’s budget
- CBO: malpractice reform reduces the federal deficit by about $57 billion over ten years
- Energy and Commerce Subcommittee discusses purchasing insurance across state lines
- Senate legislation to repeal ACA health insurer tax introduced
- House repeals graduate medical education mandatory funding
- Constitutional challenge update: judges named in multi-state challenge to ACA
- State watch
- Health exchanges: update
- Management of effort waivers: update
- MLR waivers: update
- Prescription drug fulfillment costs formula changed for state Medicaid programs
- Governors asked for Medicaid modernization ideas
- Health Information Technology
- CMS announces $75 million in Medicare EHR Incentive Payments
- ONC provides exam to help identify HIT experts
- Behavioral health, federally qualified health centers lobby for inclusion in HITECH funding
- HITECH repeal efforts
- CMS proposes changes to the Medicare eRx Incentive Program
- New accounting disclosure requirements align HIPAA with HITECH
- Industry news
- CBO: banning direct-to-consumer advertising would decrease prescriptions filled
- FDA approves drug for hospital-acquired infection, first in 25 years
- My take
- Implementation update
- Comparative effectiveness research board names Selby director
- Health insurance plan premium oversight rule published
- HHS drafting regulations on 340B drug program
- CBO: repealing IPAB to cost $2.4 billion
- Legislative update
- Marketing guidelines for Medicare Advantage, Part D issued
- Medicare EHR incentive payments expected soon
- AMA launches ad campaign for liability reform
- State watch
- Medicaid expansion costs: CBO
- Nine more states and Guam apply for medical loss ratio waivers
- Regional exchange center update
- My take
- ACA implementation update
- Costs for implementing ACO up to 15 times higher than government estimate: AHA
- ACO update: big groups push back
- $100 million in ACA grants to help create healthier U.S. communities
- Constitutional challenge update: Virginia circuit
- HHS announces new office to assist states in coordination for dual eligibles
- Kaiser report: House GOP budget plan would cut Medicaid funding by $1.4 trillion over ten years
- Legislative update
- Medicare trust fund will be exhausted in 2024: report
- House panel approves bill lifting maintenance of effort requirements
- Law seeks waiver of co-pay for telehealth
- CMS: health reforms will save Medicare $120 billion by 2015
- House Committee approves malpractice bill that sets cap on noneconomic damages
- Single-payer health system bill introduced
- Bipartisan caucus to make drugs more affordable
- ASPE study: uninsured unable to pay hospital bills
- State watch
- MLR waivers update: New Hampshire, Nevada join Maine in getting waiver
- Round-up
- My take
- ACA implementation update
- House passes bills to cut funding for health insurance exchanges, school-based clinics
- IRS seeks comment on employer shared responsibility requirements
- Constitutional challenges update
- Legislative update
- House Energy and Commerce Chair wary of Medicaid block grants and Medicare vouchers
- CMS announces new Chief Medical Officer
- Physician pay fix focus of house committee, new bill
- State watch
- CMS proposes new Medicaid rate setting process
- Round-up
- Life sciences update
- Study: awareness of comparative effectiveness research high, preparation widely varied
- Court reverses stem cell ruling; allows funding for stem cell research
- Stakeholders comment on FDA direct-to-consumer genetic tests
- FTC releases report on pay to delay activity
- Military health
- GAO report: weaknesses in policies and oversight of Medical supplies and equipment pose risk to veterans’ safety
- Study: excluding Medicare eligibles from the military health plan could save $104 million
- Provider update
- CMS simplifies hospital use of telemedicine
- Mortality linked to culture, clinical processes
- HITECH update
- ONC extends comment period on the Federal Health IT Strategic Plan to May 6
- Study: stronger business case for HIT-enabled medication management needed
- My take
- ACA implementation update
- Update: HHS implements hospital VBP program
- Business groups organize to repeal IPAB
- Dual eligibles update: CMS releases report on dual eligibles pilot program; Part D drug coverage
- CBO: repealing state health insurance exchange funding reduces deficit by $14 billion over ten years
- Legislative update
- House GOP target cuts to exchanges, school clinics, and public health funding
- House Committee to hold hearing on Medicare physician payment system
- FY 2012 budget proposals
- Inpatient rehab increase 1.5 percent; quality reporting implemented
- Skilled nursing increase 1.5 percent
- Hospice increase 2.3 percent
- Inpatient psychiatric hospitals increase 2.7 percent
- Industry update
- AHA proposes refinements to LTACH criteria, objections to IRS Schedule H
- CMS seeks comments on seven new medication-related quality measures
- Chicago to develop largest metropolitan health information exchange
- Simplified enrollment procedures for Medicaid, Medicare, CHIP programs sought
- Mystery shopper program for primary care physicians anticipated
- Food advertising targeting kids focus of new guidelines
- May 10 arguments in Richmond, VA Fourth Circuit Virginia v Sebellius
- HITECH update
- New ONC leader sets agenda for HITECH
- Consumer electronic consent solution
- State watch
- My take
- ACA implementation update
- CMS announces new database to monitor insurance exchanges
- Ambulatory surgery update: Medicare Ambulatory Surgical Center VBP Program proposed
- House Energy and Commerce Committee requests information from trade associations; Senators ask for CLASS Act details
- DOL study: “essential health benefits” widely variable in health plans
- Group health insurance market analysis concluded
- Legislative update
- CMS releases FY 2012 payment rule for acute inpatient and long-term care hospitals; reduction of 0.5 percent proposed for hospitals
- Long-term care hospitals quality reporting: new
- Medicare Advantage bill would expand open enrollment
- Physician-owned hospitals: update
- State Watch
- State-led health reform update
- Medicaid cost containment opportunities: Deloitte Center for Health Solutions’ brief
- Provider update
- NCQA plans July launch of ACO accreditation program
- Update: Alzheimer’s diagnosis and treatment guidelines
- AMA launches AMAGINE physician portal
- Drug and device
- Drug industry consortium to develop policies for electronic labeling
- BIO releases statement on House Judiciary Committee’s Patent Reform Bill
- My take
- FY2012 Budget Proposals
- PPACA implementation update
- Federal government to reimburse states for Medicaid determination and enrollment activities
- 1099 repeal passed
- New advisory chair for National Prevention, Health Promotion and Public Health Council
- IRS reviewing community benefit activities of tax-exempt hospitals
- Constitutional challenges: update
- Dates set for circuit court proceedings
- Legislative update
- Meaningful use attestation starts today
- House, Senate approve spending bill to fund government through September
- CBO estimate of savings for eliminating parts of PPACA
- Access to Medicare data to profile physician earnings from Medicare focus of new legislation
- ONC names new National Coordinator
- State Watch
- CMS proposes to expand home and community based waiver demonstration
- Dual eligible grants to 15 states
- MLR waiver update, innovation waivers
- State-led health reform update
- Industry action
- Imaging coalition opposes prior-authorization for potentially over-used imaging services
- AdvaMed issues statement on FDA medical device labeling
- Leading industry groups launch website
- My take
- Accountable care organizations: Q and A
- Which model makes the most sense?
- How big a deal is this to Medicare and CMS?
- What are the specifications for governance of ACOs?
- If an ACO overspends above its baseline, how does it collect penalties from participating providers?
- What about start-up costs for the ACO? Are there provisions for reimbursement? And what’s the likelihood an ACO will see substantial savings?
- How are payments to be distributed among ACO participants?
- How will the cost baseline be established? What Medicare data will be used to determine benchmarks?
- Can ACO providers participate in other aligned health care delivery programs?
- Can ACOs change or add their participants? May participants be in more than one ACO at a time?
- Do ACO participants have to be “meaningful users” of electronic health records?
- How do the regulations treat clinical integration in context of anti-trust? If an ACO contracts with a commercial plan or Medicaid, would the ACO’s anti-trust provisions apply?
- Can rural care providers, federally qualified health centers, and critical access hospitals be ACOs?
- Implementation update
- Update: health insurance exchanges
- FDA releases rules on menu labeling and chain restaurants
- GAO finds state Medicaid and CHIP monitoring efforts lacking
- CMS delays DME competitive bidding round two until summer 2013
- State watch
- Legislative update
- GOP FY 2012 budget plan includes changes to structure of Medicare, Medicaid
- Collective bargaining for physicians
- Hospital associations challenge repeal of self-referral limits in PPACA
- CMS releases payment rule for Medicare Advantage and Part D Plans
- CMS increases dialysis provider payments 3.1 percent
- Doc fix: update
- CER influence focus of new legislation
- CMS reports hospital acquired conditions
- My take
- ACO guidance: special report
- What is in the CMS guidance?
- How might the savings be shared? What’s the upside?
- How are ACOs aligned with other programs that influence delivery system structural changes in PPACA?
- Legislative update
- Republican Senators seek repeal of IPAB, limits for CER
- Alternatives to the individual mandate: GAO report
- House Energy and Commerce challenges funding for PPACA
- Providers (hospitals, physicians, allied health, long term care)
- CMS: physician signatures for lab services not required, but face to face visits for home care referrals required
- Federal court invalidates caps for hospices
- House Energy and Commerce Committee focuses on physician payment fix
- HITECH update
- Key dates for HITECH
- Health plans and employers
- NAIC holds meetings on exchanges and MLR requirements
- Large employers express concern about health insurance exchanges; want consistency across states
- Life sciences
- FDA hearing about food coloring and hyperactivity in children
- Supreme Court rules safety-net hospitals cannot sue drug manufacturers participating in the 340B program
- State watch
- My take
- Implementation update
- HHS publishes the National Strategy for Quality Improvement in Health Care
- Update on Medicare and Medicaid Innovation
- CMS releases guidance on HRAs
- IOM recommends standards for clinical practice guidelines and comparative effectiveness
- Legislative update
- Report: impact of small business tax credits for health insurance
- Funding for ERRP
- ONC Strategic Plan released
- Health Plans
- Blue Shield of California withdraws application for rate increases
- CMS launches database to monitor consumer feedback about health plans
- Health exchange enrollment: Kaiser study
- Providers
- ACO: investment analysis
- CMS: practitioner fee for participation in $505 fee to enroll in Medicare, Medicaid, and CHIP
- Stage 2 meaningful use deadline: policy committee update
- GAO report: including certain oral-only ESRD drugs in payment bundles for dialysis providers
- State Watch
- My take
- New study: the hidden costs of U.S. health care for consumers
- PPACA implementation
- CRS analysis: HHS has authority to waive MOE requirements
- CO-OP Advisory Board releases recommendations
- Burdensome regulations focus of legislation
- Bill introduced to repeal CLASS program
- Legislative update
- House bill would repeal Medicare bidding program
- MACPAC submits report to Congress to streamline Medicaid access
- CBO: medical liability legislation would reduce national health spending by $40 billion
- OIG releases report on unimplemented policy recommendations
- HHS starts national ad campaign to alert public about fraud
- State updates
- Providers
- ACO joint venture between clinic, plan announced
- MedPAC releases annual Medicare payment recommendations to Congress
- CDC awards funding to reduce health care-associated infections
- HIT Update
- CMS to conduct study on Version 5010 and ICD-10 awareness and readiness
- Proposed legislation to extend HIT incentive payments to behavioral health providers introduced
- Drug and devices
- R&D Investment for pharmaceutical industry, 2010
- FDA and the European Medicines Agency collaborate on drug application parallel review
- My take
- Legislative update
- Budgeting process continues in both Houses; temporary measures likely
- PCORI Program Development Committee releases 12-month objectives
- ACO guidance available in two weeks: Sebelius
- CBO analysis: budget options
- House GOP identify PPACA funding cut targets
- Insurance across state lines: the data
- Constitutional challenge update
- Government appeals Florida District Court decision
- State updates
- HHS and Treasury publish proposed rule on state innovation waivers
- MedPAC comments on CMS Innovation Center proposed demonstration programs
- Medical loss ratio, annual limit waivers
- State round-up
- Drugs and medical devices
- Senate passes major patent overhaul
- FDA advisory panel provides guidance on marketing genetic tests
- Part D formulary focus of inquiry
- House committee investigates Part D drug benefit rebates
- Lupus drug approved; first in 50 years
- Providers
- Teaching hospital medical resident compensation guidance
- Medical home guidance
- CMS provides physician payment update for 2012
- HITECH update
- ONC seeks ‘physician champions’ to facilitate electronic health record adoption
- Meaningful use: physician eligibility
- Health insurance plans
- CMS posts disclosure notices to notify consumers of potential rate increases
- My take
- Legislative update
- Continuing resolution to fund government operations passes
- President opens door to state waivers
- House Energy and Commerce Committee hears Governors
- House votes to repeal enhanced 1099 reporting requirements
- Anti-fraud legislation introduced
- PPACA implementation: update
- Funding for state rate review implementation
- GAO report: private sector bundled payment programs
- GAO report: federal health program redundancy, savings opportunities
- AHRQ publishes National Quality and Disparities Reports
- New quality measures for nursing home quality comparison
- Constitutional challenges: update
- Individual mandate challenge based on religious objection
- State watch
- Utah, Massachusetts exchanges get attention as prototypes
- HHS suggestions for state Medicaid cost reductions
- Diagnostics and therapies
- FDA to review TV ads without user fees
- HITECH update
- CDC to link public health EHRs with immunization tracking system
- My take
- Constitutional challenges: update
- Federal judge upholds PPACA’s individual mandate as constitutional
- CBO releases cost estimate for H.R. 2, the Repealing the Job-Killing Health Care Law Act
- PPACA implementation: update
- OIG report: top management and performance issues facing HHS
- CMS proposes changes to Medicare Advantage
- VA freezes drug copayments until 2010
- Kerry and Snowe reintroduce bill to eliminate Medicare mental health coverage cap
- CMS details preliminary 2012 payment policies for Medicare Parts C and D
- State watch
- Public sector employees, GOP governors clash over benefits
- Children can enroll in PCIP if they previously had a pre-existing condition
- CMS delays implementation of Medicaid RAC program under PPACA
- CMS publishes proposed rule on the Community First Choice Option for states
- HHS distributes PPACA grants to states
- States’ actions
- Discovery and innovation
- Organ transplant proposal changes eligibility procedures
- President’s budget proposal impacts biosimilars; shorter data exclusivity period problematic
- HITECH update
- Lab Interoperability Cooperative, physician alerts
- IOM study: work history feasibility in EHRs
- GAO report: inconsistencies in CMS’ EHR and e-prescribing incentive program
- HHS issues its first civil monetary penalty for HIPAA privacy rule
- ONC approves plan for Louisiana health information exchange
- My take
- Physician adoption up; incentives, demography contribute
- FY2012 budget request for HIT
- ONC study: EHR adoption increasing
- NQF converts measure to electronic reporting, seeks comments on 113 eMeasures
- HITECH implementation update: recent announcements
- White House releases FY2012 budget proposal
- House introduces funding bill for remainder of FY2011
- House reintroduces bill targeting Medicare fraud among company executives
- House Ways and Means approves repeal of 1099 requirements
- PPACA implementation: notification of long term care facility closure
- CMS data analytics said to detect fraud before payments occur
- Medically necessary food
- Elimination of FSA, HSA contribution ceilings
- PCORI elimination: proposed
- Individual mandate alternatives
- Administration asks court to clarify Florida ruling
- House resolution to expedite judicial challenges
- Medicare Advantage
- Part D online dashboard goes live
- CMS publishes rule on Medicaid payments to states for provider-preventable conditions
- Health insurance waivers
- Insurance exchange update: HIT grants
- State budget updates
- OIG report: Medicare Part B drug pricing
- Accelerated drug approvals
- Study: medical device 510k approval process
- Demand for diagnostic imaging in Medicare
- My take
- HHS announces health indicators warehouse resource
- Implementation of EHRs: update
- PPACA focus on Medicare cost: study
- Study: alternatives to the individual mandate
- Update: 5,000 in Early Retiree Reinsurance Program
- Proposed rule on student health plans published
- Funding for physician-run ACOs
- HHS announces $750 million for preventive health
- HHS provides new resources for temporary high-risk pool
- Community Health Centers funding
- Constitutional challenges: update
- House proposes cuts to health care programs
- House committee hearing on economic impact of PPACA
- Drug importation bill introduced
- House Judiciary Committee holds hearing on medical liability
- Oversight of HHS implementation sought
- Grassley encourages public access to Medicare billing records
- Wyden-Brown bill introduced to facilitate state waivers
- FMAP drawdown
- GOP governors ask HHS for waivers
- State-run co-op plans: consumer role in governance
- GAO report on CHIP eligibility
- State update
- Drug approval math
- FDA launches effort to accelerate device approval process
- My take
- Senate approves 1099 cut
- Repeal fails in Senate
- Proposed PPACA revisions and investigations
- Bipartisan bill aims to reduce government spending over ten years
- GAO accepting nominations to Medicare Payment Advisory Committee
- State watch
- Provider update: PPACA implementation guidance
- HITECH
- ICD-10, 5010
- CMS Medicare Imaging Demonstration
- Health plan update
- Salt intake reduction focus of updated dietary guidelines
- Venture-funded start-ups focus of new White House program announced Tuesday
- Injectibles market update: shortage in hospitals
- My take
- Repeal legislation: update
- Energy and Commerce Committee requests HHS high-risk pool data
- House Ways and Means hearing on economic impact of reform on jobs, coverage
- February reform calendar
- HHS study: savings for insurance provisions of PPACA
- HELP Committee report: child-only coverage gaps
- Tax credits for small businesses to purchase health coverage
- PPACA impact on employer-sponsored benefits: employers unsure about benefits changes, employees expect higher costs
- OCIIO requests comments about nonprofit health insurer plans
- AHIP study: commercial health plans saved $315 million through anti-fraud programs
- High-risk pool update: enrollment increasing as result of premium reduction
- Berwick nominated to permanent CMS post
- USDA provides funding for rural telemedicine and distance learning
- HHS, DOJ report on fraud recoveries
- FDA reopens comment period on user fees for generic drug review
- AdvaMed study: European medical device approval process faster than U.S.
- FDA pulls draft guidance on menu labeling
- CRS report: PPACA reduces direct spending by $400 billion over ten years
- $3 million appropriated to National Health Care Workforce Commission for 2011
- ONC will absorb costs for regional extension centers
- Federal court ruling: hospital charity care does not qualify toward DSH payments
- Medicare payment increase for inpatient psychiatry
- CMS actuary testimony: PPACA will “reduce deficit if provider payment cuts implemented”
- State watch
- My take
- U.S. House of Representatives passes “Repealing the Job-Killing Health Care Law Act”
- AHRQ seeks comments on barriers to meaningful use for Medicaid providers
- FDA releases 2011 plan for medical device approval process
- CMS extends the comment period for Self-Referral Disclosure Protocol (SRDP)
- HHS seeks nominations for 2011 Healthy Living Innovation Awards
- White House Executive Order: streamline regulatory processes
- CRS report: upcoming PPACA regulations
- PPACA authorizations set to expire in fiscal year 2011: Congressional Budget Office
- Update: health insurance exchange implementation
- Vermont seeks reform waiver, proposes single-payer system
- High-risk pool update: enrollment increasing as result of premium reduction
- State watch
- Update: legal challenges to PPACA; DOJ preparing for next round
- Appointments announced to PCORI’s Methodology Committee
- Focus on states: Daschle, Frist, Strickland
- High Court to hear arguments on state collection of physician prescription data
- Medicare Advantage HMO performance improvement noted: MedPAC report
- MedPAC critical of CMS MA bonus recommendation
- AHA: hospitals should step up activity in health and wellness for employees
- My take
- House to vote on PPACA repeal Wednesday
- Update: essential health benefits
- MedPAC recommends home health co-pays, increased payments for providers and hospitals
- High court says medical residents are not 'students'
- BMJ reverses autism research, cites fraud
- Herger to lead Subcommittee on Health
- OIG report: Medicare payments for new generic drugs
- State watch
- Update: hospital value-based purchasing guidance
- Fitch ratings: health insurance industry outlook “stable”
- U.S. Department of Justice weighs in on 340B drug discount lawsuit
- Update: data exclusivity rights for biologics
- My take
- Health spending up four percent to 17.6 percent of GDP
- Repeal bill introduced, vote scheduled January 12
- HHS releases plan to improve Medicaid and CHIP quality of care
- MedPAC study: regional variation in Medicare
- CMS eliminates end of advance care planning from Medicare annual wellness visit
- Senate hearings on health reform
- State watch
- Sharfstein leaving FDA for Maryland post
- Implementation update: OCIIO gets name change, moves to CMS
- CMS to upgrade computer and IT systems
- Physician Compare website launched
- ONC update: HIT certification program
- Funding for Health Insurance Cooperatives focus of Advisory Panel meeting this Thursday
- AHRQ publishes methods guide on assessing studies for comparative effectiveness research
- Health savings accounts limits for 2011
- Higher Medicare premiums in 2011
- My take
- Health reform review: key events leading to the passage of PPACA and events since its passage
- Health reform 2.0 calendar: 2011 look ahead
- HHS publishes proposed rule on “unreasonable premium increases”; ten percent or higher increases the focus of scrutiny
- Guidance for health plan compliance with enrollee notifications, steering enrollees to high value providers, et al.
- RFI about value-based insurance design for coverage of preventive services published; comments requested by February 28, 2011
- Guidance for health exchanges from NAIC
- Long term care: three month delay for face-to-face encounter requirements for hospices and home care providers
- Payment changes for therapy services
- Three major Medicare drug benefit changes per PPACA: January 1, 2011
- GAO report: Medicaid pharmacy reimbursement for generic drugs
- Nurse midwives’ payment increase
- Electronic health records grants available today: CMS
- Dual eligibles focus of FCQ
- MLR waiver indications in states
- Medicaid quality measures posted
- Florida Constitutional challenge: update
- Advance-care planning in Medicare rule
- Fifteen states get bonus payments for Medicaid program expansion
- 2011 DSH payments: slightly less than 2010
- Safe harbor changes anti-kickback statute brought by OIG; ACO guidance anticipated
Memo: November 3, 2010 - Special Edition
Memo: Special Edition - February 26, 2010
