QIO Changes Effective August 1, 2014

CMS’s restructuring of the QIO program, which splits the previous body of work into two separate contracts, one for medical case review and appeals and one for quality improvement and technical assistance, goes into effect August 1, 2014. Medical case review and appeals previously performed by each individual state’s QIO will now be handled by one of two Beneficiary Family Centered Care QIOs (BFCC-QIO). Maryland-based Livanta, LLC has the contract for the New England area and the west coast (Geographic Areas 1 & 5) and Ohio-based KePRO has the contract for the rest of the country (Geographic Areas 2, 3, and 4).

Beneficiary notices which give the contact information for the QIO (primarily expedited appeal notices) should be updated to reflect these changes. Contact info for the new BFCC-QIO’s is as follows:

Livanta                   1-866-815-5440 (P)

                               1-855-236-2423 (F)

                               TTY 1-866-2289

KePRO                  1-855-408-8557 (P)

                              1-844-834-7130 (F)

                               TTY 1-855-843-4776

Quality improvement and technical assistance will now be handled by one of fourteen Quality Innovation Network QIOs (QIN-QIO). The New England States will be served by Healthcentric Advisors, RI’s incumbent QIO, in strategic partnership with Qualidigm, CT’s incumbent QIO.

For more information on the BFCC-QIOs, click here.

For more information on the QIN-QIOs, click here.

Study: 10 Million Americans Gained Health Coverage This Year

According to a study by the federal government and Harvard University, about 10.3 million Americans gained health coverage this year as a result of the ACA. The new estimate is the largest to date and is the first to be published in a major medical journal and authored by federal health researchers. The study also found that the number of uninsured adults decreased by a little over 5 percent nationally, from 21 percent in September 2013 to 16.3 percent in April 2014. The analysis is based on data from Gallup-Healthways Well-Being Index, a daily telephone survey of more than 400,000 adults conducted from January 2012 through June 2014. However, researchers note the data’s limitations, saying the estimate could right range from  7.3 to 17.2 million adults depending on the assumptions. The Gallup-Healthways data does not include information regarding children’s insurance coverage and also does not take into account the young adults who were able to stay on their parent’s policies.

Click here to read more.

CMS: Emergency Preparedness Standards For Medicare & Medicaid Providers

CMS has issued a proposed rule to “establish consistent emergency preparedness requirements for health care providers participating in Medicare and Medicaid, increase patient safety during emergencies, and establish a more coordinated response to natural and man-made disasters.”

In the past several years, the U.S. has seen several natural and man-made disasters making readiness for public health emergency a top priority. This notice of proposed rulemaking would establish preparedness to ensure providers adequately plan for disasters.

Click here for the fact sheet detailing the requirements from CMS.

Click here for an emergency preparedness checklist (recommended tool for effective health care facility planning).

Physician Payment For CCM Services To Begin 2015

In 2015, physicians will be able to receive payment for non face-to-face time a physician and their staff spends managing the care of Medicare patients with two or more chronic conditions. CMS finalized a separate payment for chronic care management (CCM) codes last year. In this year’s rule, CMS is proposing details relating to the implementation of the new policy, including any payment rates.

CMS defines CCM as: “Chronic care management services furnished to patients with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; 20 minutes or more; per 30 days”

The CCM codes are an addition to the recently added Transition Care Management codes.

Click here to view the proposed rule.

Click here to read more.

HHS: Health Insurers Owe CT Consumers & Employers $3 Million

According to data released by the Department of Health and Human Services (HHS), health insurers owe $3 million in refunds to Connecticut consumers or their employers this summer because of a provision in the insurance reform law. The provision requires insurers to spend a minimum amount of revenue from premiums on medical expenses for consumers. Consumers will get refunds for coverage provided last year in the form of a refund check, a lump-sum reimubursement to a debit or credit card, or may receive a reduction in premiums in the future. However, it is likely that some people will not receive refunds due to employers being allowed to use them to “improve their health coverage.”

Click here to read more.

Tenet Spending About $535 Million To Acquire CT Hospitals

According to recent filings with state regulators, Tenet Healthcare Corporation is ready to spend approximately $535 million to acquire and improve four Connecticut hospitals and related subsidiaries. Tenet has already purchased Waterbury Hospital for $45 million and will invest $55 million in improvements. More recent regulatory filings indicate Tenet has deals with Eastern Connecticut Health Network, Bristol Hospital, and St. Mary’s Hospital.

Click here to read more.

Medicare Testing New Payment Options

Medicare officials are now allowing patients at dozens of hospitals participating in pilot projects to be exempted from the requirement that limits nursing home coverage to seniors admitted to a hospital for at least three days. These new experiments are being conducted to find out whether new payment arrangements with hospitals and other providers that drop the three-day rule can reduce costs or keep them the same while improving care. The experiments are being conducted under a provision of the ACA which also created the Center for Medicare and Medicaid Innovations to develop ways of improving Medicare.

If these experiments are successful, the tests will be expanded, according to Medicare officials. If patients can receive care while spending less time in the hospital, it can free up valuable resources for sicker patients and save money for Medicare because nursing home care and home health care is much cheaper than a hospital stay. Medicare’s three-day hospital admission rule has been a burden to seniors who don’t qualify for nursing home coverage because they were in the hospital under observation care rather than being admitted.

Click here to read more.