HHS Awards $665 Million To States To Improve Healthcare Quality, Accessibility & Affordability

The Department of Health and Human Services (HHS) recently announced the second round of grants as part of its State Innovation Models Initiative. The grants, totaling more than $665 million, will be split among 28 states, three territories, and the District of Columbia. The money will be used to “design or test innovative healthcare payment and service delivery models,” according to HHS and will reduce costs for Medicare, Medicaid, and the Children’s Health Insurance Program.

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HHS Report: Half Of Doctors Listed As Serving Medicaid Patients Are Unavailable

According to a new report from the inspector general of the Department of Health and Human Services (HHS), large numbers of doctors who are listed as serving Medicaid patients are not available to treat them. Investigators found that half of the providers could  not offer appointments or were not accepting new Medicaid patients. Additionally, some doctors could not be found at their last known addresses. Medicaid enrollment is up by nine million people, or 16 percent, in the past year and most of the new beneficiaries are enrolled in private health plans that use a network of doctors that manage their care.

HHS investigators found that more than one third of providers could not be found at the location listed by a Medicaid managed-care plan. Approximately 8 percent of providers at the locations listed said they did not participate in Medicaid; another 8 percent said they did participate in the program but were not accepting new patients. Also, many of those providers accepting Medicaid patients had significant wait times.

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Final Rule Fails To Promote Home Health EHRs

The final rule for the Medicare home health prospective payment system for CY 2015 includes language on the use of electronic health records by home health agencies. In the final rule, CMS says that the Department of Health and Human Services (HHS) will continue to promote the adoption and implementation of certified EHRs but doesn’t explicitly state that HHS encourages their use in a home health setting.

Last month, the proposed rule on Medicare and Medicaid Conditions of Participation for Home Health Agencies encouraged “home health providers to use-and their health IT vendors to develop-ONC-certified HIT/EHR technology to support interoperable health information exchange with physicians, hospitals, other long-term and post-acute care providers, and their patients.” The final rule also states that the ONC expressed in the 2014 Edition Release 2 final rule an intention to propose future changes to the ONC HIT Certification Program that would permit the certification of health IT for other health care settings, including long term and post acute care and behavioral health settings.

In a meeting of the HIT Policy Committee’s certification and adoption workgroup, the Pennsylvania Homecare Association (PHA) submitted a written comment which argued for the establishment of voluntary EHR certification criteria. PHA representatives stated that even if these criteria were put in place, EHR adoption among home health providers could start to “level off or even decrease” since they are not eligible for the monetary and technical assistance provided under the HITECH Act.

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Stark Law & Anti-Kickback Waivers Extended For ACOs

The Office of the Inspector General and CMS recently announced that waivers to the Anti-Kickback Statute and Stark Law for Medicare Shared Savings Program accountable care organizations will be extended through November 2, 2015. CMS and the OIG published an interim final rule with a comment period that established waivers of the applications of Stark Law, the Anti-Kickback Statute and certain civil monetary penalties to ACOs participating in the Shared Savings Program on November 2, 2011. According to the interim final rule, the waivers were to expire next month. Extending the waivers will support agencies’ goals “to balance effectively the need for ACO certainty, innovation, and flexibility in the Shared Savings Program with protections for beneficiaries and the Medicare program.”

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New HHS Initiative Will Improve Patient Care & Reduce Costs

The U.S. Department of Health & Human Services announced today that it would spend up to $840 million over the next four years to fund innovative healthcare strategies designed to improve patient care and lower costs. The initiative called the Transforming Clinical Practice Initiative is aimed at supporting networks that help doctors access information and improve outcomes. It is estimated to save between $1 billion and $4 billion. The project will fund strategies such as improving physician access to information on patient medication adherence, expanding available modes of patient/doctor communication, and improving coordinated, team-based care. The project will be open to applications from healthcare systems, providers associations, group practices and regional and state institutions.

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CMS: 2015 Medicare Part B & Deductible To Remain The Same As Last Two Years

Secretary of Health and Human Services (HHS) Sylvia Burwell announced today that next year’s standard Medicare Part B monthly premium and deductible will remain the same as the last two years. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. For the approximately 49 million Americans enrolled in Medicare Part B, premiums and deductibles will remain unchanged in 2015 at $104.90 and $147 respectively. This leaves more of seniors’ cost of living adjustment from Social Security in their pockets.

The Centers for Medicare & Medicaid Services also announced today that for the small number of beneficiaries who pay Medicare Part A monthly premiums, their monthly bill will drop $19 in 2015 to $407.  Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services.

*Information above provided by CMS

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.”

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HHS Offering States $100 Million To Improve Medicaid

HHS is offering $100 million to state Medicaid programs to “reform payment systems and improve patient care.” HHS Secretary Sylvia Burwell stated “Medicaid innovation is moving forward, and the new Medicaid Innovation Accelerator Program (IAP), announced in response to recommendations from governors, will give states the opportunity to even further their great work.” The money will help states streamline the payment process and review state Medicaid data in order to find ways to improve patient care. Past initiatives from CMS have led to decreased hospital readmissions and emergency room visits, as well as improved care and lower costs.

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ACA Consumers To Be Auto-Enrolled In 2015

Under a proposed rule issued by HHS, consumers who signed up for coverage through the state and federal exchanges will be automatically re-enrolled in coverage for 2015. HHS hopes the proposal will reduce the likelihood that there will be a large drop-off among the 8 million individuals who signed up for insurance in 2014. According to research, most individuals will not take action on their own initiative and thus would likely let policies lapse. However, this decision may be a potential problem to those plans that struggled to gain customers in 2014 or are planning on competing in the exchanges in 2015 for the first time.

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Providers Should Prepare For More Aggressive Enforcement Of HIPAA

According to an HHS attorney speaking at the American Bar Association conference in Chicago recently, healthcare providers should prepare for even more aggressive enforcement of the Health Insurance Portability and Accountability Act (HIPAA) and should expect fines to significantly increase. He also added that the government is specifically aiming for noncompliant providers in order to make examples of them. In long term care, device theft continues to be the main source for HIPAA breaches.

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