Press release: Deadline for ICD-10 allows health care industry ample time to prepare for change
CMS.gov
July 31, 2014
http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-07-31.html
The U.S. Department of Health and Human Services (HHS) issued a rule today finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015. The ICD-10 codes on a claim are used to classify diagnoses and procedures on claims submitted to Medicare and private insurance payers. By enabling more detailed patient history coding, ICD-10 can help to better coordinate a patient’s care across providers and over time. ICD-10 improves quality measurement and reporting, facilitates the detection and prevention of fraud, waste, and abuse, and leads to greater accuracy of reimbursement for medical services. The code set’s granularity will improve data capture and analytics of public health surveillance and reporting, national quality reporting, research and data analysis, and provide detailed data to enhance health care delivery. Health care providers and specialty groups in the United States provided extensive input into the development of ICD-10, which includes more detailed codes for the conditions they treat and reflects advances in medicine and medical technology.
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Temporary Moratoria Are Back- At Least for Six More Months
Bloomberg BNA
July 31, 2014
http://www.bna.com/temporary-moratoria-back-b17179893141/
If you're a home health agency or ambulance supplier looking to enroll in Medicare in the Houston area, you're out of luck, at least for the next six months. CMS recently announced it was extending temporary enrollment moratoria for HHAs and ambulance suppliers operating in several metropolitan areas. The HHA extensions apply to one county surrounding Fort Lauderdale, Fla., two counties surrounding Miami, six counties surrounding Chicago, five counties surrounding Detroit, seven counties surrounding Dallas and eight counties surrounding Houston, while the ambulance supplier extensions apply to seven counties surrounding Philadelphia and eight counties surrounding Houston.
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Next Obamacare enrollment period faces bumps: U.S. official
Reuters
July 31, 2014
http://www.reuters.com/article/2014/07/31/us-usa-healthcare-slavitt-idUSKBN0G023P20140731?feedType=RSS&feedName=topNews
U.S. consumers who purchase private health coverage through the federal Obamacare website HealthCare.gov are likely to find only modestly higher premiums but may still have technical problems signing up, a top health official said on Thursday. "It won't be perfect," Andrew Slavitt, a newly appointed principal deputy administrator at the Centers for Medicare and Medicaid Services (CMS), told lawmakers at hearing before a House of Representatives oversight committee. "It's a bumpy process at times," he added. "I think we've got a committed team of people, though, that by and large are doing a very good job. But there will clearly be bumps." However, Slavitt said the three-month 2015 open enrollment period that begins Nov. 15 will be under vastly different circumstances from HealthCare.gov's botched launch last October, when the website was overwhelmed by technical problems for weeks.
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Medicare Payment Quirk Grabs Senate Panel’s Attention
Roll Call: Healthopolis
July 31, 2014
http://blogs.rollcall.com/healthopolis/medicare-observation-status-senate-hearing/?dcz=
Senators on Wednesday mulled the impact of a restriction in Medicare payment policies that has riled both hospitals and patients. When a Medicare patient stays in a hospital under “observation status” the person does not qualify for certain Medicare coverage in a subsequent stay in a nursing home or rehabilitation facility — and may end up paying more in co-payments and drug costs. The Senate Special Aging Committee on Wednesday led an examination on the coverage quirk, which could come as a surprise to the patient and lead to additional out-of-pocket costs. HealthBeat’s John Reichard reported that a hospital might admit a patient under “observation” status because the hospital fears that auditors will challenge whether the person should be admitted, throwing the facility’s Medicare reimbursement into doubt.
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Investigators Warn of Possible Perils in Fall With Health Site
The New York Times
July 30, 2014
http://www.nytimes.com/2014/07/31/us/politics/problems-with-healthcaregov-could-force-delays-in-fall.html
The federal health insurance marketplace, a centerpiece of President Obama’s health care overhaul, still suffers from serious problems, raising questions about whether it will be ready to enroll millions more people this fall, federal investigators said Wednesday. The investigators, from the Government Accountability Office, an independent arm of Congress, said that the marketplace and its website, HealthCare.gov, were over budget and behind schedule because of “new and changing requirements” imposed by administration officials. In testimony prepared for a House hearing on Thursday, William T. Woods, a senior official at the auditing agency, warned of “significant risks” in the next open enrollment period, which begins Nov. 15. His comments were striking because the White House has said that the problems were mostly solved with the help of a new team of professionals led now by Sylvia Mathews Burwell, the secretary of Health and Human Services.
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Sens. Brown and Murray Introduce Bill to Ensure Doctors Can Continue Treating Medicaid Patients
Senator Sherrod Brown Press Release
July 30, 2014
http://www.brown.senate.gov/newsroom/press/release/sens-brown-and-murray-introduce-bill-to-ensure-doctors-can-continue-treating-medicaid-patients
With a provision set to expire this year that ensures doctors can continue to treat the 62 million Americans who depend on Medicaid, U.S. Sens. Sherrod Brown (D-OH) and Patty Murray (D-WA) today introduced the Ensuring Access to Primary Care for Women & Children Act. The legislation would extend a provision from the Affordable Care Act (ACA) that ensures reimbursement parity between doctors treating Medicaid and Medicare patients. The legislation would also ensure that other providers who treat women and children – including nurse practitioners and physician assistants – receive sufficient reimbursements that will enable them to participate in Medicaid. The bill is cosponsored by Sens. John D. Rockefeller (D-WV) and Mary Landrieu (D-LA).
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Poor planning and oversight led to HealthCare.gov flaws, GAO finds
The Washington Post
July 30, 2014
http://www.washingtonpost.com/national/health-science/poor-planning-and-oversight-led-to-healthcaregov-flaws/2014/07/30/2f1a04aa-1814-11e4-9e3b-7f2f110c6265_story.html
Federal health officials were responsible for the problem-pocked start of HealthCare.gov last year because of poor planning and lax oversight of outside contractors, according to government investigators who warned that “significant risks remain” that some Americans could again have trouble buying coverage in the federal health insurance marketplace this fall. Such management failures are the central conclusion of the first report issued by the Government Accountability Office as part of a wide-ranging appraisal of the reasons the computer system was not ready when the marketplace opened in October. The initial slice of the GAO’s work focuses on the main contractors the government hired to build HealthCare.gov, the Web site for the federal insurance exchange created under the Affordable Care Act. In particular, the report examines the shepherding of the contractors by the Centers for Medicare and Medicaid Services (CMS), the branch of the Department of Health and Human Services responsible for developing the marketplace.
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GOP-led House votes to sue Obama in first-of-its-kind lawsuit
Los Angeles Times
July 30, 2014
http://www.latimes.com/nation/la-na-house-votes-to-sue-obama-20140730-story.html
The House vote to sue President Obama is the first such legal challenge by a chamber of Congress against a president and a historic foray in the fight over constitutional checks and balances. Wednesday’s nearly party-line vote followed a feisty floor debate and offered a fresh example of how the capital’s hyper-partisanship has led both parties into unprecedented territory, going to Two years ago, the Republican-led House became the first to hold a sitting Cabinet secretary in contempt of Congress, after lawmakers accused Atty. Gen. Eric H. Holder Jr. of defying their request to turn over records about the Fast and Furious gun-running operation conducted by the Bureau of Alcohol, Tobacco, Firearms and Explosives. Last year, the Democratic-controlled Senate changed the body’s long-standing filibuster rules in response to what they said was blatant obstruction by the minority GOP of presidential nominations, including the first-ever filibuster of a nominee for Defense secretary. November’s election could further exacerbate tensions in Washington, especially if Republicans – who already hold the House – gain control of the Senate. They need a net gain of six seats to do so. The House approved the resolution in a near party-line vote, 225 to 201.
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House Votes to Authorize Boehner to Sue Obama
The Wall Street Journal
July 30, 2014
http://online.wsj.com/articles/house-votes-to-authorize-boehner-to-sue-obama-1406760762
House lawmakers voted Wednesday to authorize Speaker John Boehner to file suit against President Barack Obama on a complaint that he had overstepped his legal authority, setting up a possible constitutional test and giving both parties a potent campaign issue to take home for the five-week congressional recess. In a 225-201 vote, the House told Mr. Boehner (R., Ohio) to move ahead with the suit. House GOP leaders have said they would focus the suit on the White House's decision last year to give employers a one-year reprieve on enforcing a requirement under the Affordable Care Act that they offer health coverage or pay a penalty. The requirement was delayed until 2015, and the White House then revised the health law further by saying employers with between 50 and 99 full-time workers wouldn't have to comply or pay a fee until 2016. Five Republicans joined Democrats in voting against pursuing the lawsuit. No Democrats voted to move forward with the suit. Mr. Boehner, speaking just before the vote, said Congress needed to assert its authority under the Constitution to combat executive overreach. "This isn't about Republicans and Democrats. It's about defending the Constitution we swore an oath to uphold," he said.
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Report: Cost of HealthCare.Gov Approaching $1 Billion
Time
July 30, 2014
http://time.com/3060276/obamacare-affordable-care-act-cost/
Federal officials badly managed the development of a website to sell health insurance under the Affordable Care Act, potentially costing taxpayers hundreds of millions of dollars in cost overruns, according to testimony that will be delivered to a House subcommittee on Thursday.
In prepared remarks posted online Wednesday, William T. Woods, an official at the General Accounting Office, says HealthCare.gov, a federal website charged with managing new individual health plans for consumers in 36 states, was marred by inadequate oversight by officials from the Department of Health and Human Services. The Centers for Medicare and Medicaid Services (CMS), an HHS agency in charge of the insurance website, “undertook the development of HealthCare.gov and its related systems without effective planning or oversight practices, despite facing a number of challenges that increased both the level of risk and the need for effective oversight,” according to Woods.
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West Virginia Suit Says Obama Health-Law Waiver Illegal
Bloomberg
July 30, 2014
http://www.bloomberg.com/news/2014-07-30/west-virginia-sues-over-obamacare-non-complying-plan-rule.html
West Virginia’s attorney general accused the Obama administration of illegally forcing states to regulate individual health-insurance policies, opening another angle of attack on the health-care overhaul and the president’s alleged abuse of power. Patrick Morrisey, a Republican, claims in a lawsuit that President Barack Obama -- lacking the authority to do so -- imposed an “administrative fix” that left it up to states to determine whether individual policies needed to comply with requirements of the Patient Protection and Affordable Care Act. Under the act, the federal government was supposed to police individual plans unless a state chose to, according to the suit. The suit echoes criticism of the president by Republicans in Congress, who contend Obama has violated laws and ignored the Constitution in wielding unauthorized presidential powers. The Republican leadership in the House has scheduled a vote as early as today on a resolution to allow a lawsuit against the administration, focusing on Obama’s delay implementing the employer insurance mandate in the health-care law.
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Probe faults oversight of HealthCare.gov development
USA Today
July 30, 2014
http://www.usatoday.com/story/news/politics/2014/07/30/gao-report-obamacare-rollout/13368543/
A new report finds that the government did not plan well or properly provide oversight for the new federal health exchange launched last October. And the website faces new headaches for open enrollment in the fall if officials don't control spending, increase oversight and ensure back-end issues are properly fixed. The Department of Health and Human Services "needs a mitigation plan to address these issues," wrote the report author, William Woods, director of acquisitions and sourcing management for the Government Accountability Office. Unless the government "improves contract management and adheres to a structured governance process, significant risks remain that upcoming enrollment periods could encounter challenges."
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Feds want NY to refund $200 million in Medicaid overpayments
Poughkeepsie Journal
July 30, 2014
http://www.poughkeepsiejournal.com/story/news/2014/07/29/medicaid-reimbursement-new-york/13341289/
New York should refund $200 million in federal Medicaid overpayments, a federal health official said Tuesday. That total is derived from several audits of different parts of the Medicaid program, John Hagg, director of Medicaid audits for the inspector general at the Health and Human Services Department, told members of a House subcommittee. In response, a spokesman for the New York State Department of Health said the department will "vigorously appeal this unprecedented decision." Spokesman Bill Schwarz noted in an email that repaying the $200 million "could have untold negative consequences on the state's health care system." The previously approved federal payments date back five years, he said. Federal auditors came up with the number as a result of several audits — of state-operated facilities, home health care services, day treatment centers for people with mental illness, billing for orthodontic and dental services, and treatment of people with traumatic brain injuries.
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Healthcare.gov: Ineffective Planning and Oversight Practices Underscore the Need for Improved Contract Management
Government Accountability Office
July 30, 2014
http://www.gao.gov/products/GAO-14-694
The Centers for Medicare & Medicaid Services (CMS) undertook the development of Healthcare.gov and its related systems without effective planning or oversight practices, despite facing a number of challenges that increased both the level of risk and the need for effective oversight. CMS officials explained that the task of developing a first-of-its-kind federal marketplace was a complex effort with compressed time frames. To be expedient, CMS issued task orders to develop the federally facilitated marketplace (FFM) and federal data services hub (data hub) systems when key technical requirements were unknown, including the number and composition of states to be supported and, importantly, the number of potential enrollees. CMS used cost-reimbursement contracts, which created additional risk because CMS is required to pay the contractor's allowable costs regardless of whether the system is completed. CMS program staff also adopted an incremental information technology development approach that was new to CMS. Further, CMS did not develop a required acquisition strategy to identify risks and document mitigation strategies and did not use available information, such as quality assurance plans, to monitor performance and inform oversight.
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Appeals Court Rejects Tax Challenge to Obamacare
The Associated Press
July 29, 2014
http://abcnews.go.com/Health/wireStory/tax-challenge-obamacare-rejected-24759136
Rejecting the latest effort to sidetrack "Obamacare," a federal appeals court turned away a challenge by a conservative group that said Congress imposed new taxes unconstitutionally when it created the Affordable Care Act. Pacific Legal Foundation and a small-business owner, Matt Sissel, argued that the Affordable Care Act is a bill for raising revenue and that it violated the Origination Clause of the Constitution because it began in the Senate, not the House. The Constitution requires that legislation to raise revenue must start in the House. In a 3-0 ruling, the U.S. Court of Appeals for the District of Columbia Circuit said that rather than being a revenue-raising device, it is beyond dispute that the paramount aim of Obamacare is to increase the number of Americans covered by health insurance and decrease the cost of health care. "The Supreme Court has held from the early days of this nation that revenue bills are those that levy taxes in the strict sense of the word, and are not bills for other purposes which may incidentally create revenue," the appeals court decision said. The challengers to the law said it began in the Senate when Majority Leader Harry Reid took an unrelated House bill and inserted language that became the Affordable Care Act.
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Morrisey sues feds; AG says Obama can’t ‘pick and choose” laws to enforce
Charleston Gazette
July 29, 2014
http://www.wvgazette.com/article/20140729/GZ01/140729210/1101
West Virginia Attorney General Patrick Morrisey filed suit against the U.S. Department of Health and Human Services Tuesday, alleging that President Obama’s “administrative fix” to the federal Affordable Care Act is illegal. The lawsuit, which was filed in federal court in the District of Columbia, challenges the president’s decision last fall to suspend the federal health care law’s rules and allow people to keep health plans that do not meet the law’s minimum coverage standards. “We believe the president’s actions have uniquely harmed the states,” Morrisey said in a press release posted on his office’s website. “The administrative fix’s purpose was to shift the political accountability and discretion over enforcement of certain federal laws from the federal government to the states,” Morrisey added. “This burden on the states gives us standing to sue to vindicate the rule of law in this case.” The lawsuit is similar to one proposed by U.S. House Speaker John Boehner, R-Ohio, over Obama’s delay of the Affordable Care Act’s employer mandate. The House Rules Committee approved that lawsuit on a party-line vote last week, and the House is expected to vote on it before leaving for recess next month. Democrats have decried Boehner’s proposal as a political stunt designed to pander to those Republicans who want the president impeached.
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State's $1.3 Billion Medicaid Problem
The Wall Street Journal
July 29, 2014
http://online.wsj.com/articles/states-1-3-billion-medicaid-problem-1406686402?KEYWORDS=medicaid
The federal government has demanded that New York state pay back nearly $1.3 billion in Medicaid money distributed in 2010, prompting a rebuke from Gov. Andrew Cuomo's administration and a promise to appeal the decision. At issue are the costs of caring for about 1,300 developmentally disabled people—about $2 million per patient in 2013—in nine state facilities from Staten Island to Rochester. New York's Medicaid program is among the nation's most expensive. New York state and the federal government agreed on a payment plan in 1990. But after the Poughkeepsie Journal published a series of stories in 2010 about the extraordinary costs of the state's so-called intermediate-care facilities, the U.S. Centers for Medicare and Medicaid Services—the agency, often called CMS, that administers the program—started its own investigation. It found that New York was making exceptionally high Medicaid payments to the facilities, which are run by the state's Office for People with Developmental Disabilities. A subsequent review by federal Medicaid officials found that New York couldn't justify some of its reported costs, lacked proper internal controls, didn't comply with federal reporting requirements and had an unreliable fiscal report from 2010-11, among other issues.
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HHS: ‘Donut hole’ reforms saved Medicare enrollees $11.5 billion since 2010
The Washington Times
July 29, 2014
http://www.washingtontimes.com/news/2014/jul/29/hhs-donut-hole-reforms-saved-medicare-enrollees-11/
Hoping to spread good news about Medicare into a second day, the Obama administration said Tuesday that seniors and the disabled have saved $11.5 billion on prescriptions since the health care law passed in 2010. “By making prescription drugs more affordable, we are improving and promoting the best care for people with Medicare,” Health and Human Services Secretary Sylvia Mathews Burwell said. Officials said Obamacare saves Medicare beneficiaries money by closing the “donut hole,” or gap in coverage in which they had to pay the full cost of prescriptions before catastrophic coverage took effect. HHS said 8.2 million beneficiaries saved an average of just over $1,400 through donut hole discounts and rebates. Officials released the data one day after Medicare trustees said the hospital insurance trust fund will not go broke until 2030, or four years later than projected just one year ago and 13 years later than projected in 2009 — the last report before Obamacare became law.
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Docs Complain to CMS About ‘Sunshine’ Data Disclosures
The Wall Street Journal
July 28, 2014
http://blogs.wsj.com/pharmalot/2014/07/28/docs-complain-to-cms-about-sunshine-data-disclosures/
A group of medical societies and pharmaceutical industry trade groups is pushing the government to flesh out data that will be published next month showing how much drug makers pay doctors. They sent a letter today to the Centers for Medicare and Medicaid Services to ask the agency to explain what context will be provided to help the public understand the justification for payments, such as speaking fees and grants used to bankroll clinical research. The letter is signed by more than 20 medical societies and organizations including the American Urological Association, as well as heavyweight industry trade groups Biotechnology Industry Organization and the Pharmaceutical Research & Manufacturers of America. The missive was sent as CMS plans to post the payment data in an online, searchable database as required in the Sunshine Act provision of the Affordable Care Act. The provision was passed in response to concerns that medical practice may be unduly influenced by industry.
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New Mexico to continue using federal exchange
Miami Herald
July 25, 2014
http://www.miamiherald.com/2014/07/25/4254699/new-mexico-to-continue-using-federal.html
New Mexico decided Friday to stick with a federal online system for another year to enroll individuals in health insurance plans. The state's health insurance exchange governing board voted 11-1 to continue using the federal computer system for determining eligibility and to enroll individuals starting in November when the next open enrollment begins. A majority of board members worried that New Mexico wasn't ready to switch to a state-run online system for individuals. Any technical failures could delay enrollment and discourage consumers from trying to obtain health coverage, they said. Continuing with the federal system for another year is the "safest, most risk-free" way of enrolling New Mexicans, New Mexico Health Connections CEO Martin Hickey said. Small businesses have been using the state system since October. The exchange serves as online, one-stop shopping center for individuals and businesses to buy health coverage from private insurance companies. Premiums are subsidized for low- and middle-income residents.
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