Friday, October 30, 2015

Senate approves two-year bipartisan budget agreement


By Kelsey Snell October 30 at 8:45 AM

Live V
Congress sent President Obama an ambitious budget and debt measure that averts a catastrophic national default and sets spending priorities for the next two years. The Senate approved it by a 64-35 vote early on Oct. 30. (AP)

The Senate voted early Friday morning to approve a two-year budget deal that would increase spending limits and avert a damaging default, essentially ending the budgetary battles that have defined President Obama’s relationship with Congress in recent years.

The legislation passed by a vote of 64-35 after overcoming objections from conservative senators, including presidential candidates Rand Paul (R-Ky.) and Ted Cruz (R-Texas), that forced a rare series of votes at 1 a.m. Obama has until Nov. 3 to sign the agreement before the debt-limit deadline set by the Treasury Department.

The agreement, unveiled earlier this week, is the result of tightly held negotiations between congressional leaders in both parties and the White House.

Obama released a statement Friday morning saying he would sign the bill “as soon as it reaches my desk.”

“I applaud the Democrats and Republicans who came together this morning to pass a responsible, long-term budget agreement that reflects our values, grows our economy and creates jobs,” he said in the statement. “This agreement is a reminder that Washington can still choose to help, rather than hinder, America’s progress.”

Here's what's in the two-year budget deal

Once signed, the deal will lift the so-called sequester spending caps and increase discretionary spending by about $80 billion over two years, an amount that will be split equally between defense and domestic programs.

To offset this cost, negotiators tapped a number of sources, including making changes to Medicare and Social Security, auctioning off government-controlled wireless spectrum, selling crude oil from the Strategic Petroleum Reserve and tightening tax rules for business partnerships.

In addition, the legislation will limit a historic premium increase for some Medicare Part B beneficiaries, set to go into effect next year, for services like hospital care and doctor visits.

The agreement also will prevent a potential 20 percent across-the-board cut to Social Security Disability Insurance benefits scheduled to take place next year, by transferring resources from the main Social Security fund and making changes to the program. The cost-saving revisions include allowing some recipients who can still work to receive partial payments while earning outside income, and expanding a program requiring a second medical expert to weigh in on whether an applicant is legitimately disabled.

Senators were resigned to the late-night vote, with some saying they expected a vote to cut off debate and one on final passage to occur about 1 a.m., when their disgruntled colleagues would have less incentive to give floor speeches denouncing the agreement.

“Maybe they would decide it would be better to speak when people are actually paying attention,” said Senate Majority Whip John Cornyn (R-Texas).

Paul criticized Senate leaders for caving into demands from Democrats to negotiate on spending rather than using the upcoming debt limit deadline to force President Obama to make spending cuts.

“This is exactly the time we should be using the leverage of the debt ceiling,” Paul said just before 1 a.m. on Friday.

There was pressure to strike a deal soon because of two approaching deadlines — one fiscal, one political.

The Treasury Department has warned that the government will run out of borrowing authority by Nov. 3 and a failure to raise the debt ceiling could lead to an economy rattling default. The bill would suspend the debt ceiling through March 2017.

The second deadline was the end of this month, when former Speaker John A. Boehner (R-Ohio) planned to step down from Congress after too many fights with a band of conservatives in his party.

Boehner said he wanted to “clean out the barn” before handing over the gavel, rather than leave his successor with a pile of messy budget business to handle just as they assumed the job. On Thursday, the House elected Rep. Paul D. Ryan (R-Wis.) speaker, a day after the House passed the budget agreement on a 266 to 167, which served as a coda to Boehner’s tenure as speaker.

Conservatives in both chambers criticized the deal both because it was hatched behind closed doors rather than through the committee process and because they argued it is bad policy.

Many complained that the provisions in the bill that are used to offset the cost of the new spending are gimmicks or promise savings in the future for money the government will spend immediately.

Cruz criticized leaders for negotiating behind closed doors and for agreeing to President Obama’s requests for additional spending.

“This wasn’t a slapdash on a post-it note last night,” Cruz said. “This represents days or weeks or months of negotiations. This represents the Cartel in all of its glory because this is the combined work product of John Boehner and Nancy Pelosi and Mitch McConnell and Harry Reid.”

Once the bill is signed into law, the Appropriations Committees will begin the process of writing an omnibus bill that will determine how the funds will be spent. That process is expected to take about a month and could be complicated if Republicans try to attach controversial provisions, like defunding Planned Parenthood, to the legislation.

Democrats have vowed to block any “poison-pill” riders, which could create another spending standoff in December.

This story has been updated.
https://www.washingtonpost.com/news/powerpost/wp/2015/10/30/senate-approves-two-year-bipartisan-budget-agreement/

CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers

CMS NEWS 

FOR IMMEDIATE RELEASE

October 30, 2015                                                                                                                          

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

 

CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers

The Centers for Medicare & Medicaid Services (CMS) issued final rules this week detailing how the agency will pay for services provided to beneficiaries in Medicare by physicians and other health care professionals in 2016 that reflects the administration’s commitment to quality, value, and patient-centered care. Payment rules for the 2016 calendar year for End-Stage Renal Disease Prospective Payment System, the Hospital Outpatient Prospective Payment System, Home Health Prospective Payment System, and the Physician Fee Schedule were all finalized this week.

"CMS is pleased to implement the first fee schedule since Congress acted to improve patient access by protecting physician payments from annual cuts. These rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers," said CMS Acting Administrator Andy Slavitt. “We received a large number of comments supporting our proposal to allow physicians to bill for advanced care planning conversations and we are finalizing this rule accordingly.” 

 

Key policies finalized in the 2016 payment rules include:

  • Finalizing the Home Health Value-Based Purchasing model. This model, authorized under the Affordable Care Act, is designed to improve health outcomes and value by tying home health payments to quality performance. All Medicare-certified home health agencies that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will participate in this model starting January 1, 2016. Compared to the proposed rule, the maximum payment adjustment in the first year of the model was reduced from 5 percent to 3 percent. This was part of the Home Health Prospective Payment System final rule.

 

  • Finalizing updates to the “Two-Midnight” rule. The rule clarifies when inpatient admissions are appropriate for payment under Medicare Part A. This continues CMS’ long-standing emphasis on the importance of a physician’s medical judgment in meeting the needs of Medicare beneficiaries by providing clearer guidelines and a more collaborative approach to education and enforcement. This was part of the Hospital Outpatient Prospective Payment System final rule.

 

  • Finalizing the End-Stage Renal Disease Quality Incentive Program. The End-Stage Renal Disease final rule will apply payment incentives to dialysis facilities to improve the quality of dialysis care. Facilities that do not achieve a minimum total performance score with respect to quality measures, such as anemia management, patient experience, infections, and safety, will receive a reduction in their payment rates.

 

  • Beginning the new physician payment system post the Sustainable Growth Rate (SGR) formula and supporting patient- and family-centered care. This is the first final Physician Fee Schedule final rule since the repeal of the SGR formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Through the final rule, CMS is beginning implementation of the new payment system for physicians and other practitioners, the Merit-Based Incentive Payment System, required by the legislation. 

 

  • Finalizing provision to empower patients and their families regarding advance care planning. Consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress, CMS is finalizing its proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers.

 

Consumers Will Continue to Find Affordable Options in the Health Insurance Marketplace in 2016


Report: Consumers Will Continue to Find Affordable Options in the Health Insurance Marketplace in 2016


Today, HHS released a new report detailing affordability and plan choice in the Health Insurance Marketplace.  It finds that with applicable tax credits, more than 7 in 10 current Marketplace enrollees could find plans for $75 a month in premiums or less, and almost 8 in 10 could find plans for $100 a month in premiums or less.



Continuing its commitment to data transparency, today, CMS also released a number public use data files.

For the Health Insurance Marketplace Landscape files visit: https://www.healthcare.gov/health-and-dental-plan-datasets-for-researchers-and-issuers/

For Health Insurance Marketplace Public Use Files that include detailed information for researchers for the 2016 plan year as well as the machine-readable Public Use File visit: https://www.cms.gov/CCIIO/Resources/Data-Resources/marketplace-puf.html

For the Rate Review Public Use File which includes information on final 2016 rates in the individual and small group markets for plans inside and outside of the Marketplace for all states and the District of Columbia visit: https://www.cms.gov/CCIIO/Resources/Data-Resources/ratereview.html

 

CMS announces payment changes for Medicare home health agencies for 2016


FACT SHEET


FOR IMMEDIATE RELEASE

October 29, 2015                                                                                                                          

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

 
CMS announces payment changes for Medicare home health agencies for 2016
 

The Centers for Medicare & Medicaid Services (CMS) today announced changes to the Medicare home health prospective payment system (HH PPS) for calendar year (CY) 2016 that will foster greater efficiency, payment accuracy, and improved quality of care. Approximately 3.5 million beneficiaries received home health services from 11,900 HHAs, costing Medicare $17.9 billion in 2014. 

CMS projects that Medicare payments to home health agencies (HHAs) in CY 2016 will be reduced by 1.4 percent, or $260 million. This decrease reflects the effects of the 1.9 percent home health payment update percentage ($345 million increase); a 0.9 percent decrease in payments due to the 0.97 percent payment reduction to the national, standardized 60-day episode payment rate to account for nominal case-mix growth from 2012 through 2014 ($165 million decrease); and a 2.4 percent decrease in payments due to the third year of the four-year phase-in of the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor ($440 million decrease). Compared to the proposed rule, the maximum payment reduction in the first year of the value-based purchasing program was reduced from 5 percent to 3 percent. 

The HH PPS final rule is one of several rules for CY 2016 that reflect a broader strategy to create a health care system that supports better care, smarter spending, and healthier people. Provisions in these rules will help move the nation’s health-care system to one that values quality over quantity and focuses on reforms such as measuring for better health outcomes, helping patients return home, managing and improving chronic diseases, and fostering a more-efficient and coordinated health care system. 

Background

Medicare pays HHAs through a prospective payment system in which HHAs are typically paid a national, standardized 60-day episode payment amount for all covered home health services, adjusted for case-mix and area wage differences. The national, standardized 60-day episode payment amount is case-mix adjusted based on relevant data from patient assessments conducted by clinicians, as currently required for all Medicare-participating HHAs. The HH PPS payment rates are updated annually by the home health payment update percentage. The payment update percentage is based, in part, on the home health market basket, which measures inflation in the prices of an appropriate mix of goods and services included in home health services. 

To qualify for the Medicare home health benefit, a Medicare beneficiary must be under the care of a physician; have a part-time or intermittent need for skilled nursing care, physical therapy, and/or speech-language pathology services, or a continued need for occupational therapy; and must be homebound. In addition, the beneficiary must receive home health services from a Medicare-approved HHA. Covered home health services include skilled nursing, home health aide, physical therapy, speech-language pathology, occupational therapy, medical social services, and medical supplies.  

Payment Policy Provisions

Rebasing the HH PPS Payment Rates

The Affordable Care Act (ACA) directs CMS to apply an adjustment to the national, standardized 60-day episode payment rate and other applicable amounts to reflect factors such as changes in the number of visits in an episode, the mix of services in an episode, the level of intensity of services in an episode, the average cost of providing care per episode, and other relevant factors. CMS is required to phase-in any adjustment over a four-year period, in equal increments, not to exceed 3.5 percent of the amount (or amounts) as of the date of the enactment of the ACA (CY 2010), and be fully implemented by CY 2017. 

In this CY 2016 final rule, CMS is moving forward with the third year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates. As finalized in the CY 2014 final rule, the adjustments include increases to the national per-visit payment rates, a 2.82 percent reduction to the NRS conversion factor, and a reduction to the national, standardized 60-day episode payment rate of $80.95 for CY 2016. 

Recalibration of the HH PPS Case-Mix Weights

CY 2016 will be the second year that CMS is annually recalibrating the HH PPS case-mix weights. The methodology used to recalibrate the case-mix weights for CY 2016 is identical to methodology used in CY 2015. 

Reduction to the 60-day Episode Rate to Account for Nominal Case-Mix Growth

CMS is decreasing the national, standardized 60-day episode payment amount by 0.97 percent each year in CY 2016, CY 2017, and CY 2018 to account for nominal case-mix growth (i.e., case-mix growth unrelated to changes in patient acuity) from 2012 to 2014. CMS has adjusted home health payment in prior years before to account for nominal case mix growth. 

Other Updates

The Affordable Care Act requires that the market basket update for HHAs be adjusted by changes in economy-wide productivity. The CY 2016 home health market basket (2.3 percent) combined with the multifactor productivity adjustment (0.4 percentage points) results in a 1.9 percent home health payment update percentage. 

 

Home Health Quality Reporting Program (HH QRP) Update

Section 2(a) of the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act) requires HHAs, Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), and Long-Term Care Hospitals (LTCHs) to submit standardized patient assessment data, as well as standardized data on quality measures and resource use and other measures. The data reporting requirements and implementation of standardized patient assessment data is intended to enable interoperability and improve quality, payment, and discharge planning, among other purposes. 

The IMPACT Act requires collection of data across eight domains. In keeping with the requirements of the IMPACT Act, CMS is finalizing as proposed one standardized cross-setting measure for CY 2016 under the “skin integrity and changes to skin integrity” domain. Measures for the other domains will be addressed through future rulemaking. CMS received feedback on four future, cross-setting measure constructs to potentially meet requirements of the IMPACT Act domains of:

 

  • All-condition risk-adjusted potentially preventable hospital readmission rates,
  • Resource use, including total estimated Medicare spending per beneficiary,
  • Discharge to the community, and
  • Medication reconciliation 

The Home Health Conditions of Participation (CoPs) require HHAs to submit OASIS assessments as a condition of payment and also for quality measurement purposes. HHAs that do not submit quality measure data to CMS will see a two percent reduction in their annual HH payment update percentage. CMS is finalizing its proposal to require all HHAs to submit both admission and discharge OASIS assessments for a minimum of 70 percent of all patients with episodes of care occurring during the reporting period starting July 1, 2015. CMS is also finalizing as proposed to incrementally increase this compliance threshold by ten percent in each of the subsequent periods (July 1, 2016 and July 1, 2017) to reach 90 percent.  

Home Health Value-Based Purchasing (HHVBP) Model 

CMS is also finalizing a new initiative designed to support greater quality and efficiency of care among Medicare-certified HHAs across the nation. Authorized under the ACA and implemented by the Center for Medicare and Medicaid Innovation, the HHVBP model supports the Department of Health and Human Services’ efforts to build a health care system that delivers better care, spends health care dollars more wisely, and results in healthier people and communities.  

The HHVBP model leverages the successes of and lessons learned from other value-based purchasing programs and demonstrations – including the Hospital Value-Based Purchasing Program and the Home Health Pay-for-Performance Demonstration – to shift from volume-based payments to a model designed to promote the delivery of higher quality care to Medicare beneficiaries. The model will test whether incentives for better quality care can improve outcomes in the delivery of home health services.  

Beginning January 1, 2016, CMS will implement the HHVBP model among all HHAs in nine states representing each geographic area in the nation. All Medicare-certified HHAs that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will compete on value in the HHVBP model, where payment is tied to quality performance. HHAs in these nine states will have their payments adjusted by a maximum payment adjustment of 3-percent (upward or downward) in 2018, a maximum payment adjustment of 5-percent (upward or downward) in 2019, a maximum payment adjustment of 6-percent (upward or downward) in 2020, a maximum payment adjustment of 7-percent (upward or downward) in 2021, and a maximum payment adjustment of 8-percent (upward or downward) in 2022. 

This model is designed so there is no selection bias, participants are representative of home health agencies nationally, and there is sufficient participation to generate meaningful results among all Medicare-certified HHAs nationally.

 

For additional information about the Home Health Prospective Payment System, visit here. For additional information about the HHVBP, visit here. The final rule can be viewed at https://www.federalregister.gov/public-inspection. Please be mindful this link will change once the rule is published on November 5, 2015 in the Federal Register.

12%

... is the estimate of what insurance companies lost in 2015 on products sold on Affordable Care Act exchanges, according to Brian Blase, Ph.D., senior research fellow on health care policy at George Mason University's Mercatus Center, who recently wrote a Forbes article summarizing IRS and HHS data.

Thursday, October 29, 2015

Agents and Brokers: Plan Year 2016 Open Enrollment Begins This Sunday. Are You Ready?


The Centers for Medicare & Medicaid Services (CMS) is excited that plan year 2016 Open Enrollment begins this Sunday, November 1, 2015 at 7:00 AM Eastern Standard Time. As an agent or broker, you are a crucial partner in CMS’ goal to enroll more Americans in health care coverage. Do you need help getting started? Check out “Get Ready. Get Set. Get America Covered.” This document provides you with outreach tips, key Open Enrollment dates and deadlines, and messaging developed to help drive consumers to take action. Additional information and resources are also available on the Agents and Brokers Resources webpage

As a reminder, agents and brokers must complete the annual Federally-facilitated Marketplace (FFM) registration and training process prior to assisting consumers with enrolling in health care coverage through the Health Insurance Marketplace. Plan year 2016 registration and training are available via the CMS Enterprise Portal at: https://portal.cms.gov/

If you have questions, please email the FFM Producer and Assister Help Desk at: FFMProducer-AssisterHelpDesk@cms.hhs.gov.

CMS strengthens access to essential health care services for Medicaid beneficiaries

CMS NEWS

FOR IMMEDIATE RELEASE

October 29, 2015                                                                                                                          

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

CMS strengthens access to essential health care services for Medicaid beneficiaries

Meaningful access to health care services is crucial for the 72 million Americans who rely on the Medicaid program for coverage. As our nation moves towards better sharing and utilizing of information to improve health access, treatment, and outcomes, it is critical for us to work together to ensure continued access to preventive, primary, and specialty service that are needed to maintain the health and well-being of our most vulnerable populations.

The Centers for Medicare & Medicaid Services (CMS) today released a final rule that not only improves our ability to measure and ensure meaningful access to covered services, but also provides greater safeguards for beneficiaries who may otherwise experience great difficulty in receiving needed health care services. The intent of this final rule is to provide a framework for us to use to make better informed, data-driven decisions that support more effective service delivery systems, service rate structures, and provider payment methodologies that reflect our unique and evolving Medicaid population.

Building upon comments on the 2011 proposed rule, this final rule signifies another step forward in strengthening the delivery of health care services provided under the Medicaid program.

“Maintaining beneficiaries’ access to care is vital to the health of our nation and health of those who may not otherwise have access to essential health care services,” said Vikki Wachino, deputy administrator of CMS, and director, Center for Medicaid and CHIP Services. “Through this rule, beneficiaries will have greater confidence in the services they receive from their Medicaid health care coverage.”

The goals of the final rule are fundamental to our health care system: (1) measuring and linking beneficiaries’ needs and utilization of services with availability of care and providers; (2) increasing beneficiaries’ involvement through multiple feedback mechanisms; and (3) increasing stakeholder, provider, and beneficiary engagement when considering proposed changes to Medicaid fee-for-service payments rates that could potentially impact beneficiaries’ ability to obtain care.

To support these three goals, the final rule requires states to develop an access review plan that set out the data elements and other information to be used to ensure beneficiary access to mandatory and optional services; to establish new procedures to review the effects on beneficiary access of proposed rate reductions and payment restructuring; and to implement ongoing access monitoring reviews of key services, and additional services as warranted. These provisions enhance meaningful access to health care services by putting beneficiaries back at the center of their care.

The final rule also strengthens CMS’ ability to review and ensure Medicaid payment rates are consistent with efficiency, economy and quality and care. This aligns with the recent Supreme Court Armstrong v. Exceptional Child Center, Inc., 135 S. Ct. 1378 (2015) decision, which concluded that federal administrative agencies are better suited than federal courts to make these determinations. The court ruling placed greater importance on review and enforcement capability at the federal level; thus, improving our ability to monitor, measure, and ensure access to care within fee-for-service payment methodologies.

The final rule becomes effective on January 4, 2016, at which time states must meet the requirements established through the provisions of the rule. During the 60-day period, CMS will accept comments from the public on the access review requirements. This will enable states to begin preparing their initial review plan analysis and to assess whether adjustments to this provision are warranted.

In conjunction with the final rule, CMS today released a request for information to solicit comments on additional approaches the agency and states should consider to ensure better compliance with Medicaid access requirements. This includes comments on the potential development of standardized core set measures of access, access measures for long-term care and home and community based services, national access to care thresholds, and resolution processes that beneficiaries could use in facing challenges in accessing essential health care services. CMS will accept response to the request for information through January 4, 2016.

The final rule with comment and request for information are available on the Federal Register at https://www.federalregister.gov/public-inspection starting October 29, 2015 and can be viewed at https://www.federalregister.gov starting November 2, 2015.

Discharge Planning Proposed Rule Focuses on Patient Preferences


CMS NEWS


FOR IMMEDIATE RELEASE

October 29, 2015                                                                                                                          

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries
 

Discharge Planning Proposed Rule Focuses on Patient Preferences

 

Today, the Centers for Medicare & Medicaid Services (CMS) proposed to revise the discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies, must meet in order to participate in the Medicare and Medicaid programs. The proposed changes would modernize the discharge planning requirements by: bringing them into closer alignment with current practice; helping to improve patient quality of care and outcomes; and reducing avoidable complications, adverse events, and readmissions.

  

The proposed rule would also implement the discharge planning requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which will improve consumer transparency and beneficiary experience during the discharge planning process. The IMPACT Act requires hospitals, critical access hospitals, and certain post-acute care providers to use data on both quality and resource use measures to assist patients during the discharge planning process, while taking into account the patient’s goals of care and treatment preferences.

 

“CMS is proposing a simple but key change that will make it easier for people to take charge of their own health care. If this policy is adopted, individuals will be asked what’s most important to them as they choose the next step in their care – whether it is a nursing home or home care,” said CMS Acting Administrator Andy Slavitt. “Policies like this put real meaning behind the words consumer-centered health care.”

 

Improved Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies:

As called for in the IMPACT Act, hospitals, including inpatient rehabilitation facilities and long-term care hospitals, critical access hospitals, and home health agencies would be required to develop a discharge plan based on the goals, preferences, and needs of each applicable patient . Under the proposed rule, hospitals and critical access hospitals would be required to develop a discharge plan within 24 hours of admission or registration and complete a discharge plan before the patient is discharged home or transferred to another facility. This would apply to all inpatients and certain types of outpatients, including patients receiving observation services, patients who are undergoing surgery or other same-day procedures where anesthesia or moderate sedation is used, and emergency department patients who have been identified by a practitioner as needing a discharge plan. In addition, hospitals, critical access hospitals, and home health agencies would have to --

 

  • Provide discharge instructions to patients who are discharged home (proposed for hospitals and critical access hospitals only);
  • Have a medication reconciliation process with the goal of improving patient safety by enhancing medication management (proposed for hospitals and critical access hospitals only);
  • For patients who are transferred to another facility, send specific medical information to the receiving facility; and
  • Establish a post-discharge follow-up process (proposed for hospitals and critical access hospitals only).  

Increased Patient Participation in the Discharge Planning Process:

The proposed rule emphasizes the importance of the patient’s goals and preferences during the discharge planning process. These improvements should better prepare patients and their caregivers to be active partners for their anticipated health and community support needs upon discharge from the hospital or post-acute care setting. Hospitals and critical access hospitals would be required to consider several factors when evaluating a patient’s discharge needs, including but not limited to the availability of non-health care services and community-based providers that may be available to patients post-discharge.

In addition, patients and their caregivers would be better prepared to select a high quality post-acute care provider, since hospitals, critical access hospitals, and home health agencies would be required to use and share data, including data on quality and resource use measures. This results in the meaningful involvement of patients and their caregivers in the discharge planning process.

 

“This rule puts the patient and their caregivers at the center of care delivery,” said CMS Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., MSc. “Patients will receive discharge instructions, based on their goals and preferences, that clearly communicate what medications and other follow-up is needed after discharge, and pertinent medical information will be communicated to providers who care for the patient after discharge. This leads to better care, smarter spending, and healthier people.”

 

For more information, please visit: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-27840.pdf. This document is scheduled to be published in the Federal Register on 11/03/2015 and available online at http://federalregister.gov/a/2015-27840. There is a 60 day comment period on the proposed rule.

Wednesday, October 28, 2015

While 89% of the public says that doctors should discuss end of life care issues with their patients...

...only 17% say that they have had such discussions with their doctor, according to a recent survey.

Source: "Public Strongly Favors End-of-Life Conversations Between Doctors and Patients, With About Eight in 10 Saying Medicare and Other Insurers Should Cover These Visits," The Henry J. Kaiser Family Foundation News Release, September 30, 2015, http://kff.org/health-costs/press-release/public-strongly-favors-end-of-life-conversations-between-doctors-and-patients-with-about-eight-in-10-saying-medicare-and-other-insurers-should-cover-these-visits/

Wednesday, October 21, 2015

In 2013, prescription drugs were more expensive in the U.S. than in 13 other developed countries,

... with drug prices twice as high as in the U.K., Australia, and Canada.

Source: "US Spends More on Health Care Than Other High-Income Nations But Has Lower Life Expectancy, Worse Health," The Commonwealth Fund, October 8, 2015, http://www.commonwealthfund.org/publications/press-releases/2015/oct/us-spends-more-on-health-care-than-other-nations  

362 million


... will be paid to health insurers by CMS for the first year of the Affordable Care Act's risk-corridor program, which is approximately 12.6% of the $2.87 billion in risk-corridor payments they have requested.

2/3

... of oncologists said the lack of reimbursement for providing supportive care services is a key challenge faced by cancer care centers, according to a recent survey by the Association of Community Cancer Centers.

"Repealing the Cadillac tax sounds great


— lots and lots of people think it is [a wonderful idea] — but the reality is the Cadillac tax should be tougher. Anyone serious about health care, and I would include myself among them, thinks the Cadillac tax should have been twice as tough when they passed it. But it won't be repealed, it shouldn't be repealed, it's horrible policy [to repeal it]. The Cadillac tax is exactly the right thing. It should have been tougher."

— Tom Scully, former CMS Administrator under George W. Bush and now senior counsel for Alston & Bird LLP, told AIS's Health Plan Week.

57%


... of employees and 38% of IT professionals don't participate in their employer's "bring your own device" (BYOD) program due to a fear their employer would access their personal information, according to a recent survey by Bitglass.

"The surprising thing is the incredible resiliency

... of this [Medicare Advantage] program after four years of pretty relentless cuts" under the Affordable Care Act.

— John Gorman, CEO of Gorman Health Group, LLC, telling AIS's Medicare Advantage News for a story on CMS's 2016 "landscape files," which show a slight increase in the number of Medicare Advantage plans for the coming year.

15.7 Million Uninsured People Are Eligible for Medicaid


Kaiser Family Foundation recently conducted an analysis on the eligibility of the uninsured. Here are some key findings from the report:

·         Half of the 32.3 million nonelderly uninsured in the U.S. are eligible for Medicaid or subsidized coverage.

·         Five states account for 40% of the uninsured population that could receive Medicaid.

·         10% of the nonelderly uninsured fall into a coverage gap due to income being too low or too high to qualify.

·         The largest number of people in the coverage gap live in Texas (766,000 people).

·         35% of the uninsured in Texas qualify for Medicaid or subsidized coverage.

·         3 in 4 uninsured people in West Virginia qualify for Medicaid or subsidized coverage.

Source: Kaiser Family Foundation, October 13, 2015

7 Ways Your Health Care And Retirement Benefits May Change In 2016


1.    Higher costs for insurance - Even as the pace of increases in the cost of health care has eased, prices continue to rise

2.    Narrower health networks - Companies look for ways to reduce healthcare costs, they’re increasingly narrowing the networks of providers with whom they offer preferred rates

3.    Wellness programs with more strings attached - For at least a decade now, employers have been turning to preventative programs as a means to keep employees healthy

4.    Telemedicine services - A few years ago, employers began offering on-site clinics to give workers cheap, easy access to healthcare for minor afflictions

5.    Automatic 401(k) features - Most companies now use auto-enrollment to get all workers at least a little bit invested into their 401(k) plans

6.    A focus on student loans - PwC made headlines earlier this year for a new benefit under which it promised to pay up to $1,200 a year toward its employees’ student loans

7.    Help with financial planning - Student loans aren’t the only personal finance area in which companies are offering new benefits

Source: The Fiscal Times

2015 Average Employer Monthly Single Premiums by Plan Type


1.    HDHP/SO $464

2.    HMO $518

3.    Overall Avg $521

4.    POS $522

5.    PPO $548

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits 2015

Top Barriers to Hospital Innovation


1.    Low Employee Engagement

2.    Misconceptions about What Constitutes Innovation

3.    Regulatory Oversight

4.    Complex Value Analysis Model

5.    Antiquated Technology

Source: Advance Healthcare Network, September 21, 2015

The Number of Medicare Advantage Plans Will Increase by 3% in 2016


Kaiser Family Foundation recently conducted an analysis on changes to Medicare Advantage offerings for 2016. Here are some key findings from the report:

·         The number of Medicare Advantage plans will increase from 1,945 plans in 2015 to 2,001 plans in 2016.

·         203 Medicare Advantage plans will exit markets at the end of 2015 while 259 new plans will enter in 2016.

·         87% of plans that will be offered in 2016 were also available in 2015.

·         Medicare beneficiaries will be able to choose among 19 plans, on average, in 2016.

·         16 of the 19 average plans will offer Part D prescription drug coverage.

·         3% of Medicare Advantage enrollees are in plans that are exiting the market at the end of 2015.

Source: Kaiser Family Foundation, October 13, 2015