Washington Watch

CMS Releases Hardship Application March 15 Deadline Approaches

 Centers for Medicare & Medicaid Services (CMS) posted new, streamlined hardship applications on the Payment Adjustments and Hardship Information webpage, reducing the amount of information that eligible professionals, eligible hospitals, and Critical Access Hospitals (CAHs) must submit to apply for an exception from the 2017 payment adjustment. Application timeline:

• Eligible Professionals: March 15, 2016
• Eligible Hospitals and CAHs: April 1, 2016

Groups of providers may apply for a hardship exception on a single application. Under the group application, multiple providers and provider types may apply together using a single submission. The hardship exception categories are the same as those applicable for the individual provider application.

Governors’ Plan for Opioid Addiction

Governors from across the country from states battling the prescription drug abuse epidemic have come to Washington with a message for Congress and the federal government: We need more action to combat addiction.

The governors are offering a broad set of recommendations, including calling on the Centers for Disease Control and Prevention to release updated opioid prescribing guidelines for primary care physicians and for the Department of Veterans Affairs to require its health care providers to report information about opioids to state prescription drug monitoring programs.

The Department of Health and Human Services (HHS) should also consider how Medicare surveys on patient satisfaction could pressure doctors to prescribe opioids, and assess whether or not the surveys need to be changed, the governors said. Congress should also amend the Drug Addiction Treatment Act of 2000 (PL 106-310), the governors said, so that nurse practitioners and physician assistants can prescribe buprenorphine, a treatment for opioid addiction. Prescribers also are limited in how many patients they can treat with buprenorphine, a limit that the governors want HHS to raise. Other regulatory tweaks the governors urge include granting doctors access to patients substance use disorder treatment information.
 

Officials Propose Increased Medicare Advantage Rates

Medicare officials proposed increases of 1.35 percent that would translate into an average 3.55 percent revenue increase for most plans. Medicare adjusts payments to take into account the way that insurers code patients’ conditions. In recent years, Medicare officials often have adjusted the payments to be more generous when they finalize the rates in April.

Under the proposal, patients would be categorized into six groups of beneficiaries who live in the community or have been in an institution for less than 90 days. Three of the groups are: people who are older than 65 and are poor enough to be dually eligible for Medicaid; those over 65 who receive some help because they are partially eligible for Medicaid; and those over 65 who are not eligible for any Medicaid assistance. The other three groups are those younger than 65 who are fully, partially or not eligible for Medicaid. These changes could increase funding for plans with a large percentage of patients who also receive full Medicaid assistance in addition to Medicare benefits.

Florida Approves Aetna, Humana Merger

The Florida Office of Insurance Regulation approved Aetna Inc.’s proposed acquisition of Humana Inc. without divestiture requirements. This will be the 10th state signing off on the merger. Florida’s insurance regulator said the merger is not likely to have a “hazardous or prejudicial effect” on the public and would not “substantially lessen competition” in the state. Florida is considered a key state for regulatory approval because of its large number of Medicare beneficiaries. The Office of Insurance Regulation said it focused the bulk of its analysis on the merger’s effect on Medicare Advantage, a type of Medicare health plan offered by private insurers.

The Office of Insurance Regulation will require the merging parties to expand product offerings to underserved counties in the state. The insurance regulator said if the merger is approved by the Department of Justice, Aetna will enter five new counties by 2018. It also requires Aetna to continue “fair treatment” of patients living with HIV in accordance with an agreement reached between Florida and Humana in 2014.

CMS Hip-Knee Pilot Program Starts in April

Medicare will start in April a test program that will make about 800 hospitals financially responsible for how well people fare after knee and hip replacements. The will require that hospitals within 67 selected regions participate in the hip-and-knee program, despite complaints from providers. The 67 areas of the country sweep in hospitals in places such as New York, San Francisco and Los Angeles and greater Orlando, Florida, with limited exceptions. Under the program, the hospitals could get higher pay if their patients do well in the 90 days following hip and knee replacements, or have to repay Medicare if their patients are judged to have fared poorly.

With the program, CMS is taking on a fairly common medical procedure for people on Medicare, with more than 400,000 procedures performed on those enrolled in the program in 2014 at a cost of $7 billion. Medicare officials long have been concerned about poor results in some regions, with rates of complications and infections three times higher at some hospitals than others. Expenses for surgery and recovery vary as well, ranging from $16,500 to $33,000, according to CMS.

The hip-and-knee replacement project is one of the major initiatives led by the Center for Medicare and Medical Innovation (CMMI), which was created by the 2010 health law. The goal of CMMI is to improve the medical care provided to senior citizens and the disabled by moving away from Medicare’s longstanding fee-for-service approach. Under the fee-for-service model, Medicare has given the same reimbursement regardless of whether the care was poor or exemplary.

Medicare and Insurance Industry Merge Quality Metrics

Public and private health insurance providers announced a new set of quality measurements meant to make reporting requirements for doctors and care providers more consistent and efficient. By easing the reporting complexity for clinicians, insurers are also hoping to bring down costs for themselves and consumers. While individual payers currently utilize their own measurements, insurers have come together to agree on core measures in seven areas

The new measurements will be adopted by CMS as well as many private insurers, ultimately covering around 70 percent of all health care payers. CMS, which already uses some of the new measurements, will begin implementing the rest of the changes, including eliminating redundant measures, through its rulemaking process later this year. Private insurers are expected to phase in the changes starting in 2017. The core measures are in seven areas, including: primary care; cardiology; gastroenterology; HIV and Hepatitis C; medical oncology; obstetrics and gynecology; and orthopedics.