CMS Announces Coverage of Preventive Services to Reduce Cardiovascular Disease

Recently the Centers for Medicare and Medicaid Services (“CMS”) announced new coverage under the Medicare program for preventive services for the reduction of cardiovascular disease. CMS’ decision details that Medicare will now cover one-to-one cardiovascular disease risk reduction visits that may include three components: (1) encouraging aspirin use; (2) high blood pressure screening for adults 18 years or older, and (3) intensive behavioral counseling to encourage healthy diets.

The new coverage is part of a joint initiative between CMS and the Centers for Disease Control, the Million Hearts Initiative. Read more about the initiative here, and access CMS’ entire coverage decision here.

DC Circuit Court of Appeals Upholds Individual Mandate

On November 8, 2011, in the latest scrimmage regarding the Affordable Care Act’s (ACA’s) individual mandate, the D.C. Circuit Court of Appeals upheld the mandate’s constitutionality. The Court found that Congress could create “national solutions to national problems, no matter how local–or seemingly passive–their individual origins,” and that the individual mandate was therefore constitutional because it was within Congress’ authority.

On November 10, 2011, the United States Supreme Court will hold a private conference to decide whether to hear the challenges to the ACA.

Read the entire decision here.

2012 Hospital Outpatient Prospective Payment System Final Rule Released by CMS

On November 1, 2011, the Centers for Medicare and Medicaid Services (“CMS”) released the 2012 Hospital Outpatient Prospective Payment System Final Rule with comment period (“Final Rule”). The Final Rule, effective January 1, 2012, addresses the 2012 hospital outpatient prospective payment system including payment policies, the process for physician-owned hospitals seeking an exemption on the prohibition on expansion, and changes to patient notification requirements.

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2012 Physician Fee Schedule Final Rule Released by CMS

On November 1, 2011, the Centers for Medicare and Medicaid Services (“CMS”) released the 2012 Physician Fee Schedule Final Rule with comment period (“Final Rule”). Effective January 1, 2012, the Final Rule addresses several key components of physician reimbursement through Medicare including, to name a few, the new practice expense relative value units, changes to the adjustment of geographic practice cost indices, updates to the electronic health records incentive program, expanding the list of eligible services for telehealth services coverage, and reducing physician payments at physician wholly owned or hospital operated practices for hospital admissions occurring within 3 days of a physician service.

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CMS Releases Final ACO Regulations

Yesterday afternoon the Centers for Medicare & Medicaid Services (CMS) released the long anticipated final Accountable Care Organization (ACO) regulations, after considering the nearly 1200 comments submitted in response to the earlier proposed regulations. ACOs, created under the Affordable Care Act, are a model of health care that focuses on collaboration between providers across a continuum of care including different health care settings. The new regulations set forth the specifics for the program including payment mechanisms through which providers will be compensated for care provided through the integrated ACO model, as well as performance requirements for participating providers. The first ACOs will start operating in 2012.

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Final Antitrust Policy Statement Regarding ACOs in Medicare Shared Savings Program

On October 20, 2011, the U.S. Federal Trade Commission and the Department of Justice, which coordinate enforcement of the antitrust laws, issued their final Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program (the “Enforcement Policy”). The fundamental principle of the Enforcement Policy is that the agencies will apply the rule-of-reason analysis to all accountable care organizations applying for or participating in the Shared Savings Program and, if the same services are involved, to commercial insurance products modeled on the Shared Savings Program.

Please read the associated Duane Morris Alert for full details.

HHS Suspends ACA’s Class Act for Long-Term Care Insurance

Late this afternoon the Department of Health & Human Services’ (HHS)Secretary Kathleen Sebelius pulled back a long-term care insurance program, the Class Act, that was passed under last year’s Affordable Care Act. The Class Act’s goal was to create an insurance program that could cover the health care costs associated with many activities of daily living, including bathing and toileting. Speaking today, the Health & Human Services Secretary Kathleen Sebelius said that there didn’t appear to be a viable path for the Class Act, in part due to increasing concern that the program would have created substantial long-term costs.

Read Kathleen Sebelius’ full letter to Congress here.

Government Accountability Office Reports that 340B Program Needs Greater Oversight

Pursuant to a mandate in the Affordable Care Act, the Government Accountability Office (GAO) recently completed its review of the 340B Drug Pricing Program, which allows certain health care entities such as federal grantees and hospitals to receive discounted outpatient drugs. There are currently over 16,500 entities that participate in the 340B program.

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Affordable Care Act Funds Support Healthier Communities

The U.S. Department of Health & Human Services (HHS) recently rolled out its Community Transformation Grants program under the Affordable Care Act, geared towards fighting chronic disease and creating healthier communities. The five year grants will be used to address the “root causes” of chronic diseases through creating tobacco-free living, supporting active lifestyles and healthy eating, and reducing health disparities. 35 of the grantees will receive funding to implement intervention programs, and 26 grantees will receiving funding to build sustainable community prevention efforts.

Read more about the grants here.

HHS Announces Launch of Primary Care Bonus Initiative

The U.S. Department of Health & Human Services (HHS) recently announced the launch of its new Primary Care initiative to provide bonuses to primary care doctors for improvement of care coordination and cost efficiency. The goal of the initiative, created under the Affordable Care Act, is to facilitate care that is focused on the patient, coordination, and higher quality. The bonuses will be offered through commercial and state health insurance plans, and will come in the form of monthly fees above and beyond Medicare fees received for patient care. HHS has identified five primary areas that the fees will support including personalized care plans for chronically ill patients, 24-hour access to care and health information, preventive care, patient and family participation in care, and coordination among providers.

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The opinions expressed on this blog are those of the author and are not to be construed as legal advice.

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