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.
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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CMS Expands Medicaid Money Follows the Person Program
The Centers for Medicaid & Medicare Services (CMS) recently expanded the Money Follows the Person grant program to provide additional assistance to state grantees’ implementation of quality improvement strategies. The Money Follows the Person program was created through the Affordable Care Act (ACA), and fifteen states received funds under the program in January 2011. Due to increases in demand from states and programs under the ACA, additional funds were needed to support the new individuals benefitting from the program including support for quality mechanisms addressing the needs of vulnerable populations. Through its recent notice, CMS announced its $1.2 million expansion of the program to be used for developing technical assistance to grantee staff and subcontractors, home and community-based services programs, CMS staff oversight, and web-based technical assistance.
Access the full notice here.
Medicare Advantage Premiums Falling and Enrollment Up for 2012
HHS recently announced its expectation that Medicare Advantage premiums will fall approximately four percent in 2012, with enrollment expected to increase by 10 percent. This drop in premiums has been supported by the Affordable Care Act, which allowed CMS to prevent substantial cost increases or program cuts through elimination of co-pays and deductibles for Medicare-covered preventive services and additional discounts for Medicare beneficiaries that reach the prescription coverage “donut hole.” CMS is also offering high-quality performance incentives, including financial rewards and continuous marketing and enrollment to Five-Star Medicare Advantage and Part D plans.
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CMS Asking Providers to Submit Letter of Intent to Participate in Bundled Payments for Care Improvement Initiative
Providers, including hospitals, physicians and non-physician practitioners still have time to contribute to the growing accountable care model by submitting to CMS a Letter of Intent to participate in the Bundled Payments for Care Improvement initiative to CMS. CMS is seeking applicants who are willing to participate in one of the four models for episode-based payment for acute and post-acute care created under the Bundled Payments for Care Improvement initiative. The initiative will start in 2012 and is geared toward aligning incentives between providers to improve coordination throughout episodes of care. The four models are described in detail here: http://innovations.cms.gov/documents/pdf/Fact-Sheet-Bundled-Payment-FINAL82311.pdf.
Accountable Care Act Funding Awarded to Community Health Centers
On September 15, 2011, HHS awarded $10 million in Accountable Care Act funds to 129 organizations seeking to become community health centers, which are geared toward meeting the primary health needs in economically distressed or other vulnerable areas. The funds were specifically directed toward organizations that seek to provide primary healthcare services, or to expand existing services, to vulnerable populations. Likewise, the development of the community health centers will boost local economic growth and support local job markets. For more information on the community health centers program, see http://bphc.hrsa.gov/about/index.html.
Pennsylvania District Court Finds Individual Mandate Unconstitutional
On September 13, 2011, the United States District Court of the Middle District of Pennsylvania held that the Affordable Care Act’s individual mandate was unconstitutional as a violation of the Commerce Clause. In Goudy-Bachman v. U.S. Department of Health and Human Services, No. 1:10-CV-763 (M.D. Pa. Sept. 13, 2011), the court found, similar to its predecessors in other courts, that the federal government was one of limited enumerated powers and that “Congress [could not] invoke its Commerce Clause power to compel individuals to buy insurance as a condition of lawful citizenship or residency.” Thus, although the court recognized that “[t]he nation undoubtedly faces a health care crisis,” it severed the individual mandate, the guaranteed issue, and preexisting conditions reforms from the Affordable Care Act as unconstitutional. However, because the provisions found unconstitutional were severed from the Affordable Care Act, this decision allows the rest of the Act to stay intact and operative. The full decision is available at http://www.pamd.uscourts.gov/opinions/conner/10v763a.pdf.
On-Call Issues Persist
I have been asked to speak at the Orthopaedic Trauma Association’s 2011 meeting in San Antonio on October 15. The Association recently polled its members asking them to identify a topic for the plenary session and orthopaedic on-call compensation emerged as a common concern. In preparing for the presentation, I came across the OTA On-Call Position Statement posed on OTA’s web site.
Fourth Circuit Finds that Virginia Lacks Standing to Challenge ACA
In the latest scrimmage between states and the federal government on the constitutionality of the Affordable Care Act (ACA), the Fourth Circuit Court of Appeals found that the Commonwealth of Virginia lacked standing to challenge the constitutionality of the ACA’s individual mandate. Virginia brought suit against Kathleen Sebelius and the Department of Health & Human Services, challenging the individual mandate as unconstitutional and basing its standing on a conflict between the mandate and a new statute in Virginia, the Virginia Health Care Freedom Act. But the Fourth Circuit Court of Appeals found that Virginia lacked standing to challenge the mandate since the ACA’s mandate did not threaten the enforceability of the Virginia Health Care Freedom Act, especially where Virginia’s law simply tried to immunize Virginia citizens from the ACA individual mandate. Read the full opinion here.