Tag Archives: reform: where is the money

A Summary of Medicare Shared Savings Program and ACO Proposed Regulations

On March 30, 2011, the Centers for Medicare and Medicaid issued the long-awaited, proposed regulations for the Medicare Shared Savings Program, including details of the requirements for qualifying as an accountable care organization (ACO), such as:

  • Eligible legal entities
  • Criteria for shared governance
  • Assignment of beneficiaries to ACOs
  • Different types of risk contracts
  • Benchmarks and calculations of savings
  • Shared savings, antitrust issues and policies, Medicare anti-kickback, and other regulatory requirements as applied to ACOs

The full text of the summary is available as a Duane Morris Alert.

12 Proposed Recommendations for Accreditation of Patient-Centered Medical Homes

On March 8, 2011, a coalition comprised of physicians representing the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association, announced its completion of 12 new recommendations for accreditation organizations to use when developing and implementing standards for the patient-centered medical homes (PCMHs). The PCMHs are a central component of the Patient Protection and Affordable Care Act (ACA). The coalition developed the guidelines in anticipation of accreditation organizations, such as the Joint Commission, building upon its recommendations to establish updated standards for the PCMHs.

For additional information, please refer to the coalition’s guidelines.

New Grant Funding Opportunity to Help States Monitor and Challenge Rising Health Insurance Premiums

On February 24, 2011, the U.S. Department of Health and Human Services (HHS) announced that states can begin to apply for a second round of grants, which they can use to create or improve existing health insurance premium review programs. Approximately $200 million is available to states to better track and review premium rate increases, and make the rate process more transparent to consumers. HHS anticipates that the state review programs will also enable states to challenge or even prevent unreasonable premium increases from being implemented. This round of grants marks the federal government’s continued effort to combat rising health insurance premiums.

To read more about this announcement and to see how to access grant funding, please go to http://www.healthcare.gov/news/factsheets/ratereview02242011a.html.

$45 Million More in Federal Funding to Assist Medicaid Beneficiaries

On February 22, 2011, the U.S. Department of Health and Human Services (HHS) announced that it would provide $45 million in grant funding to 13 states for the startup and operation of Money Follows the Person (MFP) demonstration projects. States operate MFP programs to provide financial support and assist Medicaid beneficiaries with moving from institutions (i.e., hospitals and nursing facilities) and transitioning back into their communities to live in their own homes or other facilities. HHS anticipates that this federal funding will help 13,000 more Medicaid beneficiaries, and it will continue to provide grant funding through 2016 by committing at least $621 million to the state projects.

To read more about this announcement and see the list of 13 states scheduled to receive grant funding, please go to http://www.hhs.gov/news/press/2011pres/02/20110222b.html.

Medicare and Medicaid Programs; Requirements for Long-Term Care Facilities; Notice of Facility Closure

Issued by the U.S. Department of Health and Human Services (HHS)on February 18, 2011, this regulation implements section 6113 of the Patient Protection and Affordable Care Act (PPACA). The interim final rule amends existing legislation by introducing new notice requirements associated with long-term care (LTC) facility and skilled nursing facility (SNF) closures. Its purpose is twofold: to protect resident health and safety, and to facilitate a “smooth transition” in the event of a facility’s closure.

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HHS Awards $241 Million to Seven States for IT Infrastructure for Health Insurance Exchanges

On February 16, 2011, the U.S. Department of Health and Human Services (HHS) announced the states that will receive a total of $241 million to design and implement the IT infrastructure used to operate health insurance exchanges. The seven states selected by HHS are known as “early innovator” states because the infrastructure that they establish may be adopted by other states to set up their own exchanges. This announcement demonstrates HHS’s commitment to funding the development of user-friendly systems that will enable consumers to easily navigate the exchanges.

To read more about the IT grants and see the list of states scheduled to receive grant funding, please go to http://www.healthcare.gov/news/factsheets/exchanges02162011a.html.

$750 Million More in Prevention Funding

On February 9, 2011, the Department of Health and Human Services (HHS) announced that the Prevention and Public Health Fund would make an additional $750 million available to fund prevention initiatives throughout the United States for FY2011. Last fiscal year, the Prevention and Public Health Fund made $500 million available to states. This year, the $750 million will be distributed to states and local communities to address community prevention, clinical prevention, public health infrastructure, and research and tracking. This investment demonstrates the importance of prevention initiatives in improving the nation’s health. For additional information regarding this announcement, please go to http://www.hhs.gov/news/press/2011pres/02/20110209b.html.

$12 Million More in Electronic Health Record Funding

On February 8, 2011, the Office of the National Coordinator for Health Information Technology announced the availability of an additional $12 million in grant funding for the adoption and implementation of electronic health records (EHRs) by critical access and rural hospitals throughout the United States. The purpose of the additional grant funding is to help hospitals implement and adopt EHRs such that they meet “meaningful use” requirements. For additional information regarding this announcement, please go to http://www.govhealthit.com/newsitem.aspx?nid=76202.

Federal Judge in Florida Strikes Down the Health Reform Law

On January 31, 2011, a United States District Court in Florida held that the individual mandate provision in the Patient Protection and Affordable Care Act (“Act”) is an unconstitutional exercise of Congress’ power under the Commerce Clause of the United States Constitution. The court also held that “[b]ecause the individual mandate is unconstitutional and not severable, the entire Act must be declared void.” The court reasoned that “[i]f [Congress] has the power to compel an otherwise passive individual into a commercial transaction with a third party merely by asserting—as was done in the Act—that compelling the actual transaction is itself ‘commercial and economic in nature, and substantially affects interstate commerce’ . . . it is not hyperbolizing to suggest that Congress could do almost anything it wanted.” In concluding its decision, the court emphasized that the ruling only addressed a constitutional issue and that it was not about whether the Act was good or bad legislation.

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New Round of Grants to Help States Establish Exchanges

On January 20, 2011, the Department of Health and Human Services (HHS) announced an additional grant funding opportunity for states to establish their health insurance exchanges. Two types of grants will be available: Level One and Level Two. Level One grants will provide states with funding for up to one year, and subsequent to the first year, states may apply for a second year of Level One funding. Level Two grants, which provide states with funding through December 31, 2014, are available for those states that are further along in the implementation of their exchanges. For states to receive funding at either level, they must submit plans to HHS outlining how they intend to implement the exchanges along with anticipated expenditures. HHS did not disclose the amount of funding available for the grants, but it noted that funding will vary based on state need. For additional information regarding the grants, please see the Health Insurance Exchange Establishment Grants Fact Sheet.