HHS Outlines Goals for Tying Medicare and Medicaid Reimbursement to Value-Driven Care
Providers of the future will be paid based on quality and value. That was the message of Department of Health and Human Services (HHS) Secretary Sylvia Burwell this week, as she announced new measurable goals and a timeline intended to move the Medicare program further toward value-driven health care. The Secretary also announced the creation of a Health Care Payment Learning and Action Network, which will involve working with state Medicaid programs, consumers, private payers, employers, providers, and others to expand alternative payment models into their programs. This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models [APMs] and value-based payments.
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GOP Senators Reintroduce Bill to Repeal Individual Mandate
Last week, a group of 22 Senators reintroduced the American Liberty Restoration Act (S. 203), legislation to repeal provisions in the Affordable Care Act requiring individuals to have health insurance. Known as the “individual mandate,” the requirement went into effect in 2014, with this tax season being the first some will have to pay a fine for remaining uninsured.
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Who Can Sue? Supreme Court Hears Medicaid Rates Case
When Medicaid rates are too low, what right of action does the public hold? That’s the decision before the Supreme Court this spring. Last week they heard arguments about whether Medicaid providers have standing to sue state Medicaid programs for low rates.
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Federal Court Strikes Down DOL Minimum Wage Rule for Home Care Workers
Earlier this month, a federal court effectively invalidated the Department of Labor’s home care rule extending minimum wage and overtime protections of the Fair Labor Standards Act (FLSA) to almost 2 million home care workers. Home care workers play an important role in the lives of those with disabilities, ensuring that individuals who receive home care services are not at risk of institutionalization or segregation. The final rule had been slated to go into effect on January 1, 2015.
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Deep Discussions on Hot Topics in Public Policy at the 2015 National Council Conference
Looking to stay on top of the latest news out of Capitol Hill and want more than your weekly Capitol Connector? Join us in Orlando for the Policy Track at the annual National Council Conference!
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CMS Administrator Marilyn Tavenner Announces Resignation
Last Friday, the Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner announced that she will be leaving her post in February. A former hospital executive and Virginia health secretary, Tavenner was appointed interim head of CMS in 2011. Two years later, on a vote of 91-7, she became the first CMS Administrator to win Senate confirmation since 2006.
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CMS Encourages Use of Medicaid Health Homes to Address Opioid Dependency
The Centers for Medicare and Medicaid Services has released an issue brief exploring options states can use to address opioid dependency among Medicaid enrollees, including through medication assisted treatment (MAT) and the Medicaid health home state plan amendment option.
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21st Century Cures Initiative Leaders Outline Goals for 2015
New details emerged last week about a bipartisan House effort to draft a comprehensive health care bill known as 21st Century Cures. In an op-ed, House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Ranking Member Diana DeGette (D-CO) outlined five broad goals of the draft bill they plan to introduce later this month:
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National Groups Urge House to Undo Block of SSDI Funds Transfer
A coalition of health and disability groups, including the National Council, sent a letter to the House of Representatives this week urging lawmakers to reconsider a recently-passed provision in House rules that could cut Social Security Disability Insurance (SSDI) benefits by 20 percent in 2016. House Resolution 5 prohibits routine transfers between the Social Security retirement trust fund and the Social Security disability program. Without an infusion of funds, the disability program could face severe shortfalls starting next year.
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House Passes Veterans’ Mental Health and Suicide Prevention Bill
On Monday, the House passed legislation aimed at preventing veterans’ suicide. The legislation allows the Veterans’ Administration to team with nonprofits focused on promoting mental health to carry out its suicide prevention programs. Additionally, the legislation establishes a three-year pilot program to pay for psychiatrists’ education if they work at the VA for at least two years.
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E/M Codes: New Issue Brief Outlines Advocacy Strategies for Adoption
A new National Council issue brief, Coding for Behavioral Health Services: Evaluation and Management CPT Code Adoption, outlines advocacy strategies for improving reimbursement and adoption of the Evaluation and Management (E/M) code set for behavioral health services provided by certain medical professionals.
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SAMHSA Releases Guidance on Administering Naltrexone for Opioid Use Disorder
This week, the Substance Abuse and Mental Health Services Administration’s (SAMHSA) released guidance on the clinical use of extended-release injectable naltrexone for treatment of opioid use disorder. The publication is meant to serve as a guide for primary care physicians providing information on assessing patients’ need for treatment, the administration of medication-assisted treatment (MAT), the process of patient monitoring, and considerations for whether and when to end MAT.
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House Approves Bill to Change ACA Full-Time Employee Definition
Last Thursday, the House voted 252-172 to approve legislation (H.R. 30) that would change the definition of full-time employees under the Affordable Care Act’s (ACA) employer mandate from those who work 30 hours per week to 40 hours per week. All Republican members and a dozen Democrats voted in favor of the bill.
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Five Health Policy Issues to Watch in 2015
Because no New Year would be complete without a “top five” roundup of the year ahead, we’ve put together a summary of the major health policy battles we’ll be watching in 2015 – and why you should, too.
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Chronic Care Management Services Through Medicare: CMS Drops Direct Supervision Requirement
Medicare Chronic Care Management (CCM) services allow physician practices to receive a fee for engaging in care management services for beneficiaries who have long-term chronic conditions. Effective this month, CMS has dropped a requirement that non-physician clinical professionals be directly supervised by a physician. Instead, non-face-to-face services may occur “incident to” and under the general supervision of a physician or other qualified health professional, regardless of whether it is inside or outside of the practice’s normal operating business hours.
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DoJ and HHS Issue Guidance Clarifying New Home Care Rule
Last month, the Departments of Justice (DoJ) and Health and Human Services (HHS) issued a “Dear Colleague” letter providing guidance on the Department of Labor’s new home care rule, which extended minimum wage and overtime protections of the Fair Labor Standards Act to most home care workers. The letter describes the obligations of public entities under the Americans with Disabilities Act (ADA) and the Supreme Court’s Olmstead decision as they begin to implement the rule.
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CMS Clarifies Reimbursement Policy on “Free Care” in Schools
The Centers for Medicare and Medicaid Services (CMS) recently sent a letter to State Medicaid Directors withdrawing its prior guidance on the “free care” policy as expressed in the School-Based Administrative Claiming Guide and other guidances. This withdrawal will benefit children and children’s providers by clarifying complex Medicaid reimbursement policy related to “free care” provided at schools.
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As the New Congress Begins, House Takes Aim at Social Security Disability
A small provision buried in the House’s operating rules for the 114th Congress could have a major effect on Social Security Disability Insurance, potentially cutting recipients’ benefits up to 20 percent in 2016. Passed on a 224-172 vote, the change prohibits routine transfers between the Social Security retirement trust fund and the Social Security disability program. Without an infusion of funds, the disability program could face severe shortfalls starting next year.
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