Without “Doc Fix” Bill, Important CMS Provisions Expired on April 1
In addition to the expiration of the temporary fix preventing a scheduled 21% cut to Medicare physician pay, a number of provisions affecting providers expired at the end of March (also called “extenders”). The Centers for Medicare and Medicaid Services (CMS) updated providers on these expired provisions as it begins taking necessary steps to implement these changes. CMS said in a statement, that it “is working to limit any impact to Medicare providers and beneficiaries as much as possible.”
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House Passes Bill to Fix Medicare Physician Payments, Reauthorize CHIP
Today, the House passed the latest attempt to permanently repeal the complex Medicare physician payment formula – the Sustainable Growth Rate (SGR) formula – and replace it with one that links reimbursement to the quality of care provided. This move could put an end to the annual “Doc Fix” debate that is perennially required to forestall scheduled Medicare physician pay cuts.
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Obama Budget Proposal Shifts $8.86 Billion in Costs to Lowest-Income Medicare Beneficiaries
Buried in President Barack Obama’s 2016 budget proposal is a little-noticed provision that could make prescription drug coverage unaffordable to some of the lowest-income, most vulnerable beneficiaries in Medicare Part D, including those who are dually eligible for Medicare and Medicaid. The proposal is part of a package of changes that together would reduce federal Medicare spending by $423 billion between 2016 and 2025, according to the White House.
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CMS Releases Comprehensive Assessment of Quality Measures, Reporting Programs
Yesterday, the Centers for Medicare and Medicaid Services (CMS) released an assessment of quality measures intended to improve the delivery of health care services. The report – completed every three years – examines the effectiveness and impact of each measurement and outlines the performance these measures are having on patients. According to the report, these quality measures are improving care for patients, leading to smarter spending and healthier people.
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Congressional Leaders Introduce Legislation to Stem Medicare Fraud
Legislation introduced in the House this week aims to reduce Medicare fraud and abuse and strengthen the integrity of the program. Among its many provisions, the bill would create a Part D plan drug management plan to prevent prescription drug abuse. In this program, beneficiaries deemed “at risk of prescription drug abuse” would only be eligible to receive and fill prescription from specific providers and in specific pharmacies.
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GOP Moves to Draft ACA Replacement
Last Friday, House Majority Leader Kevin McCarthy (R-CA) announced that a trio of Republican committee chairmen will immediately get to work on drafting the party’s Affordable Care Act replacement plan. McCarthy announced the formation of the working group one day after House leaders scheduled a vote this week to fully repeal the 2010 healthcare reform law, marking the first such effort of the Republican-controlled Congress. The group, which includes Ways and Means Committee Chairman Paul Ryan (R-WI), is also tasked with developing a “contingency plan” to prepare for a looming Supreme Court decision in King v. Burwell that could undo ACA subsidies in 34 states.
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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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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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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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Medicare Updates CMHC Conditions of Participation to Recognize Same-Sex Marriages
The Centers for Medicare and Medicaid Services has announced it is updating its Conditions of Participation (CoPs) for Community Mental Health Centers (CMHCs) to bring them into compliance with the Supreme Court’s decision on same-sex marriage in United States v. Windsor. Under the new guidance, CMHCs and certain other Medicare-participating providers will be required to recognize clients’ same-sex marriages according to the law of the state where they were performed, regardless of whether such marriages are legal in the state in which the CMHC is located.
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MAPRx Coalition Submits Comments on 21st Century Cures Initiative
Earlier this month, the Medicare Access for Patients Rx (MAPRx) Coalition, of which the National Council is a member, submitted comments on the Energy and Commerce Committee’s 21st Century Cures initiative. 21st Century Cures is a wide-ranging legislative initiative designed to foster comprehensive improvements and innovation in the U.S. health system. The MAPRx comments, submitted to Committee Chairman Fred Upton (R-MI) and Representative Diana DeGette (D-CO), proposed recommendations for improvement to the Medicare Part D Program.
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CMS Launches Health Care Transformation Initiative
Last week, the Centers for Medicare and Medicaid Services (CMS) announced a new initiative for the development of comprehensive quality improvement strategies to achieve large-scale heath care transformation. The “Transforming Clinical Practice Initiative” is the latest CMS initiative to help clinicians and hospitals move from volume-based to valued-based and patient-centered quality health services. The initiative will provide up to $840 million over the next four years to support 150,000 clinicians in the development of comprehensive quality improvement strategies.
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National Council Reviews Behavioral Health’s Role in Medicare Quality Initiatives
Medicare is well on its way to fully incorporating mental health and addiction treatment in its quality initiatives – and behavioral health providers should prepare now for this seismic shift in payment and accountability. That’s the core message of a new National Council report, “A Place at the Table: Behavioral Health and CMS’ Physician Quality Reporting System.”
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Medicare to Survey CMHCs for Compliance with Conditions of Participation
Mental health organizations registered with Medicare as Community Mental Health Centers (CMHCs) should have received a letter from the Centers for Medicare and Medicaid Services confirming their operational status as a CMHC. This is the first step in initiating a survey process to confirm compliance with Medicare’s Conditions of Participation for CMHCs.
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Health Equity and Accountability Act Introduced
“Mental and behavioral health social workers” would be eligible for federal loan repayment benefits under new legislation introduced by Congresswoman Lucille Roybal-Allard (D-CA) with 70 cosponsors. The Health Equity and Accountability Act of 2014 (H.R.5294) adds these professionals to existing loan repayment programs, a move designed to bolster the behavioral health workforce. It also requires the National Institute on Minority Health and Health Disparities and the Institute of Medicine to conduct a study on “mental and behavioral health disparities in racial and ethnic minority groups” and issue recommendations for improvement to Congress.
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New Legislation Expands Medicare Coverage for Behavioral Health Providers
New legislation expands Medicare coverage for behavioral health services provided by marriage and family therapists and mental health counselors. Senator Al Franken (D-MN) included this important change in the Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act, a bill which amends several Medicare provisions in an effort to improve Americans’ access to mental health and […]
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Several House Committee Members Introduce Broad Behavioral Health Bill
Earlier this week, members of the House Committee on Energy and Commerce – which oversees many policies related to mental health and substance use – introduced legislation to improve the U.S. behavioral healthcare system.
The Strengthening Mental Health in Our Communities Act (H.R. 4574) was introduced by Ron Barber (D-AZ), Diana DeGette (D-CO), Doris Matsui (D-CA), Grace Napolitano (D-CA), and Paul Tonko (D-NY).
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House Passes Medicare Bill Including Excellence Act; Bill Goes to Senate
Congressional negotiators released a final Medicare SGR Repeal bill on Tuesday that includes $900 million to fund the bipartisan Excellence in Mental Health Act. The Excellence Act, sponsored by Senators Debbie Stabenow (D-MI) and Roy Blunt (R-MO) along with Representatives Doris Matsui (D-CA) and Leonard Lance (R-NJ), would improve quality and expand access to mental health care and substance use treatment through community behavioral health clinics.
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Latest Maneuver in “Doc Fix” Debate Includes Excellence in Mental Health Act
Senator Ron Wyden (D-OR), chairman of the influential Senate Finance Committee, has introduced a bill to permanently repeal the unpopular Medicare physician payment formula, while enacting a Medicaid demonstration program that would bolster the nation’s community behavioral health system.
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