The Texas Health and Human Services Commission (HHSC) adopted a rule regarding Internet Posting of Sanctions Imposed for Contractual Violations.
HHSC is authorized to impose sanctions against a Medicaid managed care organization for failing to comply with contract terms. During the 30-day comment period, HHSC received one comment:
Comment:
HHSC received a comment from DSHS, in which the commenter suggested adding language to §353.5(a), General Provisions, indicating the rule only applies to managed care organizations that contract directly with HHSC.
HHSC Response:
HHSC acknowledges the comment and disagrees with the commenter. The rule was not revised to include the commenter’s suggested language in §353.5(a), General Provisions. Section 353.5(a) establishes that HHSC determines noncompliance with the terms of a contract to provide health care services to clients through a managed care plan issued “by the MCO.” Based on this language, the rule does not apply to the Medicaid managed care contract at DSHS.
For more details, see the relevant section of the April 20 Texas Register.
The Texas Department of Aging and Disability Services has released HCSSA Houston Roundtable Questions and Answers, a table of questions and answers that resulted from two Regulatory Services staff meetings in Houston, Texas, last year. Topics include Licensing, Training, Coordination of Care, Survey Questions, Administrative Issues, OASIS, and General Questions.
For more information, download the letter and 26-page Q&A table here.
In an effort to improve the accuracy of payment under the acute care hospital inpatient prospective payment system and give hospitals incentives to improve quality, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule. From the press release:
Medicare’s inpatient rates for operating expenses will increase by 3.3 percent in FY 2008 for those hospitals that report quality data to CMS. Overall, the proposed rule is estimated to increase payments to more than 3,500 acute care hospitals by $3.3 billion.
“The payment reforms included in this proposed rule would continue a process for the third consecutive year to ensure that Medicare payments for inpatient services are more accurate and better reflect the severity of the patient’s condition,” said CMS Acting Administrator Leslie V. Norwalk, Esq. “The proposed rule also represents yet another major step forward in Medicare’s efforts to foster higher quality care in inpatient settings.”
All 50 states, the District of Columbia, Puerto Rico, Guam, the Virgin Islands will share $30 million in grant money to provide health insurance counseling services to Medicare beneficiaries, according to the Centers for Medicare and Medicaid Services. The State Health Insurance Assistance Programs, or SHIPs, will help beneficiaries figure out which insurance coverage is best for them. The program should be quite helpful for Medicare Part D enrollees.
Under SHIPs, counseling will be more personalized. For more information, see the press release.
The Centers for Medicare and Medicaid Services (CMS) has provided incentives for physicians to report quality data.
As the process may be too expensive for smaller practices, CMS implemented a three-year pilot program that will pay 800 small- or medium-sized practices in Arkansas, California, Massachusetts, and Utah to report quality care data for Medicare patients with chronic conditions. I blogged about this program last year, though it may not be the same one discussed in this press release.
CMS has posted specifications for 74 measures included in the 2007 Physician Quality Reporting Initiative. Eligible physicians may receive a bonus payment of 1.5 percent of total charges.
In another physician-related update, CMS announced the launch the Doctor’s Office Quality Information Technology University (DOQ-IT U), which will support health information technology in doctors’ offices. (Source)
Smaller and solo practices can use the web-based tool to educate themselves about such topics as culture change, vendor selection, and operational redesign, free of charge.
Leslie V. Norwalk, CMS Acting Administrator, said “DOQ-IT U’s interactive platform, self-paced curriculum, and associated tools provide physicians with easy access to the resources they need to help ensure that patients receive the highest quality of care at all times.”
The Texas Health and Human Services Commission (HHSC) has proposed a rule that will impose an age requirement for Community Care for Aged and Disabled (CCAD) services. Currently, there is no age requirement.
In response to the settlement agreement in a case titled, Alberto N., et al, vs. Albert Hawkins and James Hine (PDF), HHSC will make available personal care services for people under 21. After this program goes into effect, the Texas Department of Aging and Disability Services will offer its CCAD primary home care services program to people 21 and over only. For more information, including a section-by-section summary of the proposed changes, see the relevant section of the April 13 Texas Register.
In another update, HHSC has adopted amendments that will allow it to implement the Integrated Care Management (ICM) program required by the 79th Legislature. From the Texas Register:
ICM is a non-capitated managed care plan that integrates acute care and long term services and supports for Supplemental Security Income (SSI) and SSI-related clients. By law, the model is required to be implemented in the Dallas Service Area. At the request of local public officials, the HHSC Executive Commissioner has also approved implementing the model in the Tarrant Service Area.
For more information, see the relevant section of the April 13 Texas Register.
Congressional discussions about the government negotiating Medicare Part D drug prices is ongoing.
Although President George W. Bush has threatened to veto legislation allowing the government to negotiate prescription drug prices, lawmakers are moving forward. The House of Representatives passed a measure that would require the secretary of the Department of Health and Human Services to barter with drug companies over Medicare Part D drug prices. (UPI)
The Senate version of the bill is less extreme. It won’t require the secretary to negotiate drug prices but will allow him to negotiate. As expected, the drug industry is lobbying against the legislation. From the article:
The pharmaceutical industry has also kicked into high gear, spending $182 million on lobbying between June of 2005 and June 2006, according to the Center for Public Integrity…Touting a recent Congressional Budget Office report that found negotiations would result in negligible savings, the industry is pushing its message that interfering with the prescription drug benefit now would hurt consumers.
The Centers for Medicare and Medicaid Services (CMS) announced that payment rates for Medicare Advantage plans will increase by 3.5 percent in 2008. (CQ Health Beat News)
Medicare Advantage plans offer beneficiaries the traditional fee-for-service program with the option to receive Medicare through private insurance plans like health maintenance organizations and preferred provider plans.
CMS also announced updates to Medicare Part D. The new annual percentage increase used for updating features like the deductible, the initial coverage limit, and the out-of-pocket threshold for the standard benefit is 4.64 percent for 2008. For updating the maximum co-payments below the out-of-pocket threshold for certain dual eligibles, the percentage increase is 2.42 percent.
In a March 29 letter to Primary Home Care and Day Activity and Health Services providers, the Texas Department of Aging and Disability Services (DADS) wanted to make sure these providers were aware that they can bill DADS for PHC or DAHS services provided to consumers in counties covered by the STAR+PLUS program in rare cases. Consumers living in STAR+PLUS program coverage areas began receiving services from a Health Maintenance Organization on March 1.
For more information, including what will happen during the transition of DADS PHC and DAHS consumers to the STAR+PLUS program, download the letter here.
On April 4, DADS notified Community Living Assistance and Support Services (CLASS) Case Management Agencies and CLASS Direct Service Agencies of its intent to discontinue payment for monthly service fees for communication devices. From the letter:
As you are aware, there are individuals whose monthly service fees for communication devices (cell phones) have been paid by the CLASS program. Effective immediately, this action is explicitly prohibited as a waiver cost in the CLASS Medicaid waiver. The Department of Aging and Disability Services (DADS) CLASS program staff will not authorize new requests for payment of monthly service fees for communication devices.
For more information on future options, download the letter here.
Medicare Part D recipients who are qualified kidney dialysis patients will have extra assistance getting bone disease Medicare Part D prescription drugs. (Medical News Today)
The American Kidney Fund (AKF) may give eligible patients up to $2,000 a year in drug assistance funds. These grants will help cover “donut hole” costs for recipients caught in the coverage gap.
AKF CEO LaVerne A. Burton said, “Because they take so many prescription medications, many dialysis patients have fallen into the Part D ‘donut hole’ coverage gap, under which they must bear the full cost of their medications until they reach a certain out-of-pocket spending level. This program will provide urgently needed assistance to eligible patients who are in that situation - as well as to patients who are in the other phases of Part D coverage.”
AKF gave $81.9 million in the form of grants to 63,500 dialysis patients last year.