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1 Medicare update on Sun Nov 22, 2009 12:24 am

gypsy


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November 20, 2009
Senate Health Care Reform Bill Provides for Recovery Audit Contractor Expansion

In Section 6411 of the Patient Protection and Affordable Care Act (H.R.3590), the Senate Democratic health care reform bill provides for the expansion of the Recovery Audit Contractor (RAC) program.

Specifically, Section 6411 provides for the Medicare RAC program to be expanded to Medicare Parts C and D by no later than December 31, 2010. Section 6411 also contains some special rules. For instance, Section 6411 would require the Secretary of the Department of Health and Human Services (Secretary) to ensure that Medicare RAC contracts require RACs to:

* Ensure that each Medicare Advantage plan has an anti-fraud plan in effect and review the effectiveness of the plan;
* Ensure that each Medicare Part D prescription drug plan has an anti-fraud plan and review the effectiveness of the plan;
* Examine claims for reinsurance payments to determine whether prescription drug plans incurred costs in excess of the allowable reinsurance costs permitted; and
* Review estimates submitted by prescription drug plans (by private plans) with respect to the enrollment of high cost beneficiaries and compare such estimates with the numbers of such beneficiaries actually enrolled in the plans.

Interestingly, Section 6411 would also establish a RAC program for the Medicaid program. Based on Section 6411, it appears that a Medicaid RAC program would be similar to the current Medicare RAC program. That is, Medicaid RACs would be charged with looking for overpayments (and underpayments) and recovering the overpayments. In addition, Medicaid RACs would be paid on a contingent basis from the overpayment amounts recovered.

For more information, see Section 6411 of the Patient Protection and Affordable Care Act.
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Posted by Michael Apolskis on November 20, 2009 in Health Care Reform, Medicare Legislation, Recovery Audit Contractors | Permalink | Comments (0) | TrackBack (0) ShareThis
House Passes Medicare Physician Payment Reform Act of 2009

On November 19, 2009, the U.S. House of Representatives passed (by a vote of 243-183) the Medicare Physician Payment the Medicare Physician Payment Reform Act of 2009 (H.R.3961).

As previously reported, H.R.3961 would repeal the now 21.2 percent Medicare payment rate reduction for physician services in 2010 and restructure the sustainable growth rate (or SGR) formula.

The Congressional Budget Office recently released a cost estimate for H.R.3961 indicating that it would increase direct spending by about $210 billion over the 2010-2019 period.
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Posted by Michael Apolskis on November 20, 2009 in Health Care Reform, Medicare Legislation, Physicians | Permalink | Comments (0) | TrackBack (0) ShareThis
November 19, 2009
Senate Health Reform Bill Includes Significant Medicare Payment Reductions

On November 18, 2009, the Congressional Budget Office (CBO) releases its cost estimate associated with the Senate Democrat's Patient Protection and Affordable Care Act (H.R.3590).

According to the CBO, the provisions of H.R.3590 would cost $848 billion over 10 years (2010 - 2019), yield a net reduction to the Federal deficit of $130 billion over that time period, and extend insurance coverage to approximately 31 million eligible Americans.

However, such projections include provisions that would make changes to payment rates and rules for Medicare, Medicaid and other Federal programs. In fact, the CBO estimates that such changes would reduce direct spending by about $491 billion over the 2010 - 2019 period.

With respect to the Medicare program, the CBO reports that the H.R. 3590 provisions that would result in the largest estimated budget savings include:

* Permanent reductions in the annual Medicare payment rate updates for most services in the fee-for-service sector (other than physicians' services), yielding savings of $192 billion over 10 years.
* Setting payment rates in the Medicare Advantage (MA) program on the basis of the average of bids submitted by MA plans in each market, yielding savings of $118 billion over 10 years.
* Reducing Medicare payments to hospitals that serve a large number of low-income patients (known as disproportionate share hospitals) by approximately $21 billion.
* Establishing an independent Medicare advisory board to recommend changes to limit Medicare's spending growth rate, which would reduce Medicare spending by $23 billion over 10 years.

The Wall Street Journal (Patrick Yoest) reports that Senator Harry Reid stated that a key procedural vote that would allow H.R.3590 move forward may take place this Saturday (November 21, 2209).

Developing...
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Posted by Michael Apolskis on November 19, 2009 in Health Care Reform, Medicare Legislation | Permalink | Comments (0) | TrackBack (0) ShareThis
CMS to Host Ambulance Open Door Forum

The Centers for Medicare & Medicaid Services (CMS) recently announced that it will hold the next Ambulance Open Door Forum at 2:00 p.m. (ET) on December 9, 2009.

To participate by telephone, one must dial 1-800-837-1935 and reference conference ID 40386943. To participate in person, RSVP and security clearance is required. One must RSVP by 2:00 p.m. (ET) on December 4, 2009 to AmbulanceODF-L@cms.hhs.gov, and include your name, organization, telephone number, and "Ambulance" in the subject line. The Open Door Forum will take place at the Hubert H. Humphrey Building, 200 Independence Avenue S.W., Washington, D.C.

Beginning 2 hours after the Open Door Forum ends, CMS will also make an audio recording of the Open Door Forum available. To access the audio recording, one must dial 1-800-642-1687 and enter the conference ID. The recording will expire after 3 business days.

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UPDATE: White House Expresses Support for Medicare Physician Payment Reform Act

On November 18, 2009, the Office of Management and Budget released a statement strongly supporting the U.S. House of Representative's passage of the Medicare Physician Payment Reform Act of 2009 (H.R.3961). The American Medical Association reports that the House may vote on H.R.3961 today.

H.R.3961 would repeal the now 21.2 percent Medicare payment rate reduction for physician services in 2010 and restructure the sustainable growth rate (or SGR) formula. The Congressional Budget Office recently released a cost estimate for H.R.3961 indicating that it would increase direct spending by about $210 billion over the 2010-2019 period.

UPDATE: On November 19, 2009, the U.S. House of Representatives passed (by a vote of 243-183) the Medicare Physician Payment the Medicare Physician Payment Reform Act of 2009 (H.R.3961).



Posted by Michael Apolskis on November 19, 2009 in Health Care Reform, Medicare Legislation, Physicians | Permalin

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