Trustees Report Shows Medicare Remains Viable, But Challenges Remain

The Medicare Trustees Report released today shows that while Medicare remains solvent longer than expected prior to passage of the Affordable Care Act, challenges remain for securing the long term financial health of the Medicare program. Expenditures for the Supplementary Medical Insurance (SMI) Trust Fund were lower than expected this year. The Trustees annual report says that Medicare’s Hospital Insurance (HI) Trust Fund is now projected to remain solvent until 2024.

Without the reforms in the Affordable Care Act, the Medicare HI Trust Fund would expire in just five years – in 2016. The report issued today shows these reforms added eight years of solvency.

“This report shows that without the Affordable Care Act, the outlook for the Hospital Insurance Trust Fund today would be much worse, said Donald Berwick, M.D., Administrator of the Centers for Medicare & Medicaid Services. “CMS is implementing critical reforms to improve care and reduce costs and improve the overall health of Medicare’s beneficiaries and the Trust Fund.”

Actual Part B expenditure growth in 2010 was lower than expected. Part B is funded by a combination of beneficiary premiums and general revenue financing.

Part D, the Medicare prescription drug program, is also in financial balance as a result of annual updating of enrollee premiums and benefit payments. Projected expenditures are slightly lower overall than in last year’s report, reflecting lower-than-expected costs in 2009 and 2010 together with a reduction in the projected growth in prescription drug spending in the U.S. for the next 10 years.

HI Trust Fund expenditures have exceeded income annually since 2008 and are projected to continue doing so under current law in all future years. Interest earnings and asset redemptions are required to cover the difference. HI Trust Fund assets are projected to cover annual deficits through 2023, with asset depletion beginning in 2024.

The five year change from the 2010 trustee report was due to a slowdown in the national economy, which resulted in a decline in tax revenues and higher real projected expenditures. This is not the first time that the HI Trust Fund expiration date has been affected by a decline in anticipated revenues. In 2004, for example, the Trust Fund exhaustion date moved up by 7 years, in large part because payroll tax revenues in 2003 were lower than had been anticipated.

The projections in this year’s report demonstrate the importance of the Affordable Care Act as a tool to improve the outlook for the HI Trust Fund but also point to a need to continue serious discussions about driving care improvements that also address underlying cost drivers in the Medicare program.

The Medicare Trustees are Treasury Secretary and Managing Trustee Timothy F. Geithner, Health and Human Services Secretary Kathleen Sebelius, Labor Secretary Hilda L. Solis, and Social Security Commissioner Michael J. Astrue. The two public representatives appointed by the President and confirmed by the Senate, are Charles P. Blahous III and Robert D. Reischauer began serving on September 17, 2010. CMS Administrator Berwick is designated as Secretary of the Board.

The report is available at: http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2011.pdf

Public comment on Home and Community Based Services

The Centers for Medicare & Medicaid Services have issued a Notice of Proposed Rulemaking that would revise the regulations implementing Medicaid Home and Community Based Services (HCBS) under section 1915(c) of the Social Security Act. There are several proposed changes including the following:

· Requirement for person-centered planning

· Characteristics of home and community based settings

· Options for States to combine target groups into a single waiver

· Clarification of timing and public input requirements for amendments.

Please take a few minutes and comment on this important proposed rule.

Click the following link to view the proposed rule and make a comments:

http://www.hhs.gov/od/community/public/index.html

COMMENTS ARE DUE 5:00 PM EST JUNE 14, 2011



Assisted Living Settings/Facilities and the ADA. Information Bulletin # 331 (4/2011)

by Steve Gold

CMS issued proposed rules regarding Medicaid’s Home and Community-Based waivers. 76 Federal Register 21311 (4/15/11). One part of the proposed rules focused on Assisted Living Settings and whether these qualify under Olmstead’s “the most integrated setting” mandate. CMS stated that “a State’s obligations under the ADA and Section 504 are not defined by, or limited to, the cope or requirements of the Medicaid program; however, the Medicaid program provides an opportunity to obtain partial Federal funding to assist in compliance with the ADA and 504 through the provision of Medicaid services.”

CMS noted that older Americans “ with and without disabilities” may wish to live together. Because so many nursing homes have “converted” to ALS by changing their names and repainting the facility, it is important that advocates for older Americans “with and without disabilities” hold your State Medicaid agency accountable to make sure that the following CMS criteria are really being applied. CMS will permit Medicaid waiver funding only if the ALS were really community-based settings. Advocates can make sure the following criteria are implemented.

Here are the CMS criteria. Unless they are complied with, a Medicaid funded ALS waiver does not comply with the ADA and 504.

1. “The individual has a lease.” Leases trigger tenant rights and the proprietors of the ALS take on landlord duties. They are written and enforceable. State tenant rights statutes provide legal requirements and recourse that residents in an ALS could use if the landlord, aka provider, tries illegally to evict the tenant or act contrary to the lease.

2. The “Setting is an apartment with individual living, sleeping, bathing and cooking areas.” These rights will prevent nursing home providers from just changing the name of their facilities. Each apartment must have an individual cooking area - like a kitchen or kitchenette. Individual bathing is more than a toilet, but includes a shower and/or bathtub. Wow, this is beginning to sound like a real apartment.

3. “Individuals can choose whether to share a living arrangement and with whom.” Hey, isn’t that like what nondisabled tenants do?

4. “Individuals have lockable access to and egress from their own apartments.” That’s fancy talk for a key and a lock. Yes, the person in an ALS has the right to lock the door to her/his own apartment. What next? Invite whomever they wish into thei apartment?

5. Yes. “Individuals are free to receive visitors.” Providers cannot screen of guests.

6. Individuals can also “leave the setting at times and for durations of their own choosing.” They can go out whenever they want. No night curfews.

7. “Aging in place, or allowing individuals to remain where they live as they age and/or support needs change.” Advocates better make sure this is explicitly spelled out in the lease!

8. “Leases may not reserve the right to assign apartments or change apartment assignments.” Make sure it’s explicitly in the lease so there is no doubt about this right.

9. “Access to the greater community is easily facilitated based on the individual’s needs and preferences.” This means that the ALS provider, i.e., landlord, cannot arbitrarily deny a person the right to leave the ALS. More affirmatively, does it suggest providing some assistance in gaining such access - i.e., “easily facilitated”?

10. If there is a “person-centered plan,” compliance with it is “not in and of itself a condition of the lease.” Although the intent of this one is good, we’re not sure why compliance should ever be a condition of a lease. People in ALS should be treated like adults.

If these points are not provided for, then the ALS are “not home and community-based because they are not integrated in the community. A setting that is integrated in the community is a setting that enables individuals with disabilities to interact with individuals without disabilities to the fullest extent possible.”

CMS wrote that “we are particularly interested in gaining comments on these aspects of the proposed rule.” Anyone want to wager that the ALS industry will be against these basic rights?

Advocates for the elderly and disabled Americans should let CMS know these rights are long, long overdue. If advocates do not respond, CMS will be swamped with ALS providers opposing the changes.

Please let CMS know what you think about ALS. You have only until June 14 to respond. If you do, refer to the file code CMS-2296-P.

Electronically - http://www.regualtions.gov and follow the instructions under the “more search options” tab.

Regular Mail: CMS, Dept of HHS, Attention: CMS-2296-P [yes, I know that is different but I do not know which is correct.], P.O Box 8016, Baltimore, MD 21244-1850.

Medicare to Pay for MRIs in Patients With Pacemakers

By Chris Kaiser, Cardiology Editor, MedPage Today


The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is strong enough to reimburse for MRI exams in Medicare patients who have permanent pacemakers.

"We propose to change the language ... of the NCD Manual to remove the contraindication for Medicare coverage of MRI in beneficiaries with implanted PMs [permanent pacemakers] when the PMs are used according to the FDA-approved labeling for use in an MRI environment," the agency's proposed decision memorandum states.

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CMS Releases Hospital Error, Injury Data

By Emily P. Walker, Washington Correspondent, MedPage Today

The Centers for Medicare and Medicaid Services began reporting hospital-specific rates of eight hospital-acquired conditions (HACs), so patients can compare how often the nation's 4,700 hospitals make preventable medical errors.

The eight conditions are foreign object retained after surgery, air embolism, blood incompatibility, stage III and IV pressure ulcers, falls and trauma, vascular catheter-associated infection, catheter-associated urinary tract infection, and manifestations of poor glycemic control.

"By making HAC data transparent, CMS sheds light on those preventable events where patients are harmed while seeking care," the agency said in a press release.

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Gay Couples Closer to Receiving Medicaid Spousal Protections - NYTimes.com

By TARA SIEGEL BERNARD

Same-sex couples are one step closer to receiving protections that heterosexual married couples get when they receive long-term care through Medicaid — that is, the healthy partner will be able to keep some of the ailing partner’s money and remain in their home.

At least, that’s the goal. Right now, only opposite-sex married couples receive those rights because the federal government doesn’t recognize same-sex marriage.

To qualify for long-term care through Medicaid, individuals generally have to spend their money until it’s practically depleted. But married couples can keep more money so that healthy spouses don’t have to impoverish themselves to qualify the sick spouse for care. Nor do they have to worry about giving up their home to raise money to pay back Medicaid for its services after their spouse dies. They can stay put for the rest of their lives.

As a work-around, the Obama administration is close to notifying the state-run Medicaid programs about how they can replicate these protections for same-sex domestic partners, according to the Centers for Medicare and Medicaid Services.

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OIG Posts New Information on Accountable Care Organizations

On March 31st, OIG posted new information on Accountable Care Organizations. Thhe links provided below will take you directly to the new material.

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Federal Agencies Address Legal Issues Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program
http://oig.hhs.gov/fraud/aco.asp

Today, as part of a cross-agency, coordinated effort, several Federal agencies issued documents addressing legal issues regarding Accountable Care Organizations participating in the Medicare Shared Savings Program
(Shared Savings Program).

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would establish accountable care organizations (ACO) under the Shared Savings Program. The CMS proposed rule is available online at
http://www.cms.gov/sharedsavingsprogram

CMS and HHS Office of Inspector General (OIG) jointly issued a notice with comment period outlining proposals for waivers of certain Federal laws-the physician self-referral law, the anti-kickback statute, and certain provisions of the civil monetary penalty law-in connection with the Shared Savings Program. CMS and OIG are also asking for comments on further waiver design considerations for the Shared Savings Program and for the separate waiver authority for the Center for Medicare and Medicaid Innovation under section 1115A of the Social Security Act. The joint notice with comment period is available online at
http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1

The Federal Trade Commission and the Department of Justice jointly issued a "Proposed Statement of Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program" (Antitrust Policy Statement). The Antitrust Policy Statement is available online at:
http://www.ftc.gov/opp/aco/
 
And the Internal Revenue Service (IRS) issued a notice requesting comments regarding the need for guidance on participation by tax-exempt organizations in the Shared Savings Program through ACOs. The IRS notice
is available online at
http://www.irs.gov/newsroom/article/0,,id=222814,00.html

Launching Accountable Care Organizations — The Proposed Rule for the Medicare Shared Savings Program | Health Policy and Reform

by Donald M. Berwick, M.D., M.P.P in NEJM

A common criticism of U.S. health care is the fragmented nature of its payment and delivery systems. Because in many settings no single group of participants — physicians, hospitals, public or private payers, or employers — takes full responsibility for guiding the health of a patient or community, care is distributed across many sites, and integration among them may be deficient. Fragmentation leads to waste and duplication — and unnecessarily high costs.

Section 3022 of the Affordable Care Act (ACA) establishes the Medicare Shared Savings Program for accountable care organizations (ACOs) as a potential solution.¹ The creation of ACOs is one of the first delivery-reform initiatives that will be implemented under the ACA. Its purpose is to foster change in patient care so as to accelerate progress toward a three-part aim: better care for individuals, better health for populations, and slower growth in costs through improvements in care. Under the law, an ACO will assume responsibility for the care of a clearly defined population of Medicare beneficiaries attributed to it on the basis of their patterns of use of primary care. If an ACO succeeds in both delivering high-quality care and reducing the cost of that care to a level below what would otherwise have been expected, it will share in the Medicare savings it achieves.

On March 31, 2011, the Department of Health and Human Services took a major step toward establishing ACOs by issuing a notice of proposed rule-making that will define how physicians, hospitals, and other key constituents can adopt this new organizational form. The issuing of the proposed rule follows months of obtaining informal and formal input from throughout the health care delivery system, but at this point the rule is only a proposal. The Centers for Medicare and Medicaid Services (CMS) will carefully review the comments we receive in response to the proposed rule before issuing a final rule later this year.

A critical foundation of the proposed rule is its unwavering focus on patients. We envision that successful ACOs will honor individual preferences and will engage patients in shared decision making about diagnostic and therapeutic options. Information management — making sure patients and all health care providers have the right information at the point of care — will be a core competency of ACOs. Held to rigorous quality standards (see table), ACOs will be expected to be proactive in their orientation and to regularly reach out to patients to help them meet their needs for preventive and chronic health care. Patients who seek care at their ACO will know that their physicians are part of that ACO, but as beneficiaries of fee-for-service Medicare, they will continue to be free to seek care from any Medicare provider they wish. They will not be locked into seeing only particular health care providers.
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Medicare Moves to Pay for Prostate Cancer Drug Provenge - The Washington Post

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By Rob Stein

The federal health insurance program for the elderly moved Wednesday to pay for an expensive vaccine recently approved to treat men with advanced prostate cancer.

The Centers for Medicare and Medicaid Services proposed paying for the vaccine, known as Provenge, which costs $93,000 a patient. The proposal will be subject to public comment for 30 days, and a final decision will be issued 60 days after that.

“The evidence is adequate to conclude that” Provenge “ improves health outcomes for Medicare beneficiaries” with metastatic prostate cancer, “and thus is reasonable and necessary for that indication,” CMS said in announcing its decision.

Although Medicare is not supposed to take cost into consideration when making such rulings, the decision by CMS to launch a formal examination raised concerns among cancer experts, drug companies, lawmakers, prostate cancer patients and advocacy groups.
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CMS Puts 2012 Medicare Fee Cut at Nearly 30 Percent

Image via WikipediaBy Emily P. Walker, Washington Correspondent, MedPage Today

The Centers for Medicare and Medicaid Services (CMS) has estimated that in 2012 Medicare physician reimbursement will be cut by 29.5%.

When President Obama signed a bill in 2010 to postpone the scheduled 25% cut in Medicare reimbursement through 2011, physicians were aware that the pay cut would be greater than 25% come 2012. And, if CMS' estimate holds true, it will be.

Writing in a letter to the chairman of the Medicare Payment Advisory Commission (MedPAC), Jonathan Blum, deputy administrator of CMS' Center for Medicare, said that the "conversion factor" -- the dollar multiplier used to calculate physician payments under the current reimbursement system -- will be cut by an estimated 29.5% in 2012, from $33.98 to $23.94.

The cut is mandated by the sustainable growth rate (SGR), a formula that ties physician reimbursement to the gross domestic product; the SGR has called for cuts in pay every year since 2002. Every year since 2003, Congress has voted at the last minute to push those cuts down the road.

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Medicaid Prevention Grants

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The Centers for Medicare and Medicaid Services (CMS) is pleased to announce the invitation to States to apply for participation in the Medicaid Incentives for Prevention of Chronic Diseases Program authorized by section 4108 of the Affordable Care Act.  This nationwide program will test and evaluate the effectiveness of a program to provide financial and non-financial incentives to Medicaid beneficiaries of all ages who participate in prevention programs to address at least one of the following prevention goals: tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or improving the management of the condition; and demonstrating changes in health risk and outcomes, including the adoption of healthy behaviors.

This new funding opportunity does not require States to match the incentive payment with State funds.  Beneficiary incentives available through section 4108 may be used by States to complement other chronic condition health initiatives, such as the currently available Health Home Medicaid State plan option provided by section 2703 of the Affordable Care Act.  Approved administrative and program expenditures for successful applicants will be reimbursed through grant funds from the $100 million dollars appropriated under section 4108 of the Affordable Care Act for this program and evaluation.  The Office of the Governor or the State Medicaid Agency may apply for funding under this grant opportunity, however CMS will accept only one application per State and encourages State offices and agencies to work collaboratively to develop one application packet.

All applications must be submitted electronically through http://www.grants.gov

The solicitation and further application requirements may be obtained at http://www.cms.gov/MIPCD/
 
An applicant’s teleconference is scheduled for March 8, 2011 from 2:30 to 4:30 PM eastern time and may be accessed by calling the operated assisted toll-free dial-in number: (800)837-1935, and the Conference ID is: 2314.

The closing date for this Funding Opportunity Announcement is May 2, 2011.   

CMS Proposed Community First Choice Rule

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On February 25th, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule in the Federal Register to implement a new Community First Choice Option.  Under Section 2401 of the Affordable Care Act, this proposed rule establishes a new State option to provide home and community-based attendant services and supports through a new section of 1915 (k) to the Social Security Act.  The goal of this new option is to give States additional resources to make community living a first choice.

Starting in October, this option will allow States to receive a six percent increase in federal matching funds for providing community-based attendant services and supports to people with Medicaid.  Over the next three years—through 2014—States could see a total of $3.7 billion in new funds to provide these services.  Under this new option, States will provide consumer controlled, person-centered home and community-based attendant supports to individuals on a statewide basis.  The person-directed plans and services will be developed in a manner that is most integrated and appropriate to the individual’s needs, without regard to age, type or nature of disability, severity of disability, or form of home and community-based attendant services and supports the individual requires in order to lead an independent life. 

To find out more about the Community First Choice option and to review the proposed rule implementing this section, please visit: http://www.gpo.gov/fdsys/pkg/FR-2011-02-25/pdf/2011-3946.pdf

Comments for this proposed rule are due to CMS by April 26, 2011. 

Medicare Considers Paying for STD Screening

By Emily P. Walker, Washington Correspondent, MedPage Today

The Centers for Medicare and Medicaid Services (CMS) is considering whether to pay for sexually transmitted disease testing for elderly and disabled Medicare beneficiaries.

Medicare already pays for HIV tests, but a National Coverage Analysis (NCA) posted by CMS on Thursday announced that the agency is considering whether to include coverage for testing for chlamydia, gonorrhea, hepatitis B, and syphilis, and to pay for counseling to prevent sexually transmitted diseases (STDs).

Most of the tests would be aimed at detecting infections in high-risk groups, such as pregnant disabled women.

Medicare covers about 39 million people over the age of 65, and nearly eight million people with disabilities who are younger than 65.

The announcement comes as sexually transmitted disease rates among the elderly are increasing. Nearly one-quarter of people living with HIV in the U.S. are older than 50, and rates of chlamydia among men ages 45 to 64 tripled from 1996 to 2006, and doubled among women in the same age group, according to statistics from the CDC.

Researchers explain the increase in a number of ways, including that the elderly are more susceptible to disease, far less likely to use condoms than younger people, and excluded from virtually every STD-prevention educational program.

And then there's the Viagra explanation.
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Medicaid Incentives for Prevention of Chronic Diseases (MIPCD)

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Description

Section 4108 of the Patient Protection and Affordable Care Act (Pub. L. 111-148) (The Affordable Care Act) authorizes grants to States to provide incentives to Medicaid beneficiaries of all ages who participate in prevention programs and demonstrate changes in health risk and outcomes, including the adoption of healthy behaviors. The initiatives or programs are to be ?comprehensive, evidence-based, widely available, and easily accessible.? The programs must use relevant evidence-based research and resources, including: the Guide to Community Preventive Services; the Guide to Clinical Preventive Services; and the National Registry of Evidence-Based Programs. An application by a State for a grant under the program must address at least one of the following prevention goals: tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or in the case of a diabetic, improving the management of the condition. The incentives provided to a Medicaid beneficiary participating in this program shall not be taken into account for purposes of determining the beneficiary?s eligibility for, or amount of, benefits under the Medicaid program or any program funded in whole or in part with Federal funds.

Link to Full Announcement

Medicaid Incentives for Prevention of Chronic Diseases (MIPCD)

Affordable Care Act Sets Nation on Right Course for Health Reform, Experts Say - The Commonwealth Fund

In New Survey, Majority of Health Care Opinion Leaders Favor Implementing Health Reform Law with Little or No Change

More than nine of 10 leaders in health and health care policy believe the Affordable Care Act sets the right course for health reform, according to a new survey. And despite wide differences of opinion in Congress, and varied levels of support among the general public, nearly seven of 10 (68%) experts favor implementing the law with little or no change, according to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, which asked respondents their views about priorities for the 112th Congress.

Few leaders surveyed expressed clear opposition to the law: only 9 percent believe the health reform law sets the wrong course for the nation; none said that the health system as it stands now requires no major changes.

Respondents voiced strong support for moving forward with all the major provisions of the law, note Commonwealth Fund researchers Kristof Stremikis, Stuart Guterman, and Karen Davis, in a new data brief on the survey findings. More than eight of 10 think it is important or very important to implement state-based health insurance exchanges (86%), the requirement that individuals purchase insurance coverage (84%), and the expansion of Medicaid to cover more lower-income individuals (82%). In addition, delivery system reform provisions including the Center for Medicare and Medicaid Innovation to develop and implement new payment and delivery system approaches (83%), the Patient-Centered Outcomes Research Institute to develop best practices in health care delivery and organization (79%), and the Independent Payment Advisory Board to help reduce the growth of Medicare spending (71%) received support from a large majority of experts.

"While health reform very much remains a work in progress, it is heartening to see broad support among health care leaders for the direction laid out in the Affordable Care Act," said brief coauthor and Commonwealth Fund President Karen Davis. "The law's major provisions for expanding coverage, creating new methods of payment, and encouraging integration and innovation are supported by leaders from a range of sectors—including academia, care delivery, business, and consumers. That sort of consensus is encouraging indeed."

Health care leaders were asked about their views on new payment methods to curb costs and promote efficiency. Nine of 10 leaders believe that improving care coordination for patients with chronic conditions will be effective. Other options that received substantial support include permanent increases in Medicare and Medicaid payments to primary care physicians (72%), aligning payment methods and rates across public and private payers (69%), and accelerating the implementation of bundled payment methods (66%). Few leaders believe allowing consumers to purchase insurance across state lines (38%) or expanding the use of health savings accounts (22%) will be effective in achieving a high performance health care system.

Reducing federal health spending can play an important role in helping to shrink the federal budget deficit. The survey asked respondents for their views on several proposed cost-reduction measures included in recent proposals, most notably from the National Commission on Fiscal Responsibility and Reform. Health care leaders surveyed support expanding successful cost-containment pilots included in the Affordable Care Act (81%) and extending Medicaid prescription drug rebates to individuals who are dually eligible for Medicare and Medicaid (61%). Few leaders support converting Medicaid into a block grant program for states (26%) or converting Medicare into a premium support or voucher program (22%).

The survey is the 24th in a series from The Commonwealth Fund, and the 16th conducted in partnership with the publication Modern Healthcare. Commentaries by David M. Cutler, the Otto Eckstein Professor of Applied Economics at Harvard University, and Gail Wilensky, a senior fellow at Project HOPE, appear in the February 21 issue of Modern Healthcare. The commentaries are also posted on the Fund's Web site, along with a Commission data brief discussing the survey findings. 

Methodology

The Commonwealth Fund/Modern HealthCare Health Care Opinion Leaders Survey was conducted online within the United States by Harris Interactive on behalf of The Commonwealth Fund between January 3, 2011, and February 1, 2011, among 1,311 opinion leaders in health policy and innovators in health care delivery and finance. The final sample included 203 respondents from four sectors: academic/research institutions, health care delivery, business/insurance/other health care industry, and government/labor/consumer advocacy, for a response rate of 15.5 percent. The complete methodology is available on The Commonwealth Fund Web site.

• News Release (26K PDF)

Feds Approve Minnesota Medicaid Expansion | StarTribune.com

Gov. Mark Dayton's plan to expand the state's Medicaid rolls by 95,000 people has been approved by federal authorities, his office said Thursday.

The move, which begins March 1, will provide health insurance to 12,000 low-income adults who previously were uninsured, and broader coverage at lower cost to another 83,000 who received care under two state-funded programs, MinnesotaCare and General Assistance Medical Care.

The savings from reducing caseloads in the two state programs will offset the additional state cost in Medicaid, state budget officials have said. Medicaid, known in Minnesota as Medical Assistance, is funded jointly by the state and federal governments.
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Important Medicaid Information for States: CMS' Virtual Meeting on Cost-...

Improvements to Medicare Health and Drug Plans

AARP Press Release

WASHINGTON—AARP today submitted comments on regulations proposed by the Centers for Medicare and Medicaid Services (CMS). Many of the proposed regulations for Medicare health and prescription drug plans could improve care, lower costs and simplify enrollment for people in Medicare.

AARP Legislative Policy Director David Certner, the author of the comments, said: “We applaud CMS for working to continually improve the Medicare plans that millions of seniors rely on. While we recommend several areas to strengthen these regulations, on the whole, they will simplify and improve the plans available to people in Medicare.”

Excerpts from AARP’s letter to CMS follow:

On simplifying election periods for Medicare health and drug plans: “AARP strongly supports efforts to simplify beneficiary enrollment for Parts C and D. However, AARP is concerned that this change could result in beneficiary confusion and/or missed enrollment opportunities unless it is widely and effectively promoted. Therefore, AARP urges CMS to work with plan sponsors and beneficiary advocates to develop a public education campaign that will help ensure that all beneficiaries are aware of the new dates for the annual coordinated election period. AARP further believes that Congress should put Medicare fee-for-service and MA on a level playing field by creating an open enrollment period that makes all Medigap products available without regard to health status or pre-existing conditions.”

On income-related Part D premiums: “AARP did not support imposing an income-related premium in the Medicare Part D program. AARP has concerns about the potentially adverse effect of the income related Part D premium on the Part D program and its enrollees…. Nevertheless, we commend CMS for its efforts to develop timely regulations to implement the ACA provision. We are particularly supportive of the proposal in the NPRM to give Medicare beneficiaries a 3-month grace period, and an extension of the grace period for good cause, to pay the Part D Income-Related Monthly Adjustment Amount before their coverage could be terminated.”

On eliminating Part D cost-sharing for “dual eligibles” receiving care at home: “AARP supports the promulgation of this provision, which will create equity in Part D cost-sharing between institutionalized full-benefit dual eligibles and full-benefit dual eligibles receiving substantially the same services in the community.”

On Medicare Advantage cost-sharing for covered preventive care: “AARP strongly supports requiring [MA plans], including section 1876 cost plans, to provide preventive benefits at zero cost-sharing. This measure would align policy for the MA program with the FFS Medicare requirements. It makes sense in terms of providing appropriate incentives to MA enrollees to obtain preventive services and should have the longer term effect of improving health outcomes for the Medicare population.”

To obtain a complete copy of AARP’s letter to CMS, please contact AARP Media Relations at 202-434-2560 or media@aarp.org.

Effort To Reward Medicare Advantage Plans Draws Criticism - Kaiser Health News

By Julie Appleby

Lake Wobegon has come to Medicare – and a key advisory panel doesn't like it.

The panel, the Medicare Payment Advisory Commission (MedPac), in a Jan. 6 letter does not mention the fictional Lake Wobegon, where all the children are above average. But it hints that not every Medicare Advantage insurer deserves to be above average.

The letter, to Dr. Donald Berwick, who heads the agency overseeing Medicare, criticizes a move to extend quality bonus payments meant for top-performing health insurers to those with lower scores. In fact, the new bonus program will reward even those plans highlighted on Medicare's own website as being poor performers over three consecutive years, according to the letter signed by MedPac Chairman Glenn Hackbarth.

The effort by the Centers for Medicare and Medicaid Services (CMS) will likely result in "far greater program costs" than the reward system called for by Congress in the health law and reduces insurers' incentive to achieve high performance, the letter concludes.

Full Article

Prostate CA Vaccine Stirs Interest, Lawsuits

By Charles Bankhead, Staff Writer, MedPage Today

For the second time in as many months, the Centers for Medicare and Medicaid Services (CMS) finds itself named in a lawsuit related to the agency's handling of the prostate cancer immunotherapy sipuleucel-T (Provenge).

Judicial Watch, a Washington-based public interest group, has sued HHS to gain access to documents related to the CMS decision to conduct a one-year national coverage analysis to assess whether the therapy is "reasonable and necessary," thus qualifying for Medicare coverage.

According to a Freedom of Information Act request filed in last November, Judicial Watch wants access to "all records concerning CMS' national coverage analysis of the vaccine Provenge, including but not limited to the criteria being used to analyze Provenge."

The legal action apparently has evolved from a suspicion that the national coverage analysis is the first step toward cost-based healthcare rationing.

In a statement posted on the Judicial Watch website, representatives of the organization noted that sipuleucel-T "costs $93,000 to administer the three necessary treatments. Medicare and the FDA are legally prohibited from denying approval of a medical treatment based solely on cost. Yet, multiple press reports suggest that cost is the major factor in the unusual decision by CMS to undertake a review of the treatment which could signal a move by the Obama administration to begin implementing healthcare rationing based on the cost of treatments."
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