WASHINGTON WIRE
September 8, 2006
Issue 110
In this issue, you'll find:
- McClellan Announces his Resignation from CMS
- CMS Announces Gainsharing Demonstration
- Medicare to Place Temporary Hold on Payments
- Medicare Issues New Wheelchair Coverage Policy
- Hearings
Top Story
McClellan Announces his Resignation from CMS
On
Tuesday, September 5, 2006, Mark McClellan, M.D., Ph.D. announced that
he would be resigning from the Centers for Medicare and Medicaid
Services (CMS) at the beginning of October, 2006.
Dr. McClellan became Administrator of CMS in March 2004. Before serving at CMS, he was the Food and Drug Administration (FDA) Commissioner and a member of the President's Council on Economic Advisers.
While Administrator, McClellan oversaw the implementation of the Medicare Modernization Act of 2003 (MMA) which created the new Part D prescription drug plan, effective earlier this year. While there have been many criticisms of Part D, McClellan maintains that beneficiaries are satisfied with the program and costs are lower than first predicted. McClellan is also credited for promoting quality incentives and pay-for-performance initiatives at CMS.
Due
to the short time remaining in the Congressional calendar, it is likely
that President Bush will appoint an acting director until the 110th
Congress convenes in 2007. Herb Kuhn, Director of the Center for
Medicare Management; Leslie Norwalk, Deputy CMS Administrator; and
Dennis Smith, Director of the Center for Medicaid and State Operations
are a few of the names that have been mentioned to replace McClellan.
Health Care News
CMS Announces Gainsharing Demonstration
On
Wednesday, September 6, 2006, the Centers for Medicare and Medicaid
Services (CMS) announced a new quality demonstration project for
gainsharing.
The Physician-Hospital Collaboration Demonstration (PHCD) project extends beyond the traditional "short-term" model of gainsharing. Under PHCD, hospitals would receive their standard Medicare payment for patient care but would be permitted to pay physicians a portion of the cost savings incurred, provided the hospital is able to document cost savings resulting from improvements in quality care and efficiency on the part of the physician.
Unlike traditional "short-term" gainsharing projects, CMS wants providers to track the long-term impact of gainsharing on patients. CMS will look for proposals from hospitals that show documented improvements in cost savings and improvement in care over a longer period. CMS would like hospitals to follow patients after they leave the hospital, examine the impact on the hospital-physician collaboration of patient care, and other quality improvements.
CMS
will give preference to proposals submitted by health care consortia
(physician groups and their hospitals) and plans to chose up to 72
hospitals to participate in the demonstration project. However, it is
uncertain if hospitals will choose to share profits with physicians
since hospitals will not bring in any additional funds besides their
regular reimbursement. The announcement will be in the September 11,
2006 Federal Register.
Medicare to Place Temporary Hold on Payments
The
Centers for Medicare and Medicaid Services (CMS) will hold payment for
Medicare claims submitted during the last nine days of the federal
fiscal year, September 22 through September 30, 2006.
The Deficit Reduction Act of 2005 (DRA) mandated that the payments be held until the new fiscal year as a savings mechanism. CMS will not pay any interest or late fees incurred during this period and claims submitted during those nine days will be processed on Monday, October 2, 2006.
More information can be found at www.cms.hhs.gov or through your fiscal intermediary/ Regional Home Health & Hospice Intermediary or carrier.
Medicare Issues New Wheelchair Coverage Policy
Stakeholders
in Medicare's mobility device benefit are expressing serious concern
with a recently released Local Coverage Determination (LCD) for power
mobility devices (PMDs) that they state will force individuals with
mobility impairments into low-functioning, and often unsafe devices.
In August, Medicare's regional carriers released a final LCD that will implement a new coverage criteria and a new set of billing codes and for power mobility devices. The new LCD is one of a series of steps the Centers for Medicare and Medicaid Services (CMS) has taken in its effort to restructure the mobility device benefit in the wake a of fraud and abuse activity.
However, stakeholders claim the new policy will lead to a systematic downcoding of mobility devices, unfairly restricting access to these devices for beneficiaries with legitimate mobility needs. In fact, they state that many beneficiaries will receive devices that are inappropriate and even unsafe for consistent use, especially outside of one's home. Consumer groups connect this new coverage policy to Medicare's long-standing "in the home" restriction on all mobility devices, under which Medicare will only provide beneficiaries with devices that are necessary for use inside their homes, rather than outside and in the community.
As
the October 1, 2006 implementation date nears, stakeholders are urging
CMS to reconsider and revise the policy, taking into consideration the
functional needs of individuals with mobility impairments, both inside
and outside of their homes.
Upcoming Events
Hearings
Tuesday, September 12, 2006
Ethics Concerns at the National Institutes of Health
House Energy and Commerce - Subcommittee on Oversight and Investigations
2 p.m., 2123 Rayburn Bldg
Wednesday, September 13, 2006
Managed Care
Senate Special Aging Committee
10 a.m., 562 Dirksen Bldg
Charitable Care and Community Benefits at Nonprofit Hospitals
Senate Finance Committee
10 a.m., 215 Dirksen Bldg.
Electronic Health Records
Steering Committee on Telehealth and Healthcare Information
News Conference/Briefing
Noon, 385 Russell Bldg.
Family Health Information Technology Act
House Government Reform - Subcommittee on Federal Workforce and Agency Organization
2 p.m., 2203 Rayburn Bldg.
Reviewing the Americans with Disabilities Act
House Judiciary - Subcommittee on Constitution
2 p.m., 2141 Rayburn Bldg.
For More Information
For further information on any topics discussed or publications listed, or to get copies of anything mentioned in this alert, please call (202) 466-6550 and ask for the Legislative Practice Group.
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