HIPAA

USDHHS announced proposed HIPAA rules on August 15 that would replace the ICD-9 diagnosis and procedure code sets with an ICD-10 system to provide better support to quality reporting, pay-for-performance, electronic health records, biosurveillance, and nationwide health information networks. The proposed rules would permit a transition period until October 2011 due to the need for changes in Medicare/Medicaid billing and reimbursement systems throughout the United States.

Tom Entrikin

Medicare Pay-for-Performance Demonstration

CMS announced on August 14 that its Medicare physician group practice pay-for-performance demonstration has shown improved quality of care for patients with congestive heart failure, coronary artery disease, and diabetes. It also showed a reduction in costs in 40 percent of the participating group practices. CMS paid $16.7 million in incentive payments for the improvements in quality and for a $17.4 million reduction in costs.  Participants in the demonstration attribute its success to better coordination of multidisciplinary teams supported by electronic health records.

Tom Entrikin

Tom Entrikin is a PCG manager and former Medicaid policy specialist with the U.S. Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS).

Senators Forced to Shelve Resolution Blocking Implementation of Restrictive SCHIP Directive Due to Parliamentarian Ruling

CMS issued a final rule in the August 13, 2008 Federal Register (73 Fed. Reg. 47075) requiring all long term care facilities to be equipped with sprinkler systems by 8/13/2013.  In a June press release, CMS announced its intention to issue the rule, stating that "(i)n the past, certain older facilities were exempt from having an automatic sprinkler system, but we now will hold all 16,000 nursing homes in the nation to this standard". To comply with the rule, facilities must have sprinkler coverage in all areas, including resident rooms; kitchen, dining, and activity areas; corridors; attics; canopies; overhangs; offices; waiting areas; closets; storage areas for trash and linen; and maintenance areas. "A 5-year phase-in period balances our dual goals of improved fire safety and feasibility," the final rule said.

Sam Fish

Medicare Part D Monthly Premiums Expected to Increase $3 in 2009

CMS announced on August 14 that the average expected premium for basic Medicare Part D coverage would increase by $3 in 2009.  The $3 increase means beneficiaries will pay about $28 per month for standard Part D coverage next year.  In its press release, CMS attributed the increase to general trends in drug costs, the phase-out of an agency demonstration project, and higher plan estimates for catastrophic coverage based on prior experience.

Sam Fish

Sam Fish is a legal consultant at PCG and formerly served as Chief Regional Counsel, New England Region, for the U.S. Department of Health and Human Services.