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Archive: March 2011

DOJ/FTC issue joint policy statement on ACO antitrust enforcement

Posted on March 31, 2011

The U.S. Department of Justice (DOJ) and the Federal Trade Commission (FTC) have issued a joint policy statement on how they will enforce U.S. antitrust law related to the new Accountable Care Organizations (ACO) created by the Affordable Care Act (ACA). The two agencies are soliciting public comment on the proposed policy statement, which would create an antitrust “safety zone” and provide expedited antitrust review for certain ACOs.

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CMS releases highly-anticipated rule on ACOs

Posted on March 31, 2011

The Centers for Medicare and Medicaid Services (CMS) have issued a notice of proposed rulemaking (NRPM) on Accountable Care Organizations (ACO). The proposed rule implements Section 3022 of the Affordable Care Act (ACA), which establishes certified ACOs as formal Medicare providers under the Medicare Shared Savings Program.

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Medicare Value-Based Purchasing Programs

Posted on March 30, 2011

To improve the quality of health care delivered to Medicare beneficiaries, the Centers for Medicare and Medicaid Services (CMS) has historically used its demonstration authority to test new delivery and payment models that incentivize providers to improve the quality of care they deliver. Congress has bolstered these initiatives through a series of laws designed to augment CMS’ authority to implement these programs on a broader scale. For example, as authorized under the Medicare Prescription Drug and Modernization Act of 2003 (MMA) and extended by the Deficit Reduction Act of 2005 (DRA), CMS provides a full annual payment update to hospitals that report on specific quality measures. Failure to participate results in a two percent decrease in the annual payment update. Similarly, as authorized by the Tax Relief and Health Care Act of 2006 (TRHCA) and extended by the Medicare Medicaid and SCHIP Extension Act of 2007 (MMSEA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS provides a bonus payment to physicians that report on specific quality measures.

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New Commonwealth brief examines effects of health reform provisions on persons with disabilities

Posted on March 28, 2011

The Commonwealth Fund has released its latest brief in the series Realizing Health Reform’s Potential. The brief, “The Essential Health Benefits Provisions of the Affordable Care Act: Implications for People with Disabilities,” examines the nondiscrimination provisions of the essential health benefits provisions of the Affordable Care Act (ACA) and discusses their implications for persons with disabilities. The brief is authored by frequent HealthReformGPS contributors Sara Rosenbaum, Joel Teitelbaum, and Katherine Hayes.

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GAO issues report examining alternatives to individual mandate

Posted on March 28, 2011

The U.S. Government Accountability Office (GAO) has issued a report that examines ways to encourage individuals to voluntarily obtain health insurance. GAO was asked by Congress to undertake the report due to the chance “…that legislative or judicial action could result in a change to, or elimination of, the mandate…” and the report is based on multiple interviews from experts regarding alternative approaches to the individual mandate to purchase health insurance under the Affordable Care Act (ACA).

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Editor’s Comment: One Year and Counting

Posted on March 23, 2011

March 23, 2011, marks the one-year anniversary of the Affordable Care Act, and the Administration’s first year implementation effort spans the full scope of the law. Major areas of implementation encompass the full range of reforms under the Act: improving performance in the private insurance and employer-sponsored health plan markets; strengthening Medicare, Medicaid and CHIP; improving health care access and building a stronger health workforce; improving health care quality and accountability; increasing investments in public health; strengthening health care fraud and abuse controls; and reforming federal policies applicable to tax-exempt hospitals.

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HHS announces new national quality strategy

Posted on March 22, 2011

The U.S. Department of Health and Human Services (HHS) has released the National Strategy for Quality Improvement in Health Care (National Quality Strategy). Created by the Affordabe Care Act (ACA), the National Quality Strategy seeks to improve the overall quality of health care in the U.S. by making it more reliable and patient-centered, as well as making it more affordable.

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Waivers for State Innovation

Posted on March 21, 2011

During the congressional debate over passage of the ACA, Members of Congress on both sides of the aisle expressed interest in allowing states to innovate through waivers of ACA requirements in order to avoid what some lawmakers and policy experts have perceived as a “one size fits all” approach to coverage and health care reform. ACA section 1332 establishes a new waiver program that allows the Secretaries of HHS and Treasury to waive certain provisions of the ACA in order to support state demonstrations. Section 1332 waivers — referred to in the law as “Waivers for State Innovation” — are available for plan years beginning on or after January 1, 2017.

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HHS Office of Inspector General’s Top Management and Performance Challenges for Fiscal Year 2010

Posted on March 18, 2011

The complexity and size of the U.S. health care system makes it susceptible to fraud and abuse in both the public and private insurance markets. According to the National Health Care Anti-Fraud Association (NHCAA), an estimated 3% of all health care spending is lost to fraud; government and law enforcement agencies have estimated fraud-related loses to be as high as 10% of annual health care expenditures. The financial ramifications of these fraudulent schemes are enormous to patients, providers and the federal government. Indeed, the U.S. Government Accountability Office (GAO) estimates that for 2010, Medicare alone had $48 billion in improper payments (underpayments and overpayments). In response to its findings, the GAO recommended that the Centers for Medicare and Medicaid Services find ways to address the vulnerabilities to improper payments and enhance program integrity.

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MACPAC releases first report to congress

Posted on March 17, 2011

The Medicaid and CHIP Payment and Access Commission (MACPAC), chaired by Diane Rowland, Executive Vice President of the Kaiser Family Foundation, has released its first report to Congress on the status of the country’s Medicaid and CHIP programs. Medicaid and CHIP together provide health coverage to more than 70 million low-income adults and children in the U.S. at a cost of approximately $415 billion annually.

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