August/September 2013

WK Health Law Daily

Every day, the WK Health Law Daily features the latest news involving Medicare, Medicaid, health care reform, health care compliance, fraud and abuse, food and drug law developments, and many more health care reimbursement, compliance, and life science topics. The Daily is delivered via email to the customer’s desktop or laptop computer, tablet, or smart phone. News stories include links to full text documents: cases, administrative decisions, regulations, new laws, and more. Past daily releases are also available on IntelliConnect, which makes it easy to search for specific topics that we have covered in this dynamic new service.

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Make sure to tell all current customers as well as prospects to bookmark the Wolters Kluwer Law & Business Health Law web site and blog: Here are examples of some of the stories that first appeared on the blog this past month

Large Employers Project 7 Percent Increase in Health Care Benefit Costs in 2014.For the third year in a row, the cost of providing employee health care benefits is expected to increase 7 percent at the largest employers in the United States. The National Business Group on Health surveyed responses from 108 of the country’s largest employers to look at costs and plan design changes for 2014. The survey was conducted based on the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) before the Obama administration announced its decision to delay the employer mandate by one year; the impact of the delay on employers’ projected budgets is unknown.

OIG to Determine If CMS Awarded DMEPOS Contracts to Unlicensed Suppliers.Daniel R. Levinson, Inspector General of the HHS Office of Inspector General (OIG) has responded to a request by Congressmen Glenn Thompson (R-Penn.) and Bruce Braley (D-Iowa) that the OIG investigate whether CMS has awarded contracts to unlicensed Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) companies in an attempt to set a predetermined price point for DMEPOS categorized products. According to the Congressmen, awards to unlicensed suppliers run contrary to the eligibility rules established by CMS, which provides that such bids will be disqualified. Additionally, the Congressmen are concerned that the inclusion of unqualified bids will lead to a significant distortion of the bid prices which should require that CMS undertake an immediate review of all legal and valid bid submissions and adjust the bid prices accordingly.

Nursing Homes Using Fewer Antipsychotic Drugs, Study Finds.Nursing home use of antipsychotics is on the decline, according to new data released on Nursing Home Compare in July by CMS. Instead, nursing homes are concentrating on a more patient-centered approach to dementia and other behavioral health care as part of a nation-wide effort to improve dementia care in the past year. Unnecessary antipsychotic drug use poses a significant challenge to nursing homes when treating patients diagnosed with dementia. According to CMS, in 2010, more than 17 percent of nursing home patients had daily doses exceeding recommended levels, and the number was increasing.

Employee Wellness Progams May Be Key to Cost Control.Employer-sponsored family health care annual premiums increased just 4 percent in 2013, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2013 Employer Health Benefits Survey. This is the second straight year where the increase was less than the year before. The 2012 increase was 4.5 percent, which was less than half of the 9.5 percent rise in 2011. In fact, the 2013 premium increase was the second lowest since Kaiser/HRET began conducting the survey in 1999. At that time, increases of more than 9 percent a year were common. Over the last 10 years, the average premium for family coverage has increased 80 percent, which is almost three times as fast as wages (31 percent) and inflation (27 percent). One of the keys to slowing that increase may just be employee wellness programs, as many large companies are finding them very successful as a means of controlling costs.

Hospitals Merging at Fastest Rate Since 1990s.The biggest wave of hospital mergers since the 1990s has hospitals merging faster and in greater numbers than they have in years. In 2009, there were 50 merger deals; that number more than doubled to 105 in 2012. A consulting firm predicts that 20 percent of the hospitals in the United States may seek mergers in the next five to seven years. The rapid mergers are creating large super-regional hospital systems, which may result in higher health care costs. Larger hospital systems damage the ability of smaller and independent hospitals to compete. A large system has more negotiating clout with insurers; higher insurance premiums, co-pays, and out-of-pocket expenses may result for patients while the hospitals maintain profits.

Wisconsin Funeral Director Charged with Medicaid Fraud.A Wisconsin funeral director is charged with Medicaid fraud, forgery, and other charges related to a scheme to submit fraudulent claims for funeral expenses to the Wisconsin medicaid agency, according to a news release by the Wisconsin Department of Justice and Attorney General J.B. Van Hollen.

Employers Prepare to Make PPACA-Related Changes to Employee Health Plans.Although the vast majority of midsize and large companies responding to a survey by Towers Watson see subsidized health care benefits for their employees as an important part of employee compensation, most of these employers also see making changes to their health benefits plans by 2016 as a result of implementation of the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148).

Attorneys General for 13 States Raise Concerns Regarding Exchange Navigators.The Attorneys General of West Virginia, Louisiana, Alabama, Michigan, Florida, Montana, Georgia, Nebraska, Kansas, North Dakota, Oklahoma, Texas and South Carolina joined together to send a letter to HHS Secretary Kathleen Sebelius, raising their concerns with the data privacy risks they see in the health insurance exchange enrollment assistance programs. Health insurance exchanges begin enrollment on October 1, 2013, and HHS has also announced a number of “Navigators” receiving grants from HHS to help consumers choose the option that is best for them. The Attorneys General requested a response from Sebelius by August 28, 2013.

Florida Hospitals Find Collaboration on Quality Efforts Saves Lives.A collaborative effort by Florida hospitals led to significant improvements in patient outcomes according to five of the quality measures that affect hospital reimbursement. The Florida Hospital Association reported that participating hospitals reduced complications of surgery and infections of blood stream and urinary tract. Hospital readmissions within 15 days of discharge dropped by 15 percent in two years.

Does Meaningful Use Matter to Consumers?HHS officials recently reported to Congress on advancements in meaningful use adoption by health care providers. Meaningful use of electronic medical records (EMRs) is intended to make health care more efficient, transparent, and educational for consumers. But are consumers getting the message? A study recently published by aeffect and 88/Brand Partners suggests the answer is maybe–kind of.

CMS Requests Comments on Best Ways to Release Physicians’ Medicare Payment Data.In the wake of a May decision by a Florida district court lifting a 33-year-old “permanent” injunction that had forbidden HHS from disclosing Medicare reimbursement amounts for individual physicians, CMS on August 6, 2013 announced it was seeking public input on “the most appropriate policy” regarding release of physician payment data.

CMS Outlines New Payment Methodology for DSH and Uncompensated Care Payments.The way hospitals will be paid their disproportionate share hospital (DSH) payments will change beginning on October 1, 2013, the start of fiscal year (FY) 2014, according to the inpatient hospital prospective payment system Final rule released August 2. The changes were mandated by section 3133 of the Patient Protection and Affordable Care Act (PPACA)(P.L. 111-148), as amended by section 1104 of the Health Care and Education Reconciliation Act (P.L. 111-152), as a way to achieve savings for the federal government from the reductions in the number of uninsured. CMS has determined that if hospitals are treating fewer uninsured as a result of the policies of PPACA, then the amount of extra payments that hospitals receive to treat the uninsured also should be reduced. It is expected that hospitals will make up any lost revenue from a change in their DSH payment from insurance providers who will be paying for the care of more people.