The ACA regulators came out with FAQ XV yesterday which included a bit of a bombshell. Many years ago, the FEHB Act, 5 U.S.C. § 8902(m)(2), established a medically underserved areas policy. OPM’s web site explains that
If you live in a medically underserved area and are enrolled in a fee-for-service plan, your plan must pay benefits up to its contractual limits, for covered health services provided by any medical practitioner properly licensed under applicable State law. Each year, before the FEHB open season begins, OPM determines which states qualify as medically underserved areas for the next calendar year. OPM announces the results of this determination before each open season in a public notice in the Federal Register. The medically underserved areas are listed in each fee-for-service plan’s brochure and on OPM’s Plan Information page.
Well, a new ACA provision, Public Health Service Act § 2706(a), extends this sensible FEHBP policy to all states whether or not medically underserved according to FAQ XV, Q&A 2. The one difference is that “nothing in PHS Act section 2706(a) prevents “a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.” That caveat may be helpful to fee for service plans. (The FAQs announced that there will be no implementing regulation for this provision.) Nevertheless. The chiropractor community is overjoyed — see here and here. Cost curve up.
HHS’s Centers for Medicare and Medicaid Services is proposing to increase Medicare Part A payments to hospitals by 0.8% for the federal fiscal year that begins on October 1, 2014. CMS also is proposing changes to its hospital readmissions control program:
CMS currently assesses hospitals’ readmission penalties using three readmissions measures endorsed by the National Qualify Forum (NQF): heart attack, heart failure, and pneumonia. For FY 2014, CMS proposes a revised methodology to take into account planned readmissions for these three existing readmissions measures. CMS also proposes to add two new readmission measures, which would be used to calculate readmission penalties beginning for FY 2015: readmissions for hip/knee arthroplasty and chronic obstructive pulmonary disease.
Furthermore, CMS explained that
Section 3008 of the Affordable Care Act required CMS to establish a financial incentive for IPPS hospitals to improve patient safety by imposing financial penalties on hospitals that perform poorly with regard to hospital-acquired conditions (HACs). HACs are conditions that patients did not have when they were admitted to the hospital, but that developed during the hospital stay. This proposed rule outlines a general framework for the HAC Reduction Program for the FY 2015 implementation.
Under this program, hospitals that rank in the lowest-performing quartile of hospital acquired conditions would be paid 99 percent of what they would otherwise be paid under the IPPS beginning in FY 2015. To determine this quartile, CMS is proposing quality measures and a scoring methodology as well as a process for hospitals to review and correct their data.
On a related note, Kaiser Health News reports that efforts to coordinate healthcare still have a long way to go. Based on recent personal experience the FEHBlog agrees.
Finally, HHS’s Office for Civil Rights has posted a variety of guidance materials for consumers about the HIPAA Privacy and Security Rules here.