Baker Tilly healthcare update December 22, 2014

At the agencies

On December 11, the Centers for Medicare and Medicaid Services (CMS) released information regarding its plan for implementing a star ratings program for home health agencies (HHAs). Under the proposal, CMS will calculate a rating based on 10 of the 27 processes and outcome measures that HHAs already report to the agency. CMS plans to ask for input on the methodology and implement the ratings program in the summer of 2015.

On December 11, CMS released a proposed rule to revise its existing Medicare and Medicaid participating provider and supplier regulations to clarify that same-sex spouses need to be given equal treatment as opposite-sex spouses in situations where state law or the providers’ policies give certain rights or privileges to a patient’s opposite-sex spouse. The proposed rule was issued in light of the Supreme Court’s invalidation of certain provisions of the Defense of Marriage Act. The proposed rule would apply to nearly all hospitals, nursing homes, surgery centers, hospices, and mental health clinics that accept either program.

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released its semiannual Report to Congress on December 10. Most federal agencies release these reports in the spring and the fall of every year, in this case the HHS OIG released theirs a bit later. This document highlights the activities that the OIG has taken over the past year. According to the report, the OIG expects to recover $4.9 billion in healthcare dollars from investigations they conducted in fiscal year 2014.  The OIG also reported that it excluded over 4,000 individuals and entities from participation in federal healthcare programs and reported over 1,500 criminal and civil actions.

On December 9, CMS announced that it had awarded $36.3 million in funding mandated by the Affordable Care Act to over 1,100 health centers to reward those centers’ achievements in quality improvement and to invest in ongoing quality improvement activities. The awardees were selected based on their quality performance achievements in a variety of clinical measures and on the awardees’ use of electronic health records to report clinical quality measure data.

On December 8, HHS’s Office of the National Coordinator for Health Information Technology (ONC) released its “2015 – 2020 Federal Health IT Strategic Plan.” Under the plan, the ONC will expand use of health information technology and improve interoperability, care delivery, and research and innovation.  Public comments on the plan are due by February 6, 2015 and the ONC will release a final version of the plan later in 2015.

In the courts

On December 18, the United States District Court for the District of Columbia dismissed a lawsuit brought by the American Hospital Association (AHA) against HHS where the AHA had sought an order to compel the Department to process hospitals’ administrative appeals according to timelines set in statute. The Court said that the Department’s delay in processing the appeals was “not so egregious as to warrant intervention.”

Third parties

According to a report released by the Urban Institute, primary care physicians may have their Medicaid reimbursement cut by 43 percent after the Affordable Care Act’s primary care Medicaid fee bump expires on December 31, 2014. The Affordable Care Act included a mandatory two-year increase in Medicaid reimbursement for primary care services to match Medicare payment levels.

For more information on this topic, or to learn how Baker Tilly healthcare specialists can help, contact our team.