The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule.  HHS will announce a new compliance date moving forward.

“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius.  “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead.  We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10.  Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.
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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.

Last revised: February 16, 2012

Health and Human Services Secretary Kathleen Sebelius announced today that the Affordable Care Act provided approximately 54 million Americans with at least one new free preventive service in 2011 through their private health insurance plans. Secretary Sebelius also announced that an estimated 32.5 million people with Medicare received at least one free preventive benefit in 2011, including the new Annual Wellness Visit, since the health reform law was enacted.

Together, this means an estimated 86 million Americans were helped by health reform’s prevention coverage improvements. The new data were released in two new reports from HHS.

“Americans of all ages can now get the preventive services they need, like mammograms and the new Annual Wellness Visit, free of charge, as a result of the new health care law,” Secretary Sebelius said. “With more people taking advantage of these benefits, more lives can be saved, and costly, and often burdensome, diseases can be prevented or caught earlier.”

The Affordable Care Act requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults. The law also makes proven preventive services free for most people on Medicare.

The report on private health insurance coverage also examined the expansion of free preventive services in minority populations.  The results showed that an estimated 6.1 million Latinos, 5.5 million Blacks, 2.7 million Asian Americans and 300,000 Native Americans with private insurance received expanded preventive benefits coverage in 2011 as a result of the new health care law.

The report discussing Medicare preventive services found that more than 25.7 million Americans in traditional Medicare received free preventive services in 2011. The report also looked at Medicare Advantage plans and found that 9.3 million Americans – 97 percent of those in individual Medicare Advantage plans – were enrolled in a plan that offered free preventive services.  Assuming that people in Medicare Advantage plans utilized preventive services at the same rate as those with traditional Medicare, an estimated 32.5 million people benefited from Medicare’s coverage of prevention with no cost sharing.

The full report on expanded preventive benefits in private health insurance is available at http://aspe.hhs.gov/health/reports/2012/PreventiveServices/ib.shtml.  The report on expanded preventive benefits in Medicare and other ways that the Affordable Care Act strengthens Medicare is available at http://www.cms.gov/newsroom/.

The deal would avert a 27.4% Medicare payment cut to physicians after Feb. 29 and extend current payment rates through the end of 2012, according to a GOP aide.

“We are deeply disappointed that Congress has missed a unique opportunity to repeal the SGR once and for all and instead has chosen political expediency over patients,” Dr. Susan Turney, president and CEO of MGMA-ACMPE, formerly the Medical Group Management Association, said in a statement.

“Physician practices now face a mounting 35% payment threat from Medicare in 2013 and Congress has dug itself a $400 billion hole,” Turney’s statement continued. “Group practices are telling us that this congressional decision exacerbates an already unhealthy environment that limits their ability to plan for the future and balance their practice’s fiscal health with their desire to continue to serve Medicare beneficiaries.”

The deal also would extend certain Medicare programs—namely, ambulance add-on payments and outpatient hospital hold-harmless payments—but requires that the CMS, Government Accountability Office and Medicare Payment Advisory Commission report to Congress on the effectiveness of those programs. And two Medicare programs—Section 508 hospitals and special pathology payments—would be phased-out while providing time for providers to adapt. The agreement would also call for extending and reforming the therapy cap exception process by requiring greater accountability.

Meanwhile, about $11.6 billion in cuts to the Patient Protection and Affordable Care Act—including more than $4 billion in Medicaid spending reductions—would pay for more than half of the Medicare spending in the agreement.The healthcare savings that don’t come from the Affordable Care Act total $9.6 billion and include reductions to Medicare bad debt and clinical laboratory payments.

“The House and Senate conference committee agreement averts a 27% cut on March 1, but it represents a serious missed opportunity to permanently replace the flawed Medicare physician payment formula and protect access to care for military families and seniors,” Dr. Peter Carmel, president and CEO of the American Medical Association, said in a statement. “People outside of Washington question the logic of spending nearly $20 billion to postpone one cut for a higher cut next year, while increasing the cost of a permanent solution by about another $25 billion.”Read more: Doc associations rip Medicare pay deal – Healthcare business news and research | Modern Healthcare http://www.modernhealthcare.com/article/20120215/NEWS/302159974#ixzz1mYaqllq0
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Reuters: Obama’s ’13 Budget Plan Would Ramp Up Healthcare Savings
President Barack Obama on Monday proposed more aggressive deficit reductions through savings from Medicare, Medicaid and other federal healthcare programs than the White House put forward just five months ago. The president’s budget proposal for fiscal year 2013 seeks a total of $364 billion in healthcare savings over 10 years, which the White House hopes to achieve by cutting Medicare and Medicaid payments to healthcare providers, raising costs on future Medicare beneficiaries and cracking down on waste and fraud (Morgan, 2/13).

The Associated Press/Businessweek: Obama Sends FY2013 Budget Proposals To Congress
The projections in Obama’s budget show that he is doing little to restrain the surge in these programs expected in coming years with the retirement of baby boomers. Obama’s budget projects that Medicare spending will double over the coming decade from $478 billion this year to almost $1 trillion in 2022. Medicaid, the government health care program for the poor and disabled, would more than double from $255 billion this year to $589 billion by 2022. (Crutsinger, 2/13).

The Hill: Budget Includes Familiar Cuts To Medicare, Medicaid
President Obama’s budget proposal would require wealthy seniors to pay for a higher share of certain Medicare benefits. It would charge a co-pay for home healthcare services and put new limits on supplemental policies known as Medigap. … On Medicaid, the White House again proposed a streamlined funding system that states do not support. The plan would combine various rates of federal funding into a single percentage. States and budget analysts say that approach would simply shift costs to the states, rather than actually controlling the cost of Medicaid. Washington Gov. Christine Gregoire, a Democrat, said last year that the consolidated payment rates could be a “huge problem” for states (Baker, 2/13).

The New York Times: Republicans See Broken Promises and Gimmicks in Obama Budget
But Republicans weren’t waiting. Mitt Romney, the Republican presidential hopeful, simultaneously accused Mr. Obama of dodging the tough decisions that must be made on burgeoning entitlement programs like Social Security and Medicare and cutting Medicare benefits. … “The president has failed to offer a single serious idea to save Social Security and is the only president in modern history to cut Medicare benefits for seniors,” Mr. Romney added, referring to cuts largely to the private insurance side program, Medicare Advantage, that helped pay for the president’s health care law (Weisman, 2/13).

Politico Pro: Obama Budget Puts More Into Health Reform
CMS is one of the few health-related agencies to see a significant funding increase in the budget, released today. But even before the budget was officially released, Republicans promised to make it a fight. The CMS funding increase — of nearly $1 billion — would help the agency implement the health reform law. The budget also proposes payment reforms in Medicare and Medicaid, freezes NIH funding, and provides a small bump to the FDA, much of it in increased user fees. The budget also embraces a proposal from Sens. Ron Wyden (D-Ore.) and Scott Brown (R-Mass.) that allows states to implement their own health reforms in 2014 instead of 2017 (Haberkorn, 2/13).

The committee voted Monday to advance the bill (LB599), introduced by Campbell, to the full Legislature for debate. It would require the state Department of Health and Human Services to implement a program under the state Children’s Health Insurance Program for the unborn children of mothers who lost eligibility for Medicaid coverage in March 2010.

That includes unborn children of undocumented mothers.

Lincoln Sen. Amanda McGill said she would make the proposal her priority bill.

The committee vote was 5-1, with one senator present, not voting.

Voting yes were: Campbell of Lincoln, committee chairman; Mike Gloor of Grand Island, and Omaha senators Tanya Cook, Gwen Howard and Bob Krist.

Voting no was Sen. Dave Bloomfield of Hoskins. Sen. Paul Lambert of Plattsmouth was present, not voting.

Unborn children had never been included in Medicaid eligibility rules, but Nebraska HHS had, as a practice, included them. When federal workers learned that a couple of years ago, coverage stopped.

At the time, about 1,600 women lost coverage; half of them were in the country illegally.

Women who were citizens lost coverage because they had been sanctioned, for example, for not cooperating with child support requirements.

The bill would restore prenatal coverage July 1. It would cost about $6.4 million a year — $1.9 million in state general funds and $4.5 million in federal funds. That amount is based on coverage for about 4,700 women thought to be eligible, 3,100 of whom are undocumented.

Supporters of the bill have mounted an effort to have the bill addressed this session. About 150 people gathered this weekend for a candlelight vigil at Lincoln’s Christ United Methodist Church, urging the restoration of prenatal health coverage for low-income pregnant women.

They and health care providers for low-income pregnant women have said the lack of coverage can lead to a host of health issues for newborn babies, including increased risk of birth defects, low birth weight and slowed mental development. That can cost the state more in the long run, they said.

The burden for providing care for the women has shifted to providers.

Read more: http://journalstar.com/news/local/prenatal-coverage-bill-advances-from-committee/article_8791b55e-a1bf-52de-8db5-8a02a9e0b827.html#ixzz1mMt7gFqc

Bipartisan bill introduced to preserve rural health access

by Lindsey Corey on February 1, 2012

Today, Rep. Cathy McMorris Rodgers, R-Wash., and Rep. Mike Thompson, D-Calif., co-chairs of the Congressional Rural Health Coalition, introduced H.R. 3859, the Rural Hospital and Provider Equity (R-HOPE) Act of 2012.

This bipartisan bill would help rural communities across America protect and expand access to quality health care.

“The quality of health care you receive should not depend on whether you’re from a big city or small town,” Thompson said. “Ensuring everyone has access to high quality, affordable health care isn’t a Republican priority or Democrat priority – it is a national priority. That is why I am proud to be working across the aisle with Congresswoman McMorris Rodgers to make sure that rural America has access to health care.”

The National Rural Health Association endorsed today’s bill.

“We commend Congresswoman Cathy McMorris Rodgers and Congressman Mike Thompson for the introduction of the Rural Hospital and Provider Equity Act of 2012,” said NRHA CEO Alan Morgan. “This legislation will go far in ensuring rural providers have the necessary tools to provide quality care for all rural Americans. We encourage the passage of this vital legislation.”

Both McMorris Rodgers and Thompson were honored yesterday with NRHA’s Congressional Leadership Award during its 23rd annual Rural Health Policy Institute.

Peter was born four months early, which resulted in severe lung disease, she said. He stayed in the hospital his first 10 months and has been home about a year with his parents and brother.

The family has been fortunate, Nelson said, to receive home health care at night from a registered nurse so the parents can sleep. He would not have been able to come home without that care, she said.

With proposed cuts to Medicaid, which Peter receives with a waiver that enables severely disabled children to be cared for at home regardless of their relatives’ income, he could lose the services of nurses, she said.

She would not leave him alone with anyone but a doctor or nurse, she said, because his tracheostomy could become obstructed, his ventilator could need maintenance. And all that could require emergency reactions.

Cutting care for the most vulnerable people is going to cost more in the long term, Nelson said.

It was a familiar theme among the many who came to the Capitol on Monday to testify in front of the Appropriations Committee on the Department of Health and Human Services budget. Many also testified on a bill (LB952) that would prohibit cuts to the Medicaid program and one (LB901) that would designate money to fund the waiting list for people with developmental disabilities.

The hearings lasted more than six hours and people packed two hearing rooms. Many used wheelchairs and required medical equipment to breathe, eat and maintain their lives.

Medical administrators and caretakers also testified.

Vivianne Chaumont, director of the division of Medicaid and Long-Term Care, said the department has made a concerted effort to ensure Medicaid is sustainable. In 2011, the Medicaid and children health insurance program spent more than $1.57 billion to meet the needs of vulnerable Nebraskans, she said.

Between 2010 and 2011, the number of people served by Medicaid and CHIP increased by nearly 11,000 people. By December, the number of people eligible for the programs were more than 237,000.

Gov. Dave Heineman has recommended reductions of $3.4 million in general funds and $4.3 in federal funds for the Medicaid program for fiscal year 2013. He also has recommended reducing the children’s health insurance program.

Jody Faltys, 41, asked the committee to say no to the life-altering recommendations made by HHS regarding limits to home health care.

Her home health aides come in four times a day, to enable her to live like other able-bodied people. They help her get up, go to bed and get meals throughout the day. The proposed changes would reduce her to one visit a day.

“So which should that be? Should I get up in the morning and then stay up for 24 hours?” she asked.

At a news conference earlier in the day, Dr. M. Scott Applegate, president of the Nebraska chapter of the American Academy of Pediatrics, said cuts to Medicaid provider rates this year and in other years, has resulted in the inability for children and families to get the health care they need.

In Lincoln, about one in six pediatricians see Medicaid clients. When Medicaid patients can’t get in to see a pediatrician, they may see a family practice doctor or go to a hospital emergency department, at a much higher cost.

He and other providers were asking the Legislature to restore the 2.5 percent to provider rates that were cut this year.

John Cavanaugh, executive director of Building Bright Futures in Omaha, said that from his organization’s perspective, the lack of access to health care for kids results in the inability of students to perform successfully.

“We see too many low-income students without access to care,” he said. “So even on minor matters like immunizations, treatments for the common cold, they don’t have the care so they’re absent more days, and that impacts their performance.”

Many kids don’t get diagnosed with vision and hearing problems, he said.

That contributes to the dropout rate and failure rate among low-income students.

Proposed state Medicaid cuts and limitations

The state Department of Health and Human Services told senators this month that these proposed cuts in services and savings to Medicaid clients were being considered to go into effect on or before July 1.

* Limiting home health services to 240 hours per year, about 4.6 hours a week. This would affect about 166 clients for a savings to the state of $3.6 million. Only six of the clients are younger than 21.

* Eliminating nursing services for clients who need more individual and continuous care than is available from a visiting nurse. This would affect 341 clients for a savings of $9 million.

* Allowing personal assistance services only for those who meet nursing facility levels of care or participate in home and community-based services waivers. About 400 clients would lose eligibility for a savings of $1.1 million.

About 840 eligible clients would be limited to 60 hours per month, saving about $6 million.

* Eliminating oral nutritional supplements, not those used with a feeding device, such as formula and nutritional drinks such as Boost and Ensure. Nearly 4,500 clients could be affected, for a savings of $1.3 million.

* Limiting behavioral health therapy visits to 60 per year. About 226 clients, 84 who are younger than 21, would be affected for a savings of about $190,000.

In addition, if the federal budget crisis plays out and across-the-board cuts are made, the department would consider cuts to eight services or medical goods, such as dental services and dentures, eye glasses and hearing aids, and physical and speech therapy for adults.

It also could possibly limit coverage for prescription drugs, inpatient hospitalization for adults and physician visits for adults.
Read more: http://journalstar.com/news/local/committee-hears-pleas-against-proposed-medicaid-cuts/article_b0145aa7-87dc-5f25-827d-f01772a7da66.html#ixzz1l8k7ebik

University of Nebraska officials expressed concern Friday that it is falling behind other nearby states in investing in cancer treatment and research.

Glenn A. Fosdick, president and CEO of the Nebraska Medical Center, told NU regents that the state of Oklahoma has given the University of Oklahoma $90 million to expand cancer care and research and Kansas has committed $60 million to the University of Kansas for cancer care and treatment expansion.

“We are competing in a big market,” Fosdick said.

Last week, NU leaders asked the Legislature for $91 million for health research, treatment and education facilities and other purposes. NU leaders pitched a host of reasons for the request to regents on Friday, and the board later approved the resolution. The request includes:

* $50 million for a new cancer center in Omaha that would include a research tower, outpatient facility and inpatient cancer treatment center.

* $17 million for a new College of Nursing building in Lincoln.

* $19 million to expand the University of Nebraska Medical Center College of Nursing in Kearney.

* $5 million to plan a new Veterinary Diagnostic Center in Lincoln.

The university also plans to ask for an additional $50 million later to build the Veterinary Diagnostic Center.

The $91 million state investment would help spur a $441 million capital initiative, NU leaders have said. Of that, $300 million would come from private donations and other sources and would help pay for the cancer center at UNMC in Omaha.

Fosdick said cancer patients at the Nebraska Medical Center provide most of the hospital’s revenue and it will be important to continue to attract those patients. The $370 million cancer center in Omaha likely would allow the university to win status as a National Cancer Institute comprehensive cancer center, placing the university hospital among 40 such centers in the country.

Meanwhile, Juliann Sebastian, dean of the College of Nursing at UNMC, said the college turned away more than 400 qualified nursing applicants at its five divisions in the state last year because of lack of space. Nebraska’s shortage of registered nurses is expected to more than double by 2020, with rural areas hardest hit, according to UNMC.

Mike Flood, speaker of the Legislature, told regents state senators would seriously consider the university’s request but made no promises. He said the state is expecting to see greater revenues than expenses and senators are “looking at a number of opportunities.”

The late February revenue forecast will be important in helping senators decide where to spend money, he said. At the same time, Gov. Dave Heineman is seeking significant tax cuts this legislative session, Flood said.

Regent Howard Hawks of Omaha said he was concerned legislators may slash too many taxes that could lead to future revenue shortfalls.

“We’ve seen great things happen, especially at the university, and we’re going to take that into account,” Flood said.

In other business Friday, NU regents elected new officers, and the board’s two Lincoln regents will take the top two spots.

Regent Tim Clare of Lincoln will replace Regent Jim McClurg of Lincoln as vice chairman, while McClurg will replace Bob Whitehouse of Papillion as board chairman.