Bill to Delay ICD-10 and Sustainable Growth Rate Patch Passes House

Advocates on behalf of hospitals and practitioners were optimistic about the likelihood of a permanent 'fix' to the Sustainable Growth Rate for Medicare's physician reimbursement system. Members in both the House and the Senate introduced bills this session that would repeal the Sustainable Growth Rate in Medicare's physician payment formula. 

In a surprise development today the House passed the Protecting Access to Medicare Act of 2014, H.R. 4302, by voice vote. This bill does not provide a permanent fix, only a one year patch to the Sustainable Growth Rate. The legislation, sponsored by Rep. Pitts of Pennsylvania, did not extend a fix for the SGR to physician-owned hospitals. Insiders agree that the cost of longer term bipartisan bills with permanent fixes to SGR were tabled because the parties were not able to agree on how to pay for the costs--about $140 billion over a 10 year period.  

Many on the hill expect the Senate to move this bill to a vote tonight. Speaker Harry Reid is said to be working on a deal to bring the bill to the floor. However, Senator Wyden is said to be pushing back on passing a bill with only a short term fix. Stakeholders following SGR legislation believe that if a temporary fix is passed the Congress will feel less pressure, and efforts to pass a permanent fix this year will fade into the background. 

The Protecting Access to Medicare Act of 2014 also contains a provision to delay the ICD-10 meaningful use requirements until October 2015. CMS Administrator Marilyn Tavenner has repeatedly stated that the agency was not going to extend the ICD-10 meaningful use requirements. Many eligible practitioners and hospitals are concerned about being able to meet the deadline and have publicly appealed to the agency and Congress to extend the compliance deadline. 

More than 10,000 Electronic Health Records at Risk in Data Breach

Service Coordination notified nearly 14,000 Maryland residents this month that their personal medical information may have been compromised. Service Coordination is a state-licensed nonprofit organization based in Frederick, Maryland, that works with Maryland residents with intellectual and developmental disabilities. Service Coordination is one of five organizations licensed to provide services by Maryland's Developmental Disabilities Administration. To date there have been no reports of breaches from the other four licensed organizations. 

The organization learned of the security breach in October of 2013, but delayed notifying affected individuals at the request of the U.S. Justice Department. The Justice Department requested the delay to allow time for an unhindered federal investigation. The investigation resulted in the identification of the alleged hacker and the seizure of the hacker's equipment and accounts. 

To date there is no evidence that the data has been released or used for nefarious purposes. Service Coordination spokesman, Michael Baisey, explained that the breach involved a single document that contained personal information for nearly 70% of the group's 13,900 clients. Service Coordination will assist clients and families with credit report checks and identity theft protection. 

Polls Show Number of Uninsured Adults Lowest Since Obama Took Office

The deadline to enroll on the new insurance exchanges is quickly approaching, with just three weeks remaining. The deadline seems to be spurring a dramatic up-tick in the number of adults enrolling in health insurance plans. Acording to the Gallup-Healthways Well-Being Index released Monday the number of Americans with no health insurance has dropped to the lowest levels since President Obama was sworn in. The index found that the percent of uninsured adults dropped from 17.1-percent in the last quarter of 2013 to 15.9-percent in 2014. Experts attribute the increasing number of insured adults to the insurance plans made available by the Affordable Care Act.

The increase in enrollment was found across all demographic groups examined by the index. Hoewver, enrollment throughout the Latino demographic lagged behind other demographic groups. This is notable because the Obama Administration is actively reaching out to the relatively young Hispanic community to encourage enrollment. 

A significant drop in the rate of uninsured adults occurred among African-Americans with a 2.6 percentage point decline. The rate declined 1percentage point among white adults, but only eight-tenths of a percentage point for Latinos. The largest drop in the uninsured rate was a 2.8 percentage point difference for households with an annual income of less than $36,000.

CMS Issues Guidance on Stage 2 Meaningful Use Hardship Exceptions

The Centers for Medicare and Medicaid Services (CMS) issued guidance on qualifying for the hardship exception from Stage 2 meaningful use requirements under the federal electronic health record incentive payment program. CMS has been under pressure by stakeholders and lawmakers alike to provide clarification about how to apply and what conditions qualified hospitals and eligible professionals for a hardship exemption

The guidance explains that CMS may grant hospitals and eligible professionals the hardship exception and grant an extension for meeting the Stage 2 meaningful use requirements if their electronic health record (EHR) vendor is at fault for their failure to meet the deadline. This expands on previous statements by CMS Administrator Marilyn Tavenner that the applications for exceptions would be evaluated on a case-by-case basis. 

The guidance specifically states that providers may apply for hardship exceptions if the "EHR vendor was unable to obtain 2014 certification" or the hospital or eligible professional "was unable to implement meaningful use due to 2014 EHR certification delays." If approved, the hardship exception is valid for a single payment year. In the event the application for exception is denied hospitals and eligible professionals may not appeal the decision and any denial is considered final.

The hardship exception application for hospitals is available here.

The hardship exception application for eligible professionals is available here. 

CMS Looks to Limit Estate Recovery Actions for New Medicaid Recipients

Commentators on both sides of the Affordable Care Act (ACA) debate have pointed out that lower-income Americans may be deterred from enrolling in the expanded Medicaid program because of the currently estate recovery actions are allowed. An estate recovery action is a legal collection method that allow states to recover the amount of payments for long-term Medicaid services from patients after their death to repay the state for the cost of their medical care. 

This practice stems from a 1993 federal law that requires states to recoup the costs spent on long-term Medicaid services from the estates of deceased recipients. The 1993 law also gives states the option of recovering all Medicaid costs incurred from the age of 55 until death, even if they are not related to long-term care. In practice this often results in states placing a lien on the deceased's home after being notified of the death. However, states generally try not to collect the debt immediately in instances where a surviving spouse or dependent is living in the home. 

Last week the Centers for Medicare and Medicaid Services (CMS) issued a letter to state medicaid directors providing guidance that seek to limit estate recovery actions for Medicaid recipients that qualify under the ACA's Medicaid expansion program. While the letter does not compel states to follow the conditions set forth in the letter, experts say it will likely serve as a deterrent for states considering estate recovery actions against expanded Medicaid recipients. 


More discussion on Medicaid Estate Recovery and the CMS letter can be found at the following sources:

•  Asbury Park Press, Feds: Don't try to bill new Medicaid recipients after their death.
• National Senior Citizens Law Center, MAGI Medicaid and Estate Recovery: CMS Issues State Medicaid Director Letter.
• Modern Healthcare, Reform Update: Medicaid estate-recovery law may hamper enrollment efforts.