D.C. Report: Health Policy Calendars Filled, Medicaid Quality Measures Finalized | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

D.C. Report: Health Policy Calendars Filled, Medicaid Quality Measures Finalized

January 11, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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Health Policy Watchers Fill Their 2012 Calendars

As is customary for the first week of any new year, we take a beautifully bland calendar and scribble in the first few markings of what will become a near unreadable mess. To help you jumpstart the process, several “dates to watch” came out this week from health policy observers, inside and outside the Beltway. First, the dates you missed:

  • Jan 1– Beginning the first of this year, 32 Pioneer ACOs went live and will begin accepting flat fee payments for all care related to a small group of Medicare patients.
  • Jan 6– Briefs were filed with the Supreme Court over the health reform law on three issues. The Obama administration argued that the individual mandate is constitutional; the opponents say that the whole law should fall if the mandate is invalid; and a court-appointed outside lawyer will argue that the Anti-Injunction Act should prevent a ruling on the mandate until it goes into effect.

Looking ahead:

  • Jan – Feb ?– Sometime in late January to early February it is expected that CMS and ONC will issue proposed rules for Meaningful Use Stage 2 and EHR Standards / Certification criteria for Stage 2. Final comments are expected to be due in March or April 2012 with a final rule around July.
  • Jan – Feb ?– Also expected in late January or February, ONC will publish a notice of proposed rulemaking (NPRM) for Nationwide Health Information Network Governance (NwHIN). It’s anticipated that, similar to MU Stage 2, a final rule will be published in mid-summer 2012. As part of the governance NPRM, could be regulations that speak to the use of Metadata to support health information exchange.
  • March 26– The Supreme Court hears oral arguments on the Affordable Care Act. After the Supreme Court hears the case in March, expect a decision by early summer.
  • Oct. 1– Beyond ACOs, two other regulations go live in the Fall that will have implications for how healthcare providers get paid. New “ value-based purchasing” policies start tying hospitals’ Medicare payments to performance metrics. Another regulation will cut hospital payments for patients that are readmitted for a complication that could have been prevented, a bid to reduce unnecessary medical errors that lead to higher costs.
  • Nov. 3– Election Day – As Harvard’s David Blumenthal wrote recently in the New England Journal of Medicine, 2012 will be a “watershed election for health care.” He points out that if Republicans take the presidency, they will have a mandate and the ability to repeal the ACA “and will probably do so.” However, it’s not likely that an all-encompassing repeal would happen. If Democrats retain the White House, meanwhile, it’s likely that much of the health reform law will be implemented.
  • Dec. 31– States have had about three years to lay the foundation for health insurance exchanges, the new marketplaces that will go live in 2014. States must have the Obama administration certify, by the end of this year, that they’ve made enough progress to launch in 2014. If not, the federal government will come in and do it themselves.

Quality Measures Finalized for Medicaid-Eligible Adults

Even as the whole health IT world waits with baited breath for the proposed Meaningful Use regulations, CMS was busy finalizing other regs with implications for CIOs. A set of 26 quality-of-care measures were released this week by CMS, meant to shed more light on how adult Medicaid recipients are cared for. Many of the core measures chosen for the program are currently used in other programs, including the Shared Savings Program and the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set. Looking ahead, HHS will develop a standardized format for states to report the data generated by the measures by January 2013, and by January 2014, HHS will include information on the status of adult healthcare quality based on the new measures in a report to Congress on the quality of care for children in Medicaid and CHIP. At this point, the program is voluntary, but CMS hopes that efforts to reduce the initial number of measures from the 51 to 26 will pay dividends. The agency said it also “will provide technical assistance as well as additional guidance and tools to increase the feasibility of voluntary reporting.”

Standards for Electronic Payments Released by CMS

Also out this week, CMS published an interim final rule specifying standards and content for the electronic fund transfers (EFT) in the health care industry. Under this interim final rule, CMS has categorized healthcare EFT as a HIPAA standard with the specific format developed by NACHA, an electronic payment association, in which dollars and payment travel separately. The rule implements provisions of the Affordable Care Act and is estimated to save physician practices and hospitals from $3 billion to $4.5 billion over 10 years. All HIPAA covered entities – including private and public health plans – must be compliant by January 1, 2014. The new regulation is the second in a series of five regulations that aim to “streamline health care administrative transactions, encourage greater use of standards by providers and make existing standards work more efficiently,” according to HHS. The first regulation, issued in July, put in place operating practices that will help providers determine a patient’s coverage eligibility and claims payment status.

Edited by Sharon Canner, Senior Director of Advocacy, CHIME


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