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February 4, 2013

Affordable Care Act “sunshine” rule increases transparency in health care

The Centers for Medicare & Medicaid Services (CMS) announced today a final rule that will increase public awareness of financial relationships between drug and device manufacturers and certain health care providers. Called the “National Physician Payment Transparency Program: Open Payments,” this is one of many steps in the Affordable Care Act designed to create greater transparency in the health care market.

“You should know when your doctor has a financial relationship with the companies that manufacture or supply the medicines or medical devices you may need,” said Peter Budetti, M.D. CMS deputy administrator for Program Integrity. “Disclosure of these relationships allows patients to have more informed discussions with their doctors.”

This rule finalizes the provisions that require manufacturers of drugs, devices, biologicals, and medical supplies covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) to report payments or other transfers of value they make to physicians and teaching hospitals to CMS. CMS will post that data to a public website. The final rule also requires manufacturers and group purchasing organizations (GPOs) to disclose to CMS physician ownership or investment interests.

This increased transparency is intended to help reduce the potential for conflicts of interest that physicians or teaching hospitals could face as a result of their relationships with manufacturers.

This new reporting will apply to applicable manufacturers and GPOs. These organizations, as well as the physicians and teaching hospitals, will have an opportunity to review and correct reported information prior to its publication.

In order to give applicable manufacturers and applicable GPOs sufficient time to prepare, data collection will begin on August 1, 2013. Applicable manufacturers and applicable GPOs will report the data for August through December of 2013 to CMS by March 31, 2014 and CMS will release the data on a public website by September 30, 2014. CMS is developing an electronic system to facilitate the reporting process.

The final rule can be downloaded at:

February 5, 2013

Reforms of regulatory requirements to save health care providers $676 million annually

Reforms to Medicare regulations identified as unnecessary, obsolete, or excessively burdensome on hospitals and health care providers would save nearly $676 million annually, and $3.4 billion over five years, through a rule proposed today by the Centers for Medicare & Medicaid services (CMS). The proposed rule supports President Obama’s call on federal agencies to modify, streamline regulations on business.

“We are committed to cutting the red tape for health care facilities, including rural providers,” said Health and Human Services Secretary Kathleen Sebelius. “By eliminating outdated or overly burdensome requirements, hospitals and health care professionals can focus on treating patients.”

The proposed rule is designed to help health care providers to operate more efficiently by getting rid of regulations that are out of date or no longer needed. Many of the rule’s provisions streamline the standards health care providers must meet in order to participate in the Medicare and Medicaid programs without jeopardizing beneficiary safety.

For example, a key provision reduces the burden on very small critical access hospitals, as well as rural health clinics and federally qualified health centers, by eliminating the requirement that a physician be held to an excessively prescriptive schedule for being onsite once every two weeks. This provision seeks to address the geographic barriers and remoteness of many rural facilities, and recognize telemedicine improvements and expansions that allow physicians to provide many types of care at lower costs, while maintaining high-quality care.

Among other provisions, the proposed rule would:

  • Save hospitals significant resources by permitting registered dietitians to order patient diets independently, which they are trained to do, without requiring the supervision or approval of a physician or other practitioner. This frees up time for physicians and other practitioners to care for patients.
  • Eliminate unnecessary requirements that ambulatory surgical centers must meet in order to provide radiological services that are an integral part of their surgical procedures, permitting them greater flexibility for physician supervision requirements.
  •  Permit trained nuclear medicine technicians in hospitals to prepare radio pharmaceuticals for nuclear medicine without the supervising physician or pharmacist constantly being present, which helps speed services to patients, particularly during off hours.
  • Eliminate a redundant data submission requirement and an unnecessary survey process for transplant centers while maintaining strong federal oversight.

As part of the President’s regulatory reform initiative, CMS issued final rules in May last year that also reduce burdensome or unnecessary regulations for hospitals and additional health care providers. Those rules are saving nearly $1.1 billion across the health care system in the first year and more than $5 billion over five years.

To view the proposed rule, please visit:

To view the May 2012 final rules, please visit:

February 1, 2013

Guidance on Preventive Services (Affordable Care Act Section 4106)

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the availability of new guidance today related to section 4106 of the Affordable Care Act, which establishes a one percentage point increase in the federal medical assistance percentage (FMAP) for certain preventive services.

Click here to read the State Medicaid Director letter.

January 31, 2013

Hundreds of Providers Selected to Participate in the Bundled Payments for Care Improvement Initiative

Today, the Centers for Medicare & Medicaid Services (CMS) announced that over 500 organizations will begin participating in the Bundled Payments for Care Improvement initiative. Through this new initiative, made possible by the Affordable Care Act, CMS will test how bundling payments for episodes of care can result in more coordinated care for beneficiaries and lower costs for Medicare.

“The objective of this initiative is to improve the quality of health care delivery for Medicare beneficiaries, while reducing program expenditures, by aligning the financial incentives of all providers,” said Acting Administrator Marilyn Tavenner.

The Bundled Payments for Care Improvement initiative includes four models of bundling payments, varying by the types of health care providers involved and the services included in the bundle.  Depending on the model type, CMS will bundle payments for services beneficiaries receive during an episode of care, encouraging hospitals, physicians, post-acute facilities, and other providers as applicable to work together to improve health outcomes and lower costs. Organizations of providers participating in the initiative will agree to provide CMS a discount from expected payments for the episode of care, and then the provider partners will work together to reduce readmissions, duplicative care, and complications to lower costs through improvement.

Today’s announcement includes the selection of 32 awardees in Model 1, who will begin testing bundled payments for acute care hospital stays as early as April 2013. In the coming weeks, CMS will also announce a second opportunity for providers to participate in Model 1, with an anticipated start date of early 2014.

Today’s announcement also marks the start of Phase 1 of Models 2, 3, and 4. In Phase 1 (January-July 2013), over 100 participants partnering with over 400 provider organizations, will receive new data from CMS on care patterns and engage in shared learning in how to improve care. Phase 1 participants are generally expected to become participants in Phase 2, in which approved participants opt to take on financial risk for episodes of care starting in July 2013, pending contract finalization and completion of CMS’ standard program integrity reviews.

To see the list of awardees for Model 1 and participants for Phase 1 of Models 2, 3, and 4 and, please go to:

January 31, 2013

Proposed Rules for Minimum Essential Coverage and Individual Shared Responsibility for Health Insurance Coverage

Yesterday, the Centers for Medicare & Medicaid Services (CMS) and the Internal Revenue Service (IRS) each issued proposed rules related to the Affordable Care Act’s shared responsibility provision and eligibility for exemptions from the provision.

Starting in 2014, the individual shared responsibility provision calls for each individual to have basic health insurance coverage, known as “minimum essential coverage”, qualify for an exemption, or make a shared responsibility payment when filing a federal income tax return.  The two rules outline the nine categories of individuals who are either entirely exempt from the requirement to maintain minimum essential coverage or who are exempt from the associated tax penalty.

The CMS proposed rule (CMS-9958-P) proposes eligibility standards related to the categories of exemptions that will be handled by the Exchange, a verification and eligibility determination process for these categories of exemptions, an option for State-based Exchanges to use a federally-managed service for conducting eligibility determinations for exemptions (instead of the Exchange handling this independently), procedures for addressing changes in eligibility for exemptions during a calendar year, Exchange reporting to IRS, and other supporting functions. In addition, this rule proposes that certain coverage be designated as minimum essential coverage by the Secretary, and outlines substantive and procedural requirements that other types of individual coverage must fulfill to be recognized as minimum essential coverage.

The CMS rule can be found here:

The IRS rule can be found here:

A fact sheet about these rules can be found here: