Government News
of the Week:

5. CMS issued a proposed rule June 25 to implement reform-law provisions seeking to expand Medicare preventive services, improve payments for primary care services and promote health care access in rural areas. The proposals on Medicare payment policies and rates, which apply to services starting Jan. 1, 2011, would eliminate out-of-pocket beneficiary costs for most preventive services, including a new annual wellness visit. The proposed rule also calls for the inclusion of midlevel practitioners in incentive bonus payments for Medicare primary care services. 

“The main thing is every time they gave [financial] bonuses to primary care practitioners, they excluded nurse practitioners. Now they’re not doing that….So it really helps people have access to us,” Jan Towers, director of health policy for the American Academy of Nurse Practitioners, tells HRW. She estimates that more than 75% of the nation’s 140,000-plus nurse practitioners are Medicare providers. 

“The expansion also includes a lot of health promotion and disease prevention that heretofore has not been a part of the Medicare payment system…which clearly helps patients [to] access primary care a lot more easily,” she says. Towers contends that the new annual wellness visit for Medicare beneficiaries that’s included in the reform law will “get more people into the stream earlier.” 

According to CMS, the proposed rule will: 

• Improve access to primary care services. This would be done by implementing an incentive payment system for such services provided by primary care practitioners, including physicians, nurse practitioners, clinical nurse specialists and physician assistants. The proposal also calls for a payment incentive program for general surgeons who perform major surgery in designated Health Professional Shortage Areas, and would let physician assistants order extended care services in skilled nursing facilities after a beneficiary’s hospital stay. It also would pay certified nurse midwives for their services at the same rate as physicians under the Medicare fee schedule. 

Lorrie Kaplan, executive director of the American College of Nurse-Midwives, describes the proposed new parity in Medicare payments to nurse-midwives and physicians as “extremely” significant. “We’ve been [Medicare] providers since the late ’80s, but at 65% of the Medicare fee schedule, which has really made it difficult…so [payment parity] is a great benefit to improving access to midwifery care.” She adds that many insurers follow Medicare payment rules, so the payment change should result in better midwifery pay across-the-board. u

• Improve the accuracy of physician payment rates. This would be done by implementing reform mandates to identify services in categories at major risk for inaccurate payment. 
• Further reduce payments in 2011 for diagnostic imaging equipment used in diagnostic computed tomography and magnetic resonance imaging services. CMS also proposes requiring physicians who self-refer beneficiaries to CT, MRI and positron emission tomography (PET) services in their offices under an exception to the general physician self-referral prohibition to notify patients in writing at the time of the referral that they may get the same services from others in the area and to furnish a list of 10 alternate supplies within a 25-mile radius. 

The proposed rule is scheduled to be published July 13 in the Federal Register. CMS will accept public comments until Aug. 24, and expects to issue a final rule around Nov. 1.

View CMS’s fact sheet on the proposed rule, under the June 25 entry, at www.cms.gov/apps/media/fact_sheets.asp.

7. The Florida Agency for Health Care Administration will hold several public hearings before filing a request with CMS to continue the state’s controversial Medicaid managed care pilot program. The pilot covers about 260,000 Medicaid recipients in Baker, Broward, Clay, Duval and Nassau counties and is set to expire on June 30, 2011. Despite spending much of the 2010 legislative session discussing ways to overhaul the state’s Medicaid program, the Florida Senate and House were unable to agree on a plan. They did, though, pass a bill requiring AHCA to file a three-year extension for the program with CMS by July 1.