Saturday, May 19, 2012
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HHS Reveals New Details On Potential Federal Risk Adjustment Methodology

HHS officials during a recent meeting revealed additional details on the risk adjustment methodology the department may use when it operates the health law program in states, but cautioned attendees that its intentions are not final policy.

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Top Story

HHS Mum On States' Funding Responsibility In Partnership, Federal Exchanges

HHS has not specified if states might be responsible for ongoing exchange costs in situations where the federal government partners with a state on an insurance exchange or runs a federal exchange in lieu of a state exchange, an uncertainty that complicates decisions by states on which exchange model to pursue.

Latest News

IRS Punts On 'Families Glitch' In Final Premium Tax Regulation

The IRS on Friday revealed that it would issue future regulations detailing whether the family members of a worker whose employer offers health insurance benefits that meet the affordability threshold for self-only coverage would be eligible for advanced premium tax credits, punting on an issue that has received from key congressional Democrats and family advocates. An advocate, however, says that while the agency's regulations leave this issue open, the IRS appears to be “moving it the right direction.”

mHealth Regulatory Coalition, FDA Oppose Mobile App User Fee Measure

Companies developing mobile medical applications, FDA and other stakeholders have come out against a last-minute addition to the Senate user fee bill that would require an outside working group report to Congress on a proposed regulatory framework for health information technologies before FDA could issue final mobile medical application guidance. The mHealth Regulatory Coalition, Qualcomm and FDA all said on Friday that they do not support the Senate measure that they contend would put a de facto 18-month moratorium on FDA issuing long-awaited final guidance on mobile medical applications, and as a result would crush innovation and growth in this area.

CMS Rejects OIG's Call To Audit 1,700 Docs' E&M, Targets Top Billers

CMS says an Office of Inspector General proposal that the agency audit almost 1,700 physicians tagged by the OIG as billing evaluation and management services at consistently complex, and therefore expensive, levels, likely would not produce a high enough return on Medicare Audit Contractors' investment, and the agency instead has asked its contractors to target the top 10 billers in their jurisdictions.

CMS To Unveil E&M Comparative Billing Report In June, Eyes More Billing Reports

CMS will issue a comparative billing report June 4 addressing 5,000 providers' evaluation and management services, and the agency told the Office of the Inspector General that the report will include 1,700 physicians tagged in a recent OIG report as billing for the most complex, and therefore most expensive, E&M services more than 95 percent of the time. CMS conducted the comparative billing study instead of asking its contractors to conducts claims reviews of all 1,700 physicians, and may increasingly conduct such Medicare billing studies in other areas.

CMS Warns Part D Plans Not To Transfer Prescriptions Without Consent

At the urging of retail pharmacies, CMS sent a warning notice to all Part D plan sponsors reminding them not to transfer beneficiary prescriptions to plan pharmacies, which are often mail order pharmacies, without express written consent from the beneficiary.

Holtz-Eakin Latest To Criticize MA Star-Rating Bonus Demonstration

The Medicare Advantage star-rating program does not encourage plans to improve their performance, reduces the number of plans, steers plans toward standards that do not necessarily meet seniors' needs and hurts the poor, according to a report by the American Action Forum.

Consumer Groups Focus On Implantable Devices In Final User Fee Push

As FDA user fee bills head to the full House and Senate, consumer and safety advocates are focusing their lobbying efforts on convincing lawmakers to add provisions that would institute additional safeguards for implantable medical devices, including measures that would reduce the number of products cleared through the 510(k) process, while acknowledging that limiting the use of recalled devices as predicates for new device clearances is not likely to be included in user fee legislation.

Daschle, Franken Tout Diabetes Prevention Efforts, Stakeholders Seek Updated USPSTF Proposals

Former Senate Majority Leader and DLA Piper consultant Tom Daschle said Tuesday that diverting money from -- or fully repealing -- the health reform law's Prevention and Public Health trust fund to offset other spending is “extraordinarily shortsighted” and argued that efforts such as combating diabetes should rise above politics and be addressed regardless of the election or the fate of the health law.

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Focus on User Fees

Reid Seeks Swift Passage Of User Fee Bill Monday, White House Backs Measure

Senate Majority Leader Harry Reid (D-NV) is urging senators to be ready to quickly pass the FDA user fee legislation bill on Monday (May 21), warning that if he is forced to instead hold a cloture vote, debate on the bill could not begin until Wednesday (May 23).

GPhA To Pull User Fee Support If Pay-For-Delay Amendment Added

A Health Policy Blog

Industry blasts CA insurance rate ballot measure

Consumer Watchdog announced Friday (May 18) that it has collected 800,000 signatures necessary to put a measure that would grant the California state Insurance Commissioner . . .

Democrats' gray market probe expands to distributor of injectable drugs

A trio of top congressional Democrats on Friday (May 18) expanded their bicameral drug shortage investigation by seeking information on injectable drug sales by pharmaceutical . . .

Pro-innovation bio policy framework needed in U.S., PhRMA says

The pharmaceutical industry trade group says a new study detailing foreign countries' substantial investments in pro-innovation policies shows that those countries recognize the benefit of . . .

Health and consumer advocates call for retail food menu labeling

Health and consumer advocacy groups sent a letter to President Obama and First Lady Michelle Obama on urging the administration to revise proposed health reform . . .

Report: U.S. may fall behind in biomedical research, jobs if NIH funding cut

The United States could fall behind other countries, including China, France and Germany, in high-wage, high-skilled life sciences jobs if National Institutes of Health . . .

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