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Published 11/1/2018

Second Look – Advocacy

CMS looks to decrease administrative burden

A total of 170 medical groups, including AAOS, wrote a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma in support of the agency’s Patients Over Paperwork initiative. The letter notes that excessive evaluation and management (E/M) documentation requirements take time away from patient care and make locating medical information in patients’ records more difficult. However, the organizations raised concerns about a portion of the proposal that seeks to collapse payment rates for eight office visit services for new and established patients down to two each. The groups say this could have unintended consequences related to coding policies.

Elimination of ‘gag clause’
for pharmacists

The Senate passed a bill making it illegal for insurance companies to prevent pharmacists from telling patients when their prescriptions would cost less out of pocket than under their insurance plans. Representatives said getting rid of “gag clauses” will allow for more transparency in the pharmaceutical industry. The legislation pertains to all health insurance plans. On Sept. 4, the Senate passed legislation eliminating “gag clauses” for Medicare Part D drug plans. The House Commerce Committee previously approved similar legislation, but, currently, no vote is scheduled in the House of Representatives.

Medicaid spending in 2017

A report from CMS stated that Medicaid spending hit $592.2 billion in fiscal year 2017, up from $580.9 billion in 2016. Most of the funds went to traditional Medicaid beneficiaries, including children, people with disabilities, and frail individuals. Despite waivers that imposed work requirements and coverage lockouts, Medicaid spending is forecasted to grow an average of 5.7 percent each year for the next decade. By 2026, spending is expected to hit $1 trillion, with an enrollment of 82.3 million people.

Medicaid work requirements

The California Senate passed a bill that would ban work requirements related to Medicaid, as well as waivers that impose waiting periods, time limits, and coverage lockouts if beneficiaries do not pay premiums. If Gov. Jerry Brown signs the bill, California would be the first state to ban employment obligations for Medicaid recipients.

GAO input on reusable medical equipment

A report from the Government Accountability Office (GAO) called for more oversight of reusable medical equipment (RME) in the Department of Veterans Affairs (VA). Reprocessing RME includes cleaning, disinfecting or sterilizing, and storing the equipment between uses. GAO reiterated three recommendations it made in a previous report that highlighted issues including workforce needs and incomplete inspection reports. The VA said it concurred with and would implement the recommendations.

CMS proposes elimination of certain compliance measures

CMS proposed a new rule that would eliminate unnecessary and burdensome Medicare compliance requirements for healthcare facilities. Several of the proposals seek to simplify and streamline Medicare’s conditions of participation, conditions for coverage, and other requirements for participation by facilities, according to the agency. Some of the provisions of the rule include:

  • streamlining hospital outpatient and ambulatory surgical center requirements for conducting comprehensive medical histories and physical assessments
  • allowing multihospital systems to have unified and integrated Quality Assessment and Performance Improvement programs for all their member hospitals
  • simplifying the ordering process for portable X-rays and modernizing the personnel requirements for portable X-ray technologists
  • removing duplicative ownership disclosure requirements for Critical Access Hospitals