Legislative Activity

This Week’s Hearings:

  • Wednesday, June 10: The House Committee on Ways and Means will hold a hearing titled “Obamacare Implementation and the Department of Health and Human Services FY 2016 Budget Request.”
  • Wednesday, June 10: The House Committee on Veterans’ Affairs Subcommittee on Oversight and Investigations will hold a hearing titled “Prescription Mismanagement and the Risk of Veteran Suicide.”
  • Wednesday, June 10: The Senate Committee on Health, Education, Labor, and Pensions (HELP) will hold a hearing titled “Health Information Exchange: A Path Towards Improving the Quality and Value of Health Care for Patients.”
  • Thursday, June 11: The House Committee on Energy and Commerce Subcommittee on Health will hold a hearing titled “Examining H.R. 1786, James Zadroga 9/11 Health and Compensation Reauthorization Act.”

Regulatory Activity

CMS Releases Payment Data for Hospitals and Physicians

On Monday, June 1, the Centers for Medicare and Medicaid Services (CMS) posted its third annual release of Medicare hospital utilization data and its second annual release of physician and other supplier utilization and payment data. The release of the data, collected during 2013, is part of CMS’s larger endeavor to make spending more public and transparent. The agency is working on initiatives to increase quality over quantity in health care services, in order to produce smarter spending and healthier individuals.

The data illustrates that the charges of the most common hospital services continued to grow at a modest rate in 2013. It also shows that over 950,000 providers received a collective total of $90 billion in Medicare payments.

Second Week of ICD-10 Testing Declared a Success

On Tuesday, June 2, CMS released the results of the second week of end-to-end testing of the tenth edition of the International Classification of Diseases (ICD-10) and declared it a success. ICD-10 is set to become the coding system of the United States on October 1.

During the test period, from April 27 through May 1, CMS received 23,138 test claims. Of these claims, 88 percent were accepted and two percent were rejected due to invalid submission of an ICD-10 diagnosis or procedure code. This marks an improvement from CMS’s first week of end-to-end testing in January, during which 81 percent of claims were successfully processed through the agency’s billing system.

CMS stated that the testing demonstrates that CMS systems are ready to accept ICD-10 claims. The final end-to-end testing week is scheduled for July.

CMS Issues Final Rule on ACOs

On Thursday, June 4, CMS released a final rule titled “Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations.” This rule addresses changes to Accountable Care Organizations (ACOs) that participate in the Medicare Shared Savings Program (MSSP) and follows proposed regulations, which the agency released in December 2014.

This rule includes provisions which would encourage greater ACO participation in risk-based models, streamline data sharing between CMS and ACOs, and revise the beneficiary assignment algorithm. Of note, the rule finalizes that ACOs will not be required to move to two-sided risk during the second three-year contracting period. Currently, the majority of MSSP ACOs are one-sided, meaning that they may qualify for savings but are not responsible for losses. CMS backed away from its previous proposal to require ACOs to move to two-sided risk, and thus be accountable for both savings and losses, during the second contracting period.

This rule is scheduled for publication in the Federal Register on June 9.