The Centers for Medicaid & Medicare Services (CMS) has delayed the requirement that physicians revalidate their Medicare enrollment under the program integrity screening provisions of the Affordable Care Act. According to CMS, the revalidation effort, originally scheduled for March 23, 2013, will be pushed back through 2015. Physicians will be among the last to revalidate. Physicians who have already received revalidation notifications from Palmetto GBA should fill out the form and return it to Palmetto per the instructions in the notice. The revalidation requirement is necessitated by new screening criteria that were implemented this past March. Newly enrolling and revalidating providers will be placed in one of three screening categories representing the level of risk to the Medicare program. The level of risk will determine the degree of screening to be performed when processing the enrollment application. Do not do anything until you get a letter instructing you to revalidate. (This is very important to ensure an orderly enrollment process.) Physicians who are making changes (moving, closing practice, etc.) should continue to submit their changes as usual.

CMS is inviting medical societies and its physician members located within the CMS San Francisco Region to participate in a conference call with CMS Region IX on November 15, 2011, from 2 pm to 3 pm PST.  The call will cover Accountable Care Organizations (ACOs), Pre-Existing Condition Insurance Plan (PCIP), Medicare Provider Revalidation, Version 5010, and ICD-10. To access the conference, call (877) 267-1577 and enter meeting ID 2184. Questions? Please contact Neal Logue at (415) 744-3551.

The federal government has granted California permission to make further cuts to Medi-Cal, paving the way for other states to do the same. The Centers for Medicare & Medicaid Services (CMS) will allow the state to cut reimbursement rates by 10 percent this fiscal year for a variety of Medi-Cal providers, including physicians, pharmacists, and optometrists. The state Department of Health Care Services says it will not cut rates paid to pediatricians, home health providers or nursing homes. California Medical Association said Thursday his group will file suit asking the court to immediately block this latest round of Medi-Cal cuts. California, which already ranks among the nation's worst in Medicaid reimbursements, approved 10 percent rate cuts as part of the 2011-12 budget deal. The state initially faced a $26 billion deficit, which lawmakers and Brown resolved by a mix of cuts and an assumption that tax revenues would grow throughout the fiscal year. State leaders also approved mandatory co-payments for Medi-Cal patients, as well as a conditional cap on health care visits. Federal officials have yet to weigh in on those cuts. All told, Medi-Cal cuts add up to $1.7 billion, though not all require federal approval. Providers and patients filed suit against similar rate cuts in previous budgets. Federal courts blocked or reduced those reductions, but the U.S. Supreme Court this month heard arguments on whether outside groups had the legal right to challenge Medicaid cuts.

The U.S. House of Representatives today passed a bill (HR 674) that would eliminate a 3 percent tax withholding on Medicare payments that was created under the Tax Increase Prevention and Reconciliation Act of 2005. The provision, scheduled to take effect in January 2012, requires a mandatory 3 percent withholding from payments made by government agencies in an attempt to address tax noncompliance. Although programs with eligibility based on recipient income (e.g., Medicaid) would be exempt, programs with eligibility based on age (e.g., Medicare) would not be. The bill now heads to the U.S. Senate. The Senate must also pass this bill for it to become law. If this provision is allowed to take effect, the Internal Revenue Service would require Medicare contractors to withhold 3 percent of Medicare payments to physicians and other health care providers. The 3 percent payment cut would be in addition to any cuts brought on by the Medicare physician payment formula. The withholdings would then be applied to physicians’ tax obligations for the year. Any withholdings in excess of actual taxes due would be refunded after physicians file their tax returns the following spring. SFMS, CMA, and others in organized medicine have told Congress that this flawed provision is untenable in the current Medicare payment system. Not only is there a 20 percent gap between what Medicare pays physicians and the actual cost of providing care to physicians, but physicians are also facing a 30 percent cut on January 1 due to the broken sustainable growth rate (SGR) formula. See additional information in the Wall Street Journal article.

Federal officials gave negative assessments to more than 25 percent of Medicare’s rated prescription drug plans that will be available to seniors in 2012. The Centers for Medicare and Medicaid Services (CMS) is putting these plans on notice that, unless they take steps to improve their performance over the next few years, they face expulsion from Medicare. CMS this month revised the way it rates Medicare drug plans to focus more on quality, and many plans’ ratings fell from 2011 to 2012. The criteria changed to stress clinical outcomes, such as whether a patient takes his medication the way he is supposed to, in addition to process measures, such as how long a patient is kept on hold when calling the plan. In judging 2012 plans, CMS for the first time considered whether patients kept up with medications for diabetes, hypertension, and cholesterol, and it also considered complaints lodged against plans, and the numbers of people who choose to leave plans. While the new system labeled more plans as poor performers, CMS says this will likely lead to better options for the 28 million elderly and disabled beneficiaries who rely on those plans to help pay for their medications. Traditional Medicare does not cover most prescription drug costs for beneficiaries, but they can voluntarily buy private Medicare Part D drug plans. CMS rates the prescription plans according to a star system, with five stars indicating the highest quality and one star the lowest. That system is similar to ratings for the private Medicare Advantage health plans that about a quarter of seniors choose instead of traditional Medicare. Earlier this month, CMS proposed a new rule that would allow it to oust plans that score below three stars for three consecutive years. The rule would take effect in 2013, and would also allow CMS to terminate low-performing Medicare Advantage health plans on the same timetable. Nationally, of the 557 rated drug plans that will be available for next year, 24 percent get the top ratings of four or five stars, and about half fall in the middle with three stars. Another 28 percent score below three stars; only one comes in below two. Source: Kaiser Health News, October 26, 2011