Posts Tagged ‘Kathleen Sebelius’

MedPAC Reissues 2012 Recommendations

January 14, 2013

Last week, the Medicare Payment Advisory Commission met to finalize its 2013 Medicare recommendations to Congress. MedPAC reiterated its 2012 recommendations including the following:

  • The Secretary of the U.S. Department of Health and Human Services, with the Office of Inspector General, should conduct medical review activities in the counties that show aberrant home health utilization. The Secretary should implement the new authorities to suspend payments and the enrollment of new providers if they indicate significant fraud.
  • The Congress should direct the Secretary to begin a two-year rebasing of home health rates and eliminate the market basket increase.
  • The Secretary should revise the home health case mix system to rely on patient characteristics to set payments for therapy and non-therapy services and should no longer use the number of therapy visits as a payment factor.
  • The Congress should direct the Secretary to establish a per-episode copayment for HH episodes that are not preceded by hospitalization or post acute care use. (more…)

Rollout Posted for Frail Elderly to Enter HMOs

January 14, 2013

By , Health News Florida

The region that includes Orlando and Melbourne will be the first in the state to enroll its frail elderly patients who are on Medicaid into managed-care plans, the Agency for Health Care Administration announced Monday.

map on AHCA’s website offers a guide as to which counties are included in the rollout, which hinges on approval by the U.S. Department of Health and Human Services for Florida’s requests for a waiver of federal law for its Statewide Medicaid Managed Care program. (more…)

Florida Senate President: Separate Medicaid Waiver from Obamacare

January 11, 2013

From POLITICOOne of the going theories about Florida Gov. Rick Scott’s meeting with Department of Health & Human Services Secretary Kathleen “two-terms” Sebelius on Monday was that his request for a Medicaid waiver had become intertwined with his willingness to cooperate on the Affordable Care Act. Well, the state’s Senate president, Republican Don Gaetz, wants it known that he rejects any such connection. “I believe that the approval of Florida’s request for federal waivers should not be linked to how the state addresses options under Obamacare. I believe those are separate issues,” he told POLITICO. “I believe that the waiver requests stand on their own merits and ought to be approved, and whether they are or are not approved would certainly not require us to take any particular action one way or another on the options available to Florida under PPACA.”

Gov. Scott Meets with HHS Chief Sebelius to Talk Health Care

January 8, 2013

U.S. Health and Human Services Secretary Kathleen Sebelius, here in a 2009 meeting about the H1N1 flu, met with Gov. Rick Scott on Monday to discuss how Florida can comply with the federal Affordable Care Act. Photo by Pete Souza.By James Call, The Florida Current

Gov. Rick Scott said he had a productive meeting with U.S. Health and Human Services Secretary Kathleen Sebelius on Monday in Washington. Scott is lobbying HHS to approve a plan to overhaul Medicaid in Florida and said he discussed his concerns about expanding Medicaid eligibility under the federal Affordable Care Act.

“We had a great conversation with Sec. Sebelius today about how we can improve cost, quality and access in health care,” Scott said in a prepared statement released by his office. “I also asked Sec. Sebelius to approve our state’s Statewide Medicaid Managed Care and long-term care proposals.” (more…)

AHCA Says Health Care to Cost Billions More

December 28, 2012

By Gary Fineout, Associated Press

The administration of Gov. Rick Scott now contends that the federal health care overhaul will cost state taxpayers billions more than estimates from just a few months ago.

Scott’s health care agency has drawn up dramatic new estimates that now prices the cost of implementing the overhaul — including expanding the state’s safety net health care program to thousands of Floridians currently ineligible — at nearly $26 billion over a 10 year period. (more…)

State’s Medicaid-Expansion Estimates Soar

December 21, 2012

By , Health News Florida

Gov. Rick Scott will be armed with new, far higher cost estimates for Medicaid expansion when he meets with Health and Human Services Secretary Kathleen Sebelius on Jan. 7.

Under the Affordable Care Act, approximately 1 million uninsured Floridians would be eligible for the joint federal/state program in 2014. The Supreme Court ruled in June that the Medicaid expansion was voluntary. (more…)

Feds Say No to Partial Medicaid Expansion

December 11, 2012

health-care-reform2Source: The News Service of Florida

TALLAHASSEE – Florida and other states will have to fully expand Medicaid eligibility if they want to tap into billions of dollars in extra money under the federal Affordable Care Act, Obama administration officials said Monday. (more…)

Obama Administration Moves Forward to Implement Health Care Law

November 21, 2012

The Obama administration moved forward to implement provisions in the health care law that would make it illegal for insurance companies to discriminate against people with pre-existing conditions. The provisions of the Affordable Care Act also would make it easier for consumers to compare health plans and employers to promote and encourage employee wellness.

“The Affordable Care Act is building a health insurance market that works for consumers,” said Health and Human Services Secretary Kathleen Sebelius. “Thanks to the health care law, no one will be discriminated against because of a pre-existing condition.”

“The Affordable Care Act recognizes that well-run, equitable workplace wellness programs allow workers to access services that can help them and their families lead healthier lives,” said Secretary of Labor Hilda L. Solis. “Employers, too, can benefit from reduced costs associated with a healthier workforce.”

The Obama administration issued: (more…)

People With Medicare Have More High Quality Choices

October 15, 2012

Health and Human Services Secretary Kathleen Sebelius announced late Friday that people with Medicare have more high quality choices and the performance of Medicare Advantage plans is improving. HHS also released the 2013 quality ratings for Medicare health and drug plans on the web-based Medicare Plan Finder. During Medicare Open Enrollment, people with Medicare can use the star ratings to compare the quality of health and drug plan options and select the plans that are the best value for their needs for 2013.

“In 2013, people with Medicare will have access to a wide range of plan choices, including more four and five star plans than ever before,” said Secretary Sebelius. (more…)

Congress Calling on CMS to Impose Temporary, Targeted Moratorium

October 5, 2012

Florida congressman joins call for moratorium

In light of ongoing reports of Medicare home health care fraud across the nation – including yesterday’s news that indictments were filed in Miami in a fraud case totaling more than $200 million in fraudulent claims – members of the U.S. House of Representatives are sending a letter to the U.S. Department of Health and Human Services calling for a targeted, temporary moratorium on new Medicare provider numbers “until better controls to prevent waste, fraud and abuse can be put in place.”

The letter does not specify what targeted areas would be subject to the moratorium, but Miami-Dade County is expected to be part of the discussion considering Medicare home health claims far exceed the national average.

The letter is spearheaded by U.S. Reps. James McGovern (D-MA) and Walter Jones (R-NC), indicating this is a bipartisan effort to crackdown on what is perceived as rampant Medicare fraud in targeted areas of the nation. The congressmen are calling on colleagues in Congress to cosign the letter, which is expected to be sent to HHS Secretary Kathleen Sebelius later this month.

HCAF, with The National Association for Home Care & Hospice and affiliated state home care associations, supports a temporary, targeted moratorium. The Patient Protection and Affordable Care Act, President Obama’s signature legislative achievement, gave HHS the authority to impose moratoriums in targeted areas with aberrant fraud, abuse and waste.

Yesterday, Congressman Ted Deutch (D-Boca Raton) became Florida’s first member of Congress to cosign the letter to Secretary Sebelius. HCAF appreciates Congressman Deutch’s leadership on this critical issue and is calling on the 24 other members of the congressional delegation to follow his lead and show their support for this initiative.

The full text of the letter to Secretary Sebelius is below:

Dear Secretary Sebelius,

With a rapidly aging population and a need to control costs, our country, now more than ever, has a demand for quality home health care services. There is, however, growing evidence of a rapid escalation in the home care marketplace, raising the prospect of providers who have a much greater interest in exploiting the Medicare program than in providing quality patient care.

A recent case of Medicare fraud, where a $375 million scheme was uncovered, multiple arrests were made and payment was suspended to 78 home health agencies, was only the latest example.

As a result of the fraudulent activity of a few, the home health community at large is seeing their reputation assaulted and their agencies subject to increasing regulatory burdens and payment reductions.

We applaud your leadership in bringing a renewed energy to anti-fraud task forces and enforcement, through the establishment of HEAT (Health Care Fraud Prevention and Enforcement Action Team) and the introduction of stiffer penalties for offenders. We also believe it is time that a focus equal to that now placed on enforcement is placed on prevention. Current efforts, such as pre-payment claims edits that have saved HHS $208 million, are a good start, but not enough. We respectfully, ask that you direct the Centers for Medicare and Medicaid Services (CMS) to use its authority to put a temporary and targeted moratorium on new home health agencies until better controls to prevent waste, fraud and abuse can be put in place. 

Both through the analysis of MEDPAC and CMS regional and state specific data, it is possible to identify areas to target, ideally where growth in numbers of agencies and utilization of the Medicare benefit has exceeded a certain baseline of growth or a ratio of population to the number of agencies. Putting in place such a temporary, targeted moratorium would provide HHS and CMS time to revisit and revise either the current home health Conditions of Participation or the “deemed” accrediting practices to put in place more rigorous upfront accounting for fiscal stability and program quality standards compliance. A targeted moratorium will send a strong signal that the Medicare program is serious about preventative and anti-fraud measures.

Although it is not the driving factor in calling for a moratorium, it should be noted that the cost savings potential of a moratorium is not insignificant. Data from MEDPAC and others indicate that oversupplied areas tend to push per capita utilization of the home health benefit beyond any reasonable expectation, even considering a region’s demographics. We owe it to both the taxpayers and Medicare beneficiaries to see that they receive only quality, necessary home health services.

Your attention to this matter is very much appreciated and we hope you will seriously consider action on this issue.