Pre-Thanksgiving News Round Up

Good afternoon!  OPGA Government Relations presented at the Mississippi/Alabama O&P Owners and Managers meeting last week. It was great meeting independent O&P owners that understand the changing regulatory landscape and are passionate about standing up for our profession. I wanted to post some of the important stories and issues that have been in the news that last few days.

CMS Behind Schedule on High-Tech Fraud System — CMS has missed several key deadlines on implementing their new “predictive modeling” fraud detection system.  Despite rolling out the new program in July and spending nearly $80 million, the new system still does not interface with current claims or payment processing data. CMS now says that will be ready by January 1st, 2013.  Read the report here.  

CMS Delay’s State Health Exchange Deadline, Again — CMS has now twice delayed the deadline for states to submit their intentions and plan on the development of state health insurance exchanges as mandated by PPACA (Obamacare). The initial deadline of November 16th proved difficult for many states to make a decision with many waiting until after the Presidential election before moving forward. In moving the deadline, CMS is hoping more states will choose to create their own exchanges, rather than choosing to have the federal government create one for them.  Many governors and insurance commissioners are asking for additional guidance on the creation of the exchanges, as well as the essential health benefits package (minimum insurance plan that can be sold on the exchanged). 

Appeals Court Sides with CMS Contractor on Lawsuit — The U.S. Court of Appeals for the Third Circuit has rebuffed a former DMEPOS provider who fought an audit and won, then filed a $10 million lawsuit against the CMS contractor that conducted the audit. Dominic Rotella, the owner of Nichole Medical Equipment, which was improperly audited by TriCenturion and subsequently went out of business, says the outcome of the case threatens not only the HME industry, but any industry that contracts with CMS. “This is no longer about TriCenturion and Nichole Medical, or about auditors,” Rotella said. “This is about whether or not we want to give CMS absolute, total power to do whatever they want, without fear of civil litigation.” Read more from HME News

Election Drives Activity on State Health Exchanges — Throughout the summer and fall many state insurance commissioners and governors tabled discussions of creating state based health insurance exchanges, citing the costs of creation and the uncertainty of the election results.  Now that President Obama has been reelected, many of these states are moving very quickly to either create plans for their own state-run exchange, or choosing to to act which will leave the federal government to create an exchange in their state. 

In total, 17 states have announced their intention to create their own state exchange.  Many other states are awaiting additional guidance on creating a state-federal partnership exchange. Florida Governor Rick Scott (R-Fl) , one of the most vocal critics of Obamacare, recently pivoted and wants to negotiate with CMS on the exchange and potentially on Medicaid expansions.  Governors across the country are getting pushed from all angles on creating or not creating the exchanges and expanding Medicaid to 133% of FPL.  Hospitals, a powerful lobby, will see payments from the federal government for treatment of uninsured patients cut dramatically over the next few years from $34 billion to $15 billion as Obamacare assumes a dramatic decline in the number of uninsured. Many safety net hospitals are pushing for both the Medicaid expansion and exchange creation to ensure they can make up the lost revenue with new patients.  MORE

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