Safety Net Clinic Week Is Almost Here!

Don't forget to celebrate Safety Net Clinic Week! Safety Net Clinic Week, August 18th - 22nd, is a week dedicated to celebrating Rural Health Clinics and Community Safety Net Clinics. In its fifth year, this week provides the opportunity to express our appreciation and gratitude to all the clinics who dedicate their time, energy and resources to serving their communities. Despite limited human and technical resources, these clinics are creating innovative solutions to delivering patient-centered, high quality care to patients in your community!  

IOM Report Questions Physician Shortage

An Institute of Medicine panel's vision for overhauling Medicare-funded medical training questions two beliefs that are widely held in healthcare: that a severe physician shortage is imminent and the only way to avoid it is an infusion of federal money for more residency positions. The report (found here), written by a 21-member committee co-chaired by former CMS administrators Dr. Donald Berwick and Gail Wilensky, says shortages are created by poor geographic distribution of physicians and lopsided ratios of primary care and specialty physicians and that recent research suggests the answers lie in new technology and innovations in healthcare delivery.

Read more about the report and reaction from physician groups in or Modern Healthcare.

Mounting Challenges Put Nonprofit Hospitals At Tipping Point

According to a report released Wednesday from Standard & Poor's Rating Services, small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, with more signals of stress on the way.

The rating agency warned the healthcare sector was at, "a tipping point where negative forces have started to outweigh many providers' ability to implement sufficient countermeasures." Beginning in 2013 and continuing into this year, credit downgrades outpaced upgrades at an accelerating rate.

Stand-alone providers are under greater pressure from physician departures, rising bad debt and higher employee benefit costs. To shoulder the challenges, smaller providers have increasingly sought out mergers with larger health systems in order to seek scale and offset increasing operating pressures. Larger healthcare organizations can better leverage their scale with vendors and insurers, eliminate duplicate services, absorb major IT project costs, as well as attract top management and physicians. Read the article in Reuters here.

How Will You Celebrate Safety Net Clinic Week?

The fifth annual Safety Net Clinic Week is quickly approaching! Safety Net Clinic Week (SNCW), co-sponosored by CRHC and ClinicNET, will be held August 18th through the 22nd. It is dedicated to celebrating Rural Health Clinics (RHCs) and Community Safety Net Clinics (CSNCs). In an effort to celebrate, support and raise awareness for Colorado's healthcare safety net, we encourage your clinic to participate in this important week devoted to educating the public, policymakers and other community leaders about Colorado's RHCs and CSNCs. 

We have created a toolkit to help clinics participate in SNCW 2014. We encourage you to use the resources below to have the most successful advocacy week as possible. In addition, a webinar is available to CRHC members on August 6th at 12:00 PM to provide more information on SNCW and the resources available to clinics to celebrate. 

The toolkit links can be found below, and click here to register for the webinar.  

Short Overview of SNCW
SNCW 2014 Logo
Governmental Proclamation or Resolution
SNCW Invitation Template
SNCW Fact Sheet
SNCW Press Release
List of All RHCs and CSNCs

Critical Times for Small and Rural Hospitals

Although Critical Access Hospitals (CAHs) are protected from many of the disruptions of the Patient Protection and Affordable Care Act, their fates will differ greatly depending on their individual circumstances. Geography, the right mix of services, affiliation with larger partners, and, most critically, cuts of preferential reimbursements that CAHs currently receive but that are far from guaranteed in the future—all of these play a role.

Thanks to the decision of many states not to expand Medicaid, whether a small rural hospital or critical access hospital survives may depend on a host of variables over which leaders have little or no control. For instance, many organizations stand to benefit as more of the previously uninsured acquire health insurance, unless, of course, your state decided to not expand Medicaid. 

Read the article in HealthLeaders Media here.

CMS Wants to Know - Can Medicaid Beneficiaries Find a Doctor?

The Centers for Medicare and Medicaid Services (CMS) is planning to conduct its first nationwide research effort to answer the question of whether adult Medicaid beneficiaries can find providers, and if factors such as being in managed Medicaid versus a fee-for-service offering aid or hurt the search. 

What it's likely to find, according to interviews conducted with state Medicaid officials and medical society officials in 20 states, is a mixed picture overshadowed by general concerns that reimbursement rates remain too low to entice many doctors to accept new Medicaid patients. Read the article in Modern Healthcare here.

CMS Proposes Rule to Expand Telehealth Payments

Wellness and behavioral health visits are among a few telehealth coverage expansions the Centers for Medicare & Medicaid Services (CMS) wants to add to the list of Medicare reimbursable telehealth activities under a proposal released Thursday last week. Providers also would be paid for telehealth services in rural areas nearer big cities under a geographical expansion in the proposed rule.

The 609-page proposed rule principally deals with annual changes to polices under the Medicare Physician Fee Schedule, including eliminating the exclusion for continuing medication education (CME) under the Sunshine Act that requires drug companies and medical device makers to disclose payments to physicians.
Added to the list of covered telehealth services by the proposal are annual wellness visits, both for an initial visit, and for subsequent visits, if they include a personalized prevention plan of service. 

Read the article in Modern Healthcare here (requires a free subscription).

A June 27th article in Insurancenewsnet.com discusses four major barriers to telehealth adoption. Read the article here, which includes an interview with Ed Bostick, Executive Director of the Colorado Telehealth Network.

Medical Boards Draft Model Law Designed to Make It Easier to Treat Patients Out-of-State and Online

Officials representing state medical boards across the country have drafted a model law that would make it much easier for doctors licensed in one state to treat patients in other states, whether in person, by video-conference or online.

The plan, representing the biggest change in medical licensing in decades, opens the door to greater use of telemedicine and could alleviate the doctor shortage, a growing problem as millions of people gain insurance coverage under the Affordable Care Act.

The draft legislation, in the form of an interstate compact (a legally binding agreement among states), was developed by the Federation of State Medical Boards, composed of the agencies that license and discipline doctors. “The proposed compact would create a new pathway to speed the licensing of doctors seeking to practice medicine in multiple states,” said Dr. Humayun J. Chaudhry, the president of the Federation. “It would allow doctors to see more patients than ever before, if they want to.”

Read the article in the New York Times here.

Provider Shortage Worsening, Demand Growing

Health and Human Services spokeswoman Erin Shields Britt says continuing to build the primary care workforce will take time, but she notes President Obama's budget working its way through Congress has several new ways to expand the primary care workforce, which includes nurse practitioners and pediatricians. The Affordable Care Act (ACA), she says, significantly increases the number of primary care providers in rural and underserved areas and increases Medicare and Medicaid payment for services delivered by primary care practitioners.

An article in USA Today this week outlines some of the challenges that continue to get in the way of training and placing providers. The challenges include the rising cost of medical school, more lucrative specialty care and scope of practice laws. Read the article here.

Medicaid Dental Benefits Extended Further Beginning July 1

Beginning July 1st, Medicaid beneficiaries have access to more dental services under a benefit that became available April 1st.

The new benefit provides Medicaid adults age 21 and older with access to up to $1,000 in dental services per state fiscal year, according to a release from the Colorado Department of Health Care Policy and Financing (HCPF). "A healthy mouth and health body go hand-in-hand," said Susan Birch, Executive Director of HCPF in a statement. "We have already heard from many of our clients how grateful they are since the initial benefit began in April. Having this enhanced benefit in place will help our clients maintain good oral health and improve their overall health and quality of life."

The extended benefit covers basic preventive dental exams, diagnostic and restorative dental services including extractions, root canals, crowns, partial dentures, complete dentures, periodontal scaling, root planning and other procedures requiring prior authorization.

The expansion is funded through the federal and state government. Colorado's share of the funding comes from a state fund that formerly funded Cover Colorado.

Read the July 1 press release from HCPF here.    

Celebrate the 5th Annual Safety Net Clinic Week August 18th - 22nd!

The Colorado Rural Health Center and ClinicNET are celebrating the 5th annual Safety Net Clinic Week (SNCW) August 18th through the 22nd! In an effort to raise awareness about the diversity and impact of Colorado's healthcare safety net, this week is devoted to educating public officials and the community about these vitally important healthcare clinics - federally certified Rural Health Clinics (RHCs) and Community Safety Net Clinics (CSNCs).

RHCs and CSNCs provide access to primary care serves for individuals and families that are low-income, underinsured and uninsured and to those residing in rural and frontier communities. Patients who are uninsured and do not qualify for public insurance are often asked to pay for services as a flat fee or on a sliding fee scale based on their income level, and some clinics are free.

More information about SNCW 2014 will be coming soon. Think about hosting an open house or offering tours to your elected officials. It’s a great opportunity to showcase what you do to provide access to health in your community!

340B Drug Discount Program Under Scrutiny

The 340B drug pricing program lets thousands of hospitals, community health centers and family planning clinics buy outpatient prescription medications from manufacturers at an estimated 25 to 50 percent discount. Participants can then charge higher rates to insured patients and keep the additional revenue.

To qualify for the program, hospitals and clinics must meet federal requirements, such as non-profit status, serving a certain percentage of low-income or uninsured patients or receiving federal grants. The Affordable Care Act broadened the type of facilities that can qualify for the 20-plus year program, including Critical Access Hospitals, the smallest rural hospital.

Growth in the program is raising alarms among drug makers and some members of Congress who say that some facilities should not be eligible and that the money they receive from the discounts is not always being plowed back into patient care. The Health Resources and Services Administration (HRSA) runs they program, and Administration officials have promised to propose clearer rules for the program. Proposed regulations had been expected as early as this month, but a recent federal district court ruling has put into question whether HRSA has that authority.

Despite the ruling, HRSA says they plan to move forward with the proposed regulation, and it has been expected to touch on several areas, including eligibility and contracting. 

• Eligible patients: Patients who have a “relationship” with a 340B hospital or clinic are eligible to receive the discounted 340b drugs. But exactly what constitutes such a relationship isn’t clearly defined. “There’s always been a discussion about who truly is a patient of a covered entity and who truly can receive a 340B drug,” said David Ivill, a 340B expert with the law firm McDermott Will & Emery.
• Eligible facilities: Currently if a clinic is included in an eligible hospital’s Medicare cost report it can qualify for 340B drug pricing. Analysts expect a new regulation would provide more clarity on which facilities qualify and which ones don’t. While one part of a qualifying 340B hospital might serve large number of poorer patients, an affiliated clinic could see mostly insured patients. Under current rules both qualify to receive the discounted drugs.
• Contract pharmacies: Some providers in the 340B program can contract with outside pharmacies, like Walgreens, to give patients the flexibility of filling their prescriptions at locations that may be more convenient than a hospital pharmacy. A report released in February by the HHS Inspector General found inconsistencies in how some contract pharmacies determine who is eligible for the discounts and in how they conduct the oversight activities that HRSA recommends. In a statement, a HRSA spokesman said the agency has followed up individually with pharmacies identified in the report “to determine necessary next steps.”

Read the full article in Kaiser Health News here.

Missouri Bill Aims to Reduce Workforce Shortage by Allowing New Route to Become “Assistant Physicians”

Missouri may soon allow licensed medical school graduates to practice medicine and prescribe drugs without having completed a residency.

The proposal (Senate Bill 716), which has passed the state legislature and awaits the governor's signature, aims to address the issue of providing adequate healthcare in rural and other underserved areas of the state.

Under the bill, graduates of accredited medical schools could become “assistant physicians” and provide primary care services in rural or medically underserved areas if they haven't completed residency training. However, they must have completed the first two steps of their medical licensing exam. A collaborating physician would be responsible for all services rendered by the assistant physician.

Under rules from the Centers for Medicare and Medicaid Services, an assistant physician would also be considered a physician assistant. Read the article in Modern Healthcare here (requires a free subscription).  

Colorado Division of Insurance Releases First Look at Health Plans for 2015

The Colorado Division of Insurance released preliminary information this week from plans submitted by health insurers for Affordable Care Act (ACA) coverage in 2015. Rate and benefit information for the 2015 plan year was submitted to the Division of Insurance (DOI) on June 6th. Since that time, DOI staff has been conducting initial reviews to check the filings for completeness.

According to the preliminary study of rate filings provided by the DOI, Colorado residents and small businesses could face anywhere from a 10 percent increase in their health insurance premiums next year to a 10 percent drop in prices.

Commissioner of Insurance Marguerite Salazar commented, “We are pleased to see such a high number of carriers and plans. Rates seem to be holding relatively steady, which means we will continue to see a strong market in 2015 that will provide Colorado consumers with many options for health insurance.”

Over the summer, the Division of Insurance staff will examine each plan to make sure it is in compliance with the requirements of the Affordable Care Act and state and federal laws. The DOI will review the rates to ensure they are not excessive or inadequate. In addition, the DOI will also verify whether the plans meet the federally defined metal tier coverage levels: bronze (60% of medical expenses paid by the plan), silver (70%), gold (80%) and platinum (90%). These percentages are referred to as “actuarial value.” 

During the review period, Colorado consumers can submit public comments on the filings, which will be reviewed and considered by the Division of Insurance. The DOI will complete its review in September, then notify carriers and Connect for Health Colorado of the approved plans for 2015. Once approved, final plans will be posted on the DOI’s website. DOI will also provide summary information and charts detailing the number of approved carriers and plans for 2015, both on and off Connect for Health Colorado. Read the press release from the DOI here.  

AMA Calls to Give Veterans Access to Private Sector Health Providers

According to the American Medical Association (AMA), veterans facing long wait times for healthcare at government hospitals should have access to private doctors.

The AMA, the largest doctor’s group in the U.S., voted at its annual meeting yesterday to ask President Obama to give veterans access to private-sector health providers until a backlog at the Veterans Administration is reduced. More than 57,000 veterans waited longer than 90 days for an initial appointment at VA medical centers, according to an audit released yesterday. Read the article in in Bloomberg News here.

New Report About Narrow Networks Released by McKinsey Center

Roughly half of the products sold on exchanges in 2014 were narrow-network plans, according to a study by the McKinsey Center for US Health System Reform (read the study here). In the largest city in each state, that figure jumped to 60 percent.

The vast majority of exchange customers had a choice between broad- or narrow-network plans, the McKinsey study found. Broad network plans were available to 90 percent of potential customers, while narrow-network plans were an option for 92 percent of that population. Read the rest of the article in Modern Healthcare here (requires a free subscription). 

Creating rules around network adequacy are difficult for rural areas as a balance must be struck to create standards strong enough for meaningful access protections, but flexible enough to be achievable for the Qualified Health Plans. This discussion won't be over any time soon.

New Study From CHA Shows Impact of Medicaid Expansion on Hospital Volumes

A new study from the Colorado Hospital Association (CHA) shows the impact of Medicaid expansion on hospital volumes in the 26 states that chose to expand Medicaid eligibility under an option offered through the Affordable Care Act. The study shows that the Medicaid proportion of patient volume at hospitals in states that expanded Medicaid increased substantially in the first quarter of 2014. At the same time, the proportion of self-pay and overall charity care declined in expansion-state hospitals. You can listen to the article on Colorado Public Radio here, and read the study from CHA here.

Save the Date for Safety Net Clinic Week 2014!

Save the date for Safety Net Clinic Week 2014! SNCW 2014 will be celebrated August 18th through the 22nd. It is a week dedicated to raising awareness of all the various types of clinics with a commitment to serving patients who might otherwise have difficulty getting medical care.

Why is it important to celebrate Safety Net Clinic Week? Because while safety net clinics have some similarities, they also look very different from one another, and it is important to know where, why and how healthcare is currently being delivered. When it comes time for the federal, state, or even local government to make decisions regarding provider reimbursements, tobacco tax funds, Medicare or Medicaid payments, public coverage program eligibility, electronic health records (EHR) incentives, or other important policy choices, the people making those decisions need to understand how they affect safety net clinics like yours.

Therefore, the Colorado Rural Health Center and ClinicNET encourage you to celebrate Safety Net Clinic Week August 18th through the 22nd. Look for more information from CRHC and ClinicNET soon!

What Will Happen As Networks Continue to Narrow?

In the midst of all the turmoil in healthcare these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.

These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in healthcare coverage offered by employers and in private Medicare Advantage plans.

Insurers, ranging from national behemoths like WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully embracing the idea, saying narrower networks are essential to controlling costs and managing care. Major players contend they can avoid the uproar that crippled a similar push in the 1990s. Read the article in the New York Times here.

Division of Insurance to Seek Shift on Geographic Rating Areas for 2015

Press Release from Colorado Division of Insurance (May 9, 2014)

The Colorado Division of Insurance (DOI) today announced it will ask the federal government for approval to change Colorado’s geographic rating areas for health insurance for 2015.

Geographic rating areas are geographical units made up of metropolitan statistical areas (MSAs), counties or three-digit zip codes, which are used by insurance carriers to price premiums.

The DOI seeks to reduce the number of rating areas from 11 to nine, combining four rural areas into two larger rating areas, while retaining the seven urban (or metropolitan statistical areas, or MSAs). Such a change will require approval from the U.S. Department of Health and Human Services.

“Consolidating the higher health cost regions into larger rating areas will spread the risks and the costs of providing health care more equitably over a larger population,” said Marguerite Salazar, Commissioner of Insurance. “We understand that people across the state are concerned about high health care costs and the impact on health insurance premiums. This is the fairest way of addressing the issue and working toward stable premiums in all regions of the state.”

The announcement comes after a meeting last week of the Health Care Cost Study Group. At that meeting, the DOI put forth three options for rating areas following presentation of an actuarial analysis commissioned by the DOI for the study group. The DOI invited comments through Wednesday, May 7.

The DOI received 306 comments of which 138 addressed the rating area options. Of those, 117 were supportive of the nine rating areas structure.

As part of this change, on Friday, May 9, DOI will formally request approval from the Department of Health and Human Services to change Colorado’s rating area structure. Due to this change, the DOI also will extend its deadline for insurance carriers to provide plans and rates for 2015 from May 15 to June 6, providing time for insurance carriers to adjust to the new areas.

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The Colorado Division of Insurance regulates the insurance industry and assists consumers and other stakeholders with insurance issues. DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado.

Survey Says - Healthcare Executives Don't Trust Payers

A survey designed to measure the level of trust that hospital executives have in health insurance companies finds several factors that contribute to low scores, including the length of time it takes for claims to be paid, and the rates hospitals and physicians are paid.

Payers scored poorly on all three of the new trust questions in the annual National Payor Surveyconducted by ReviveHealth, a Nashville, TN based strategic communications firm and Catalyst Healthcare Research. The results from the final question, which asked providers whether a particular payer "balances its interests with ours and doesn't routinely take advantage of us," were particularly dire. Read the article in HealthLeaders Media here.

New Telemedicine Policy Draws Opposition

New guidelines issued by the Federation of State Medical Boards (FSMB) could have a chilling effect on the growth of telemedicine – especially in rural areas and among low-income patients, say some patient advocates, healthcare providers and healthcare companies. But the Federation says the updated guidance will safeguard patients’ privacy and ensure high-quality care in the current fast-changing healthcare delivery environment.

As part of a wide-reaching April 26 policy statement, FSMB changed the definition of telemedicine to care that “typically involves the application of secure videoconferencing… to provide or support healthcare delivery by replicating the interaction of a traditional encounter in person between provider and a patient.” It is not, according to the Federation, “an audio-only, telephone conversation, e-mail/instant messaging conversation or fax.”

The statement, which is not a legal document but is intended to help state medical boards’ develop professional policies and standards for their members, triggered a backlash from some stakeholders. Read the rest of the article in Kaiser Health News here. 

Telemedicine Still Facing Barriers In Most States

With more than 7 million people signing up for coverage under federal healthcare reform and millions more gaining coverage under Medicaid Expansion, providers now need to reach more rural patients than ever before. But providers and payers in many states are still struggling with outdated laws and other obstacles in their effort to reach patients in remote areas.

But experts say those barriers to care are slowly disappearing as more states pass laws to allow Medicaid to reimburse providers. That effort is also being helped by pilot programs launched by providers and insurers in an effort to improve care and generate savings by allowing rural residents to address health problems before they get worse. Read the article in Health Leaders Media.

Insurance Extension Decision Could Impact Many Coloradans

Insurance Commissioner Marguerite Salazar announced Friday that state residents who extended plans that do not meet minimum benefits required under federal healthcare reform before the end of last year may extend them again through the end of 2015 if their insurers continue to sell the plans.

It is unknown how many of the roughly 100,000 people currently covered by such plans in Colorado will have the opportunity to re-up and will choose to do so. But the people in such plans are viewed by many health analysts to be healthier than those who recently have purchased insurance for the first time. And keeping them out of the larger risk pool could cause prices for insurance policies to rise across the board.

Read more about how the extension decision could impact Coloradans in the Denver Business Journal or read about a national study on the impact of the canceled plans in Politico.

Is Rate Relief Coming to Colorado's Ski Towns?

Last Friday, Colorado Insurance Commissioner Marguerite Salazar said she wants to redraw the geographic rating boundaries which previously lumped together Garfield, Pitkin, Eagle and Summit Counties and created the most expensive insurance market in the U.S. Commissioner Salazar announced that by redrawing the boundaries, those counties will now be part of a 22 county region. 

Read more about the change in boundaries in Kaiser Health News or in Health News Colorado.

Study Says When Hospitals Buy Physician Practices, Costs Go Up

A new study gives ammunition to what health economists and health insurers have argued for years: When hospitals buy physician practices, the result is usually higher hospital prices and increased spending by privately insured patients.

The study, published Monday in the journal Health Affairs, was based on an analysis of 2.1 million hospital claims from workers of self-insured employers between 2001 and 2007. The analysis by Stanford University researchers found prices were most likely to increase when hospitals bought physician practices, as opposed to hospitals forming looser contractual relationships with physicians.

Read the article in Kaiser Health News.

Tax Credit Extension Sought to Aid Rural Providers

Advocates are trying to persuade Congress to permanently extend a tax incentive program that helps small and rural healthcare providers obtain financing for building and expansion projects.

The New Markets Tax Credit Program was authorized in 2000 and last extended for two years on Jan. 1, 2013. The current push is to make the program permanent, which President Barack Obama supported in his fiscal 2015 budget proposal. In the House, Reps. Jim Gerlach (R-PA) and Richard Neal (D-MA) reintroduced legislation earlier this month that would make the program permanent rather than requiring reauthorization every two years. Similar bipartisan legislation was introduced in the Senate last summer.

Cuyuna Range Hospital District in Crosby, MN, is among the rural providers that have taken advantage of the program. The district, which operates 25-bed Cuyuna Regional Medical Center, wanted to finance a $15.7 million project last year to expand its operating rooms and surgical clinics. The program allowed Cuyuna to save 18 percent on its borrowing costs, or about $2.3 million. 

“It's a real opportunity for rural healthcare for expansion,” said John Solheim, Cuyuna Regional's CEO. “It helps you create equity and economic development.”

For healthcare providers, the program allows them to reap savings through a lower interest rate from lenders and makes them more attractive borrowers at a time when many rural hospitals are struggling to obtain financing.  

Read the full article in Modern Healthcare (requires a free subscription).  

AHA Files Suit Against HHS Over "Two-Midnight" Rule

The American Hospital Association filed two lawsuits Monday against the two-midnight rule and was joined in its suit by several state hospital associations and individual hospitals.

“The two-midnight rule undermines medical judgment and disregards the level of care needed to safely treat patients,” said Richard Umbdenstock, president and CEO of the AHA, in a release announcing the lawsuits. “Hospitals stand by a physician's decision on what care is appropriate for each patient. The two-midnight rule is misguided and we feel confident the court will agree.”

“The hospitals take issue with the wholly arbitrary requirement that a physician must certify at the time of admission that a Medicare patient is expected to need care in the hospital for a period spanning two midnights to be considered an inpatient,” the release also said.

The doc-fix bill recently approved by Congress included a six-month extension before compliance would be enforced for the two-midnight rule. AHA apparently plans to use that time contesting it in court.

The existing two-midnight rule says admitting physicians must have good reason to believe that a patient will need two nights in the hospital before Medicare will pay full inpatient rates under Part A for the stay. Lacking such documentation, Medicare auditors will generally classify the stay as outpatient observation, which pays hospitals much less under Part B and sticks the patient with a 20% co-payment. That rule went into effect Oct. 1. But it was modified so that Medicare's aggressive recovery audit contractors could not overturn claims under the new policy until Sept. 30, 2014.

The enacted legislation requires Medicare to extend that recovery-auditing moratorium until March 31, 2015. It also gives Medicare officials the discretion to extend what's known as the “probe and educate” process until the same date next year. Under that process, a different set of companies, known as Medicare administrative contractors, can audit a small number of short-stay inpatient claims and train hospitals on how to submit more accurate bills. 

Read the article in Modern Healthcare (requires a free subscription).  

HHS Secretary Kathleen Sebelius Resigns, OMB Director Sylvia Mathews Burwell to Step In

Health and Human Services Secretary Kathleen Sebelius announced her resignation Friday, ending a tumultuous tenure as the public face of the Affordable Care Act. In a Rose Garden ceremony, President Obama nominated his budget director as her successor.

According to federal health officials, Sebelius approached Obama in early March and told him that, with the insurance enrollment period ending that month, the time had come for new leadership at HHS. A White House official, who spoke on the condition of anonymity to discuss internal deliberations, said Sebelius told the president that “she felt confident in the trajectory for enrollment and implementation of the Affordable Care Act.”

Obama on Friday nominated Office of Management and Budget Director Sylvia Mathews Burwell to take Sebelius’s place. Although Burwell does not have an extensive background in healthcare policy, she is known for her strong management skills and has experience in issues of poverty and global health issues from her time at the Bill and Melinda Gates Foundation. Moreover, she is popular on Capitol Hill. The Senate confirmed her as OMB director 96 to 0 almost exactly a year ago. Her nomination to lead HHS will require Senate confirmation as well. Read the full article in The Washington Post.

When A Rural Hospital Closes, The Town Struggles To Survive

The story of Hancock Memorial Hospital in the tiny town of Sparta, Georgia is not unique. Hancock Memorial Hospital was among the first of nine rural hospitals that have closed across Georgia since 2000. Today, it’s overgrown with weeds and vines, while the roof caves on the gurneys and computers still inside. When County Commissioner Sistie Hudson tries to recruit a new industrial employer, one of the first things they ask is: “Do you have a hospital?” That's a non-starter for most businesses. 

University of North Carolina professor Mark Holmes studied the economic impact of 140 rural hospital closures nationwide. He found that three years out, losing a hospital costs a community, on average, “about 1.6 percentage points in unemployment, about $700 in per capita income, and that was in [year] 2000 dollars so that’d be probably about $1,000 currently." 

Read, or listen, to the story on American Public Media, Marketplace.

Obama Signs Doc-Fix Bill

A 64-35 Senate vote Monday cleared the measure through Congress. The law also delays nationwide implementation of the ICD-10 diagnostic codes until 2015.

The $21 billion bill would stave off a 24% cut in Medicare reimbursements to doctors for a year and extend dozens of other expiring healthcare provisions, such as higher payment rates for rural hospitals. The legislation is paid for by cuts to healthcare providers, but fully half of the cuts won't kick in for 10 years.

This patch comes after lawmakers failed to reach a deal on financing a permanent fix. Read the article in Modern Healthcare here.

Final Surge Pushes ACA Enrollment in Colorado

Enrollment for private health insurance coverage for this year ended Monday with a surge that led to 118,628 Coloradans signing up on the state exchange (Connect for Health Colorado). Some 12,000 people signed up during the last week of open enrollment.

Enrollments under the Affordable Care Act are expected to continue to climb over the next few weeks in Colorado. Those who started their applications prior to the deadline, but were unable to complete them, will be given more time.

Connect for Health Colorado reported yesterday (Tuesday) that between Oct. 1st and March 31st, more than 277,000 Coloradans obtained either commercial or public health insurance under the Affordable Care Act. Medicaid gained 158,521 enrollees. The federal program expanded under the law in Colorado to cover lower-income single adults as well as disabled people, mothers, pregnant women and children.

Read the article in the Denver Post here.

With ICD-10 Delayed, Answers Needed from CMS

As part of the House's Protecting Access to Medicare Act of 2014, which delays cuts in physician's Medicare rates (SGR) by another year, the national implementation of the next-generation medical coding system known as ICD-10 has also been pushed out. This delay has focused intense attention on the Centers for Medicare and Medicaid Services (CMS) to provide clarity for how hospitals, doctors, insurance companies should move forward.

The bill signed by President Obama on Tuesday prohibits CMS from enforcing any mandate to switch to the newer system until at least Oct. 1, 2015, but the act leaves CMS with many questions to answer. Among them:

• Will Oct. 1, 2015, become the new deadline?
• Will the agency allow organizations that are ready to implement ICD-10 to do so voluntarily?
• Would the agency scrap ICD-10 altogether and instead wait for ICD-11, which is due to be released in 2017?

Read the article in Modern Healthcare here.

Update from the National Rural Health Association on HR 3402

On Monday the Senate passed a 12-month delay of cuts scheduled to take affect under the Medicare Sustainable Growth Rate (SGR). In addition to the delay of these cuts, the bill (H.R. 3402) would extend the Medicare Dependent Hospital Program, Low-Volume Hospital adjustment, current rural and “super-rural” ambulance payment rates, and the rural “work floor” in the geographic practice cost index. The National Rural Health Association (NRHA) is appreciative of efforts made to extend these programs permanently in the Senate as well as the one year extension of the programs.

NRHA also sought to include regulatory relief as part of this bill, including addressing issues with the 96-hour condition of payment rule currently experienced by Critical Access Hospitals as well as mandating that supervision levels for outpatient therapy services be reverted to a level of “general.” While these issues were not included in the package passed Monday, NRHA will continue to advance these efforts through NRHA-supported legislation that has already been introduced in both the House and Senate.​

Will New Rules to Prevent Narrowing of Networks Drive Away Payers?

Healthcare providers have raised alarms over narrow provider networks in the public health insurance exchanges, but Moody's Investors Service says proposed rules to open up the networks could drive health plans to drop out of the new market.

Proposed federal rules that would limit the ability of health plans to craft narrow provider networks for the Affordable Care Act exchanges would benefit some hospitals, but tighter regulation could create an unbearable level of risk for insurers, market analysts say. In a healthcare "sector comment" released recently, Moody's Investors Service predicts that plans to limit narrow networks in 2015 would benefit rural hospitals and safety net hospitals because those facilities are the most likely to be left out of a narrow network.

"If [hospitals] are considered essential, that would protect them from being excluded from a narrow network," Moody's Senior Vice President Lisa Martin said Monday of the new rules under consideration at the federal Centers for Medicare & Medicaid Services. "[They provide] protection in terms of market share."  Read the article in Health Leaders Media here. 

New Revenue Projections Released in Advance of Budget Bill

Economists delivered new projections to the legislature's budget committee last week in advance of the introduction of the budget bill for fiscal year 2014-15. 

Revenues have rebounded solidly since the Great Recession, and the state expects a surplus of $257 million this fiscal year, and more than double that next year. Democratic Senator Pat Steadman of Denver says much of that money is already slated to be spent on education or other programs, or will go to trying to restore past budget cuts. “The legislature this year has a very ambitious number of proposals introduced for tax credits and new spending, not all of which I think can be funded under today’s revenue estimate," Steadman says. Read the rest of the article about the revenue forecast at Colorado Public Radio here.

On March 20, 2014 the Joint Budget Committee approved a state budget to be introduced in the House and Senate. The budget shows a total increase of 17.9% and a General Fund increase of 8.7% compared to fiscal year 2013-2014. Provider reimbursements will be expanded by 2% for children's hospitals, after care hours, surgery centers, and many other areas to improve health care costs for all. The State Legislature has also approved funding to the Department of Human Services for increased coverage, awareness, and help for those affected my mental illness. In addition to healthcare, the budget also allocates additional funding to higher education, K-12 education, flood and wildlife recovery.

Update on the Doc Fix

From the National Rural Health Association (NRHA): Early this morning the House Rules Committee posted a bill that would delay all scheduled cuts under the Sustainable Growth Rate (SGR) for 12 months. In addition to the delay in SGR cuts, the bill includes a number of rural Medicare extenders that NRHA has been advocating for. Specifically, the current ambulance payment rates for rural and super-rural trips, the "work floor" in the geographic practice cost index, the Medicare Dependent Hospital program, and the Low-Volume Hospital adjustment were included in the package. The therapy cap exception process is also included in this bill. 

While NRHA had hoped that a permanent fix for the SGR and permanent extension of the rural Medicare programs could be accomplished, we are pleased that the House has decided to include these critical programs in another patch. The inclusion of these programs will stave off draconian Medicare cuts for rural providers throughout the nation. It is important to note, however, that some of the offsets or "pay-fors" proposed in this bill would harm rural providers. Extension of the Medicare sequester and modification of Medicaid DSH payments will harm many providers.

Read what Modern Healthcare had to say about the doc fix in this article posted yesterday.

Colorado Legislature Readies to Tackle Telecom, Rural Broadband Reform - Again

Colorado House Democratic leaders say they plan to reintroduce telecommunications law reforms as early as next week, believing they have tweaked the legislation enough to get it over the hurdles that killed similar bills the past four years.

Rep. Angela Williams, the Denver Democrat who will sponsor the package, said that one of the keys to this year’s effort will be breaking the changes into three bills rather than one large proposal that united opponents to various facets of it in the past.

“We’ve been working since November with over 50 individuals, coalition partners and eight sponsors to develop what I call legislation that will change the landscape in Colorado,” Williams said. “What we’ve tried to do is find a good balance ... Everybody has had an opportunity and has had to give and take.” Read the article in the Denver Business Journal here.

With Less Than Two Weeks To Go, More Than 100K Coloradans Have Signed Up For Private Insurance

There's less than two weeks remaining for people who don't have health coverage to get it. Plans won't be available on demand after that until next fall. So far, more than 100,000 Coloradans have now signed up for new, private health insurance plans through the state's online shopping portal. That number is less than initial goals anticipated, but still good compared with other states in general. About 15,000 Coloradans bought health plans through Connect for Health Colorado in the past two weeks. That's the fastest pace since mid-December, when there was a surge of customers getting coverage that would start Jan. 1, 2014. Read the story in CPR news here.

Connect for Heath Colorado and Colorado Medicaid have released their most recent enrollment metrics as of March 17, 2014. Since October 1, 2013, Medicaid has enrolled 151,050 individuals under the Medicaid expansion and Connect for Health Colorado has enrolled 100,112 Coloradans in private health insurance coverage.

For more Medicaid enrollment metrics, including by gender, age and county of residence click here. Additional enrollment metrics from Connect for Health Colorado can be found here.

House Passes SGR Bill Without Rural Extenders, Senate Bill To Come to Floor Next Week

A once-bipartisan proposal to finally reform the deeply flawed way that Medicare pays doctors succumbed Friday to the partisan politics of Obamacare, particularly the unpopular individual mandate. The House voted 238-181 to replace the payment formula -- the complicated equation that for more than a decade has required annual "doc fixes" -- and to pay for it by delaying Obamacare's individual mandate for five years. Read the full article in Politico here.

An article posted Friday in Modern Healthcare said the legislation to pay for a permanent repeal of Medicare's physician-payment formula by delaying financial penalties for those without health insurance coverage by five years would increase the number of Americans without health insurance by about 13 million in 2018, the nonpartisan Congressional Budget Office reports. Read the article here.

S. 2110, the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 will likely come to the Senate Floor next week. This bill, introduced by Senate Finance chairman Ron Wyden late last week, is modified from previous Senate legislation but is similar to a strong rural bill that was reported out of the Senate Finance committee last December. S. 2110 contains a permanent fix to the SGR and includes all rural Medicare extenders (the Work geographic adjustment, Medicare payment for therapy services, Medicare ambulance services, the Medicare Dependent Hospital program and the Low Volume Hospital adjustment) and make all but the ambulance provisions permanent.

The bill’s passage is in doubt and strong grassroots support is needed. A likely partisan fight will occur over how to pay-for the bill. (Democrats support using savings from the scaling down of overseas conflicts and Republicans support eliminating the health insurance mandate in the ACA). Ranking Finance member, Orrin Hatch introduced a Republican bill (S.2122) which also contains the rural Medicare extenders but utilizes the ACA cuts as a pay-for.

Sweeping New Health Plan Rules Proposed

The Obama administration issued sweeping new proposed rules (PDF) late Friday affecting provider networks in insurance exchange plans, consumer access to quality information about plans, selection of plans in the small business exchanges, state rules on enrollment navigators, and reinsurance and medical loss ratios for insurers.

The Centers for Medicare and Medicaid Services (CMS) and (US Department of Health and Human Services) HHS said the proposed rules and draft standardized notices that issuers would be required to use when renewing or discontinuing plans will help to ensure consumers understand the changes and choices in the individual and group market.

“We are concerned that some enrollees, particularly those with certain complex medical conditions, are having trouble accessing in a timely fashion clinically appropriate prescription drugs,” read a preamble to the proposed rules.

Healthcare providers and consumer advocacy groups have complained about exchange health plans narrowing their networks to exclude a significant number of hospitals,physicians, clinics, and other providers. Plans say narrowing their networks is necessary to keep premiums affordable. The insurance industry and business groups are likely to view the new proposed rules with concern. Read the rest of the article in Modern Healthcare here.

House Passage of H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014

The following note regarding the passage of HR 4015 was released today, March 14th, by the National Organization of State Offices of Rural Health (NOSORH).  It provides some helpful insight into the next steps and political viability of the bill.    

Today, in a largely partisan vote, the House of Representatives passed a bill permanently repealing the Medicare Sustainable Growth Rate (SGR). H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, is the previously agreed upon bipartisan/bicameral framework put forth by the three Congressional Committees with jurisdiction over the SGR.

In addition to formally repealing the SGR, the bill:

• Authorizes annual automatic 0.5% payment update for five years (2014 – 2018).
• Consolidates the three existing Medicare quality programs into a single value-based incentive program.
• Provides incentives for providers to switch to alternative payment models (APMs) such as a 5% bonus to providers who receive a significant portion of their revenue from an APM.

Although the framework for the permanent fix has broad support, finding $138B over ten years to pay for the permanent fix has been a serious obstacle that has become increasingly partisan as today’s vote approached.

The bill passed today by the House, pays for the permanent fix with a Republican supported measure delaying the Affordable Care Act’s individual mandate for five years (starting next year). In addition to covering the cost of a permanent fix, the Congressional Budget Office has estimated that this “pay for” will save an additional $30B but will also result in 13 million more people being uninsured and an average increase of health insurance premiums between 10 and 20 percent. Democrats have attempted to use unspent war funds as the offset; however Republicans are adamantly against such a measure.

The bill still must pass through the Democrat-controlled Senate and be signed by the President in order to become law. The prospect of this bill, with a five year delay of the individual mandate as the offset, becoming law is extremely unlikely. The Democrats in the Senate are publicly opposed to this offset and the President has already stated he will veto the bill if it comes to his desk in this form.

Congress has until March 31st, when the current patch expires, to prevent automatic 24% cuts in Medicare payments to physicians under the SGR. Congress could still come together to figure out agreeable offsets for a permanent fix or they could pass another short-term patch to give them more time to come to an agreement on offsets. A nine-month patch to prevent the 24% cuts through the end of the year has been discussed.

With Deadline For Open Enrollment Looming, Nearly 4.2 Million Have Enrolled in Private Health Plans Sold Through Exchanges

More than 4.2 million people have enrolled in private health plans sold through the Affordable Care Act's insurance exchanges as of March 1, the Obama administration reported Tuesday.

However, the administration didn't say how many of those people have paid their first month's premiums or how many were previously uninsured.

The 4.2 million mark is well below the goal of 5.6 million that federal health officials had when open enrollment started last October. Open enrollment ends March 31 and the White House had hoped to enroll 7 million by that time. Read the rest of the article in Medpage Today here.

Are Rural Interests Being Met By the Colorado Legislature This Year?

As the legislature reaches mid-session, lawmakers are receiving an “incomplete” grade for addressing rural Colorado; being told by rural interests that they still have much more work to do.

Even though both sides of the aisle included rural Colorado in their talking points at the beginning of the session, provincial interests have watched as proposals they supported this year were killed. And they have not seen other bills move to address several important issues to them, including lowering healthcare premiums and addressing transportation needs. Read the full article in the Colorado Statesman here.

It's Looking Likely That We'll See Yet Another SGR Patch (That Makes 18!)

Lawmakers can't agree on a way to plug the $122 billion hole in the budget that would be created by the elimination of the reimbursement cuts and "chances are not great" for a permanent fix by the March 31 deadline, says the co-chair of the GOP Doctors' Caucus.

Congress likely will not find a permanent solution for the Sustainable Growth Rate (SGR) funding formula before the deadline expires at the end of March, and will impose yet another temporary fix and re-address the issue later this year, a leading House Republican says. Read the rest of the article in Health Leaders Media here.

For more information, check out last week's article by Emily Ethridge of CQ Roll Call, or read the article by Kristin Paulson, CIVHC's Senior Manager of Policy and Initiatives, on how the Doc Fix has the potential to improve readmissions here.

Bill Aims to Encourage Doctors to Try Rural Colorado

A bill making its way through the legislature this year aims to encourage doctors to give rural Colorado a try. Senator Aguilar's bill, Senate Bill 14-144, would require the state to study how rural residency programs aid rural communities in recruiting and retaining doctors, what effect massive medical school loans have on physician retention, and investigate possible future funding options from federal, state or private sources. Read the full bill here, and check out the rest of the article here at Colorado Public Radio.