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Comments Needed on Medicaid and Medicare Regulations
June 23, 2011

Several critical regulations have been proposed with comments needed this summer. Instructions for commenting are included in the respective documents.

Medicare and Medicaid Programs; Opportunities for Alignment Under Medicaid and Medicare – This proposed rule addresses services for dual eligible individuals, many of whom are chronically ill and require some of the most costly services. Statistics cited in the preamble to the proposed rule indicate that 43 percent of dual eligibles have at least one mental or cognitive impairment and 60 percent have multiple chronic conditions. Nineteen percent of dual eligibles live in institutional settings. Dual eligibles comprise 16 percent of the Medicare enrollment and 27 percent of expenditures and 15 percent of Medicaid enrollees, but 39 percent of expenditures. The Medicare-Medicaid Coordination Office, established by the Affordable Care Act, is responsible to identify existing rules that are outmoded, ineffective, and excessively burdensome and to amend or repeal them. These proposed rules are intended to address conflicting requirements between Medicare and Medicaid that create barriers and add costs to care and services. Access the proposed rule. Comments are due July 11.

Medicaid Program; Methods for Assuring Access to Covered Medicaid Services – This proposed rule would establish a standardized process for states to “assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan…” This proposed rule addresses a variety of issues that impact access to care and services, including payment rate development, numbers of available providers, Medicaid State Plan review process, and other issues. The proposed rule is available in the May 6 Federal Register. Comments are due July 5.

Medicare Program; Conditions of Participation for Community Mental Health Centers – This proposed rule establishes conditions of participation (CoPs) for community mental health centers that must be met in order to participate in Medicare. The proposed CoPs would “focus on the care provided to the client, establish requirements for staff and provider operations, and encourage clients to participate in their care plan and treatment. The new CoPs would enable the Centers for Medicare and Medicaid Services (CMS) to survey Community Mental Health Centers for compliance with health and safety requirements.”  Read the regulation and comment by August 16

Medicare Program; Proposed Changes to the Electronic Prescribing (eRx) Incentive Program – The proposed rule would modify the 2011 eRx quality measure, provide for additional hardship exemption categories for eligible professionals  to request an exemption for the 2012 payment adjustment, and extend the deadline for submitting requests for consideration for existing hardship exemption categories. CMS proposed to revise the quality measure to add language that the measure documents whether an eligible professional has adopted a qualified eRx system that performs the required functions or is certified electronic health record technology. One of the proposed hardship categories is Eligible Professionals who Register to Participate in the Medicare or Medicaid EHR Incentive Programs and Adopt Certified EHR Technology.  The proposed rule is available in the June 1 Federal Register. Comments are due July 25.

Medicare Program; Availability of Medicare Data for Performance Measurement – The proposed rule provides information for use of standardized extracts of Medicare claims data to measure performance of providers and suppliers under Medicare Parts A, B, and D. Access the proposed rule and provide comment by August 8.

Members are requested to send a copy of any comments submitted to CMS to Betty Simmonds at PCPA (betty@paproviders.org).

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