WASHINGTON WIRE
April 3, 2009
Issue 196
CONGRESS PASSES BUDGET RESOLUTIONS ALONG PARTY LINES
Senate Confirmation Vote on Sebelius Delayed
CMS to Begin New Pay For Performance Nursing Home Demo
FAIR Fund Backs Complaint against CMS
Top Story
CONGRESS PASSES BUDGET RESOLUTIONS ALONG PARTY LINES
On Thursday April 2, the Senate and House passed their Fiscal Year 2010 budget resolutions along party lines, with all Republicans voting against them. The $3.5 trillion budget plans include President Obama's budget priorities, although the House version is more consistent with Obama’s healthcare reform agenda.
The House version includes a September deadline by which committees must complete healthcare reform legislation; a failure to meet that deadline would trigger “reconciliation” budget rules requiring a simple majority for passage in the Senate. The Senate version of the budget plan lacks the same deadline tactic, meant to ensure that healthcare reform legislation is passed in each chamber this year.
After the April recess (April 4-19), a conference committee will begin negotiating the two versions of the budget plans.
Health Care News
Senate Cofirmation Vote on Sebelius Delayed
A Senate vote to confirm Kansas Governor Kathleen Sebelius (D) as secretary of the Department of Health and Human Service will likely not occur until April recess. Some Republicans blocked consideration of the nomination on April 2, saying that it was necessary to have a full 48 hours' notice of a committee vote before proceeding.
President Obama announced his administration's selection of Kansas Governor Kathleen Sebelius (D) as the next chief of HHS on Monday, March 2. Sebelius' selection came on the heels of Secretary-designate Tom Daschle's withdrawal of his nomination because of tax issues.
Stakeholders were concerned that Daschle's withdrawal could delay healthcare reform. But advocates in DC publicly praised the choice of Sebelius. The White House and key Democratic leaders in Congress are continuing to push for healthcare reform legislation in 2009. The latest indications point to details of a potential draft bill to be released this summer, possibly as early as June.
CMS to Begin New Pay For Performance Nursing Home Demo
On March 27, CMS announced a demonstration project that involves providing cash incentives to nursing homes for improving the quality of care while producing savings. The Nursing Home Value-Based Purchasing demonstration is expected to begin this July and continue through June 2012. The study will measure quality measures in four areas: nurse staffing, avoidable hospitalizations, resident outcomes and the scope and severity of deficiency citations the home has received during inspections.
Nursing homes in Arizona, Mississippi, New York, and Wisconsin will be asked to participate on a volunteer basis. The goal is to get at least 100 nursing facilities in each state to apply.
FAIR Fund Backs Complaint against CMS
On March 24, Palomar Pomerado Health filed a complaint in federal district court challenging the procedures used by Medicare Recovery Audit Contractors (RACs) to reopen Medicare claims. This suit alleges that the Centers for Medicare and Medicaid Services (CMS) unlawfully reopened a claim by Palomar Medical Center without showing "good cause" as required by Medicare regulations. The complaint was filed in the Southern District of California with the support of the Fund for Access to Inpatient Rehabilitation (the "FAIR" Fund), a common legal defense fund comprised primarily of inpatient rehabilitation hospitals and units.
Hospitals were very successful in administrative appeals on this issue. ALJs have held that thousands of RAC claims were unlawfully reopened. However, in February 2008, the Medicare Appeals Council (Council) ruled that ALJs did not have jurisdiction over this issue. While ALJs have continued to rule in favor of hospitals and other providers on this issue, the Council has consistently overturned those decisions. The complaint alleges that the Council has misinterpreted the regulations and that ALJs do have authority to review whether contractors have lawfully reopened claims.
"It is perfectly reasonable to expect CMS and its contractors to adhere to the regulations when auditing claims," stated Ronald S. Connelly, a principal with the law firm Powers Pyles Sutter & Verville, PC, who is serving as counsel for the FAIR Fund. "These are regulations that CMS itself drafted and published, and they provide important due process protections for hospitals and other Medicare providers."
Upcoming Events
Hearings
Congress is on recess from April 4 through April 19.
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