Points of Interest 04/15/2014

Points of Interest

April 15, 2014

 P4P – What’s Next ?

 Pay-for-performance programs are likely to expand across US health care in the near future, especially with implementation of the Affordable Care Act. But experience to date with pay-for-performance initiatives has raised a number of questions that require more research and experimentation.

 Transitioning to ICD-10

 Given the political fallout from the data system problems encountered with implementation of the health insurance exchanges, the Obama administration will likely be extremely sensitive to any potential problems with claims processing due to the ICD-10 conversion. Extensive testing, both of the system's connectivity and of coding accuracy, is needed to ascertain readiness for the conversion. In February 2014 CMS administrator Marilyn Tavenner had announced that there would be no further delays and implementation would proceed on October 1, 2014. However, since Congress responded to physicians' concerns and again delayed implementation, the administration and providers must deal with the implications of the delay and revise plans for training and testing. While the delay will be costly for organizations that have already made substantial investments in preparing for the change, it may also provide more time to make sure the transition occurs more smoothly.

Mental Health Parity

The push to make mental health treatment equal to treatment for other health issues has a long history in Congress, in state legislatures, and with the Federal Employees Health Benefits (FEHB) program. In 1996 Congress passed the Mental Health Parity Act (MHPA, championed by Senators Paul Wellstone (D-MN) and Pete Domenici (R-NM). This law applied to large employer-sponsored group health plans (those with more than fifty employees) and prohibited them from imposing higher annual or lifetime dollar limits on mental health benefits than those applicable to medical or surgical benefits. The law applied to both fully insured group health plans (those that purchased insurance from an insurance company or issuer) and self-insured group health plans (those that retained the financial risk for health care claims). The law contained a cost exemption that allowed group health plans to receive a waiver, exempting them from some of the law's key requirements, if the plans demonstrated that costs increased at least 1 percent as a result of compliance. It is important to note that the MHPA did not mandate coverage for mental health treatment, rather, it only applied to group health plans that offered mental health benefits.

Medicare Advantage (MA) Rolls On

Monday afternoon, the Centers for Medicare and Medicaid Services (CMS) released the final rates and other reimbursement policies for Medicare Advantage (MA) plans, referred to as the Final Call Letter. Once again, the Administration took pains to ameliorate planned cuts to MA, demonstrating the program’s increasing popularity with seniors and, by extension, its robust political strength.

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