Government News of the Week
Medicare Compliance, HIPAA, Medicare Advantage and Part D,
Health Care Reform, and Other Federal and State Government Developments
Government News of the Week is a weekly email newsletter with timely news stories from Washington, D.C., and the 50 state capitals. Articles are selected for their impact on hospitals, health plans, medical group practices, physicians and other health care providers. Subscribe now to get an issue delivered to your inbox every Monday!

January 26, 2015

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(1) Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) took another stab at killing off the Affordable Care Act’s (ACA) individual mandate when on Jan. 21 the pair, along with 20 other senators, reintroduced the American Liberty Restoration Act (S. 203) .... (more)

(2) CMS Administrator Marilyn Tavenner will step down at the end of February, closing out five years at the helm of the agency charged with implementing the health reform law since its inception in 2010, according to a Jan. 16 email from HHS Sec. Sylvia Burwell to CMS staff. In the note, she thanked Tavenner for her service and said Principal Deputy Administrator Andy Slavitt has agreed to become the acting administrator. Tavenner came under fire in November after she said her agency had inadvertently double-counted nearly 400,000 people on public exchanges. Two months earlier, she had told Congress that 7.3 million Americans were enrolled in marketplace coverage and had paid their premiums. But that number represented enrollments in both medical and dental plans. It wasn't the first time Tavenner took some congressional heat. On Oct. 29, 2013, less than a month after the dismal debut of the website, she was called before the House Ways & Means Committee to explain what went wrong and how it was being fixed. While some media outlets cited the negative publicity CMS garnered late last year for miscounting public exchange enrollment levels for her reason for leaving, industry consultants said Tavenner did a solid job under trying circumstances. (From Inside Health Insurance Exchanges' E-Alert)

  From the AIS Blogs
  When the Biologics Price Competition and Innovation Act passed as part of the health reform law, it established a pathway by which biosimilar drugs could gain abbreviated approval by the FDA. But beyond creating that pathway, little else about the process was laid out in the law, leaving the details up to the FDA’s discretion. Almost four-and-a-half years later, the agency has yet to approve a drug using this pathway. Do you think more guidance is needed before the FDA can approve biosimilars, or is the available information sufficient? Join the conversation at the AIS Blogs.

(3) Yorkville Endoscopy LLC, the Manhattan ambulatory surgery center that was scheduled for Medicare termination Jan. 31, was given another chance by CMS. In a Jan. 16 letter, CMS extended Yorkville Endoscopy’s date of termination until March 2 .... (more)

(4) Medicare enrollment data recently released by CMS for the 2015 plan year show a slight increase in overall enrollment for stand-alone Prescription Drug Plans (PDPs) .... (more)

  From Congress and the Federal Agencies

(5) UnitedHealth Group lost its bid to start selling insurance coverage on public exchanges statewide in California in 2016 when on Jan. 15 the Covered California board adopted new rules to limit the insurer's footprint on the marketplace, according to The Los Angeles Times. The new rules would allow new carriers to join the exchange only in geographies lacking in insurance options. However, the newspaper said there are plans to offer statewide plans in 2017. UnitedHealth announced in 2013 that it would depart the California individual market, where it had a minimal presence. (From Inside Health Insurance Exchanges' E-Alert)

(6) Gov. Asa Hutchinson (R-Ark.) on Jan. 22 said he will ask the state legislature to fund the Arkansas “private option” Medicaid exemption program through the end of 2016 .... (more)

(7) A U.S. District Court judge on Jan. 20 denied Sorkin’s Rx Ltd.’s motion for a temporary restraining order and preliminary injunction against Express Scripts Holding Co. Sorkin’s, doing business as CareMed Pharmaceutical Services, on Jan. 14 filed a lawsuit in the U.S. District Court for the Eastern District of Missouri (4:15-cv-00114-JAR) alleging unlawful termination of its network pharmacy agreement with the PBM .... (more)

(8) A New Jersey physician pleaded guilty to health care fraud in connection with a scheme to bill Medicare for services that were not rendered or were rendered by unlicensed providers .... (more)

(9) The Alabama Medicaid Agency approved an additional five probationary regional care organizations (RCOs) in its shift to a managed care model, the department said on Jan. 7. Alabama’s 11 probationary RCOs have until April 1, 2015, to build a provider network that meets the state’s expectations .... (more)

(10) Some providers are erroneously billing Medicare for evaluation and management services rendered in private residences, according to National Government Services (NGS), a Medicare administrative contractor .... (more)

(11) The medical necessity of cochlear implants showed up in a new Medicare compliance review, which may be a sign that the HHS Office of Inspector General is expanding the risk areas in its comprehensive hospital audits .... (more)


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