Recent Articles

Individual Services . . .
Aug 18, 2010

• A/B MAC for Jurisdiction 12 Issues Bulletin on Coverage Status of Provenge®
• BCBS of Rhode Island Release New Coverage Policy for Provenge®
• A/B MAC for Jurisdiction 4 Says That, Starting in October, Simponi® is Non-Covered 
• BCBS of Kansas Releases Revised Coverage Policies for . . . Cardiac Rehabilitation Programs . . . Homocysteine Testing . . . Outpatient Pulmonary Rehabilitation Programs . . . Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux (VUR) . . . Total Facet Arthroplasty
• BCBS of Rhode Island Posts Revised Coverage Policies for . . . Cone Beam CT Scan . . . DME Rent/Purchase and Repair/Replacement
• BCBS of Tennessee Posts Draft Coverage Policy for CT Angiography for Coronary Artery Evaluation
• Medicare Plans New Reviews of Medical Necessity of Chiropractic Services 

First Sweep . . .
Aug 18, 2010

• News, Blogs, Journals

Groups, Research, Resources . . .
Aug 17, 2010

• NAIC Approves Form for Financial Reporting on Medical Loss Ratio (Text of Proposed Form is Here)
• AHIP Says NAIC Proposal Could Have Effect of "Turning Back the Clock" (Sebelius Statement is Here)
• NAIC Turns on Wednesday to . . . Medical Loss Ratio Rebate Issues . . . Other Issues Associated with Medical Loss Ratio
• Study Finds Recession Associated with Reduction in Volume of Routine Health Care Services
• HRSA, American Pharmacists Association Release Pre-Registration Checklist for Hospitals Eligible for 340B Drug Discount Program

Medicare & Medicaid . . .
Aug 17, 2010

• CMS Letter to State Medicaid Directors Provides Guidance on EHR Incentive Payments
• CMS Listening Session to Address Receipt by Medicare Beneficiaries of Extended Observation Services in Hospital Outpatient Settings
• CMS Memo to PDP Sponsors Describes Process for 2011 Reassignment of Low-Income Subsidy Beneficiaries

Individual Services . . .
Aug 17, 2010

• Medicare Pricing, Data Analysis and Coding Contractor Posts Notice on Coding for Pneumatic Knee Splints
• BCBS of North Carolina Releases Revised Coverage Policy on Proteomics-based Testing for the Evaluation of Ovarian (Adnexal) Masses
• BCBS of Tennessee Posts draft Coverage Policies on . . . Home Uterine Activity Monitoring . . . Artificial Intervertebral Disc . . . Sacral Nerve Neuromodulation / Stimulation for Pelvic Floor Dysfunction . . . Photodynamic Therapy (PDT) for Dermatologic Conditions . . . Human Growth Hormone Therapy . . . Panitumumab
• DME MAC for Jurisdiction B Posts Product-Specific Qs and As
• NICE Posts Agenda for September 16 Session of Medical Technologies Advisory Committee
• AHRQ Releases Guide, Other Resources on Use of Blood Thinner Pills

First Sweep . . .
Aug 17, 2010

• BLS Releases Producer Price Index for Health Care, Other Economic Sectors
• News, Blogs, Journals

Medicare & Medicaid . . .
Aug 16, 2010

• CMS Posts Agenda for August 23-24 Session of APC Advisory Panel
• CMS Posts Draft of State Medicaid HIT Plan
• CMS Posts Medicaid Qs and As on EHR Incentive Program Final Rule

Insurers & Employers . . .
Aug 16, 2010

• CMS Releases Latest Drug Plan Data . . . Contract and Enrollment Summary . . . Enrollment by Plan . . . MA State/County Penetration . . . PDP State/County Penetration . . . MA Directory . . . PDP Directory . . . SNP Comprehensive Report
• American Benefits Council Submits Comments on Interim Final Rules on Grandfathered Health Plans
• HHS Grants Aimed at Helping States Police Insurance Rate Hikes  (Here are Statements of Baucus . . . Angoff)

Groups, Research, Resources . . .
Aug 16, 2010

• Center for Health Value Innovation Releases Paper on Framework for Outcomes-Based Contracting
• AHRQ Statistical Brief Provides Data on Chronic Conditions Among Those Under Age 40
• Group Establishes Resource Center for Hospitals Newly Eligible for 340B Drug Discount Program
• GAO Report Finds Enrollees in Consumer-Directed Health Plans Generally Had Better Health, Lower Spending

Individual Services . . .
Aug 16, 2010

• U.S. Preventive Services Task Force Seeks Comments on Recommendations for Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum
• AHRQ Technical Brief Addresses Vulnerable Atherosclerotic Plaque
• AHRQ Seeks Comments on Key Questions for Comparative Effectiveness Reviews for . . . Techniques in the Treatment of Asthma . . . Dietary Supplements for Adults Taking Cardiovascular Drugs
• A/B MAC for Jurisdiction 9 Releases New LCD for Allergy Testing
• A/B MAC for Jurisdiction 4 Posts Revised LCDs for . . . Assays for Vitamins and Metabolic Function . . . Mycotic Nail Debridement . . . Routine Foot Care 
• Comment Period Ends for A/B MAC Jurisdiction 4 Draft LCDs for . . . Vestibular and Audiologic Function Studies . . . Pulmonary Rehabilitation Programs . . . CT Coronary Angiography
• BCBS of Tennessee Posts Revised Coverage Policies for . . . Collagenase Clostridium Histolyticum for Dupuytren’s Contracture . . . Molecular Anatomic Pathology Testing

First Sweep . . .
Aug 16, 2010

• AHRQ Adds 23 Items to Quality Measures Inventory  (August 16)
• NAIC Posts Materials for Today's Session on Medicare, Other Issues
• News, Blogs, Journals

Medicare . . .
Aug 15, 2010

• CMS Posts Meeting Documents for September ICD-9 Committee Session
• CMS instructions Provide for Revisions to Present-on-Admissions Indicator
• CMS Issues Instructions on Implementation of Inpatient Rehabilitation Facility Annual Update
• CMS Instructions Address National Council for Prescription Drug Programs Code Set Updates
• 136 House Members Write Berwick on Transparency of DMEPOS Competitive Bidding

Groups, Research, Resources . . .
Aug 15, 2010

• National Coalition on Health Care Details Upcoming Health Reform Commenting Opportunities, Deadlines
• AHA Sets Town Hall on Accountable Care Organizations
• NAIC Posts Health Exchange Comments of . . . National Association of Health Underwriters . . . Tim Jost . . . Council of Insurance Agents & Brokers 
• RW Johnson Foundation-Sponsored Issue Papers Examine Massachusetts Health Reform's Effects on . . . Uninsured Adults . . . Young Adults
• National Governors Association Posts Summary of Weekly HHS Health Reform Call with State Officials
• OIG Publishes Monthly Update Report on ARRA-Related Activities

Individual Services . . .
Aug 15, 2010

• A/B MAC for Jurisdiction 14 Posts Updates to LCDs, Articles
• DME MACs Post Text of Revised Article on Oral Anticancer Drugs
• Humana Releases Revised Coverage Policies  (8/12)
• BCBS of Tennessee Adds 6 Revised Coverage Policies  (Effective 10/9)

First Sweep . . .
Aug 13, 2010

• Medical Care CPI Fell 0.1 Percent in July
• CMS Posts Updated Fact Sheets on . . . Present-on-Admission Indicators . . . Hospital-Acquired Conditions
• CMS Posts Updated Manual for Nursing Home Quality Assessments
• HHS Files Proposed Information Collection for ONC Temporary Certification Program
• News, Blogs, Journals

Insurers . . .
Aug 12, 2010

• For Session on Consumer Information, NAIC Posts . . . Agenda and Materials Packet 1 . . . Materials Packet 2 . . . Materials Packet 3
• President Obama to Address Health Reform Implementation in Remarks to NAIC National Meeting

Medicare . . .
Aug 12, 2010

• RAC for Region B Lists 18 Medical Necessity Reviews That CMS Has Approved for Audit
• CMS Posts Updated 2010 Home Health PPS PC Pricer Files

Groups, Research, Resources . . .
Aug 12, 2010

• RW Johnson Foundation/Urban Institute Analyses Address ACA's Effects on . . . Purchase of Insurance Across State Lines . . . Cost Containment . . . Medical Malpractice
• Premier Says 40 Health Systems Now Members of ACO Readiness Collaborative
• ASCO Submission to HHS Says Oncology Serves as Key "Laboratory" for the Conduct of Comparative Effectiveness Research
• Just-Released Results of June Survey Show Tightening Job Market for Radiologic Technologists
• Study Looks at Drug Price Difference in EU Market
• HHS Releases Latest Compilation of ARRA Communications Reports

Quality . . .
Aug 12, 2010

• National Quality Forum Posts Agenda for August 17 Session on Medication Safety
• Joint Commission Seeks Feedback on Revisions to Universal Protocol on Patient Safety
• NICE Announces Plans for Developing New Quality Standards for 9 Conditions

Individual Services . . .
Aug 12, 2010

• CMS Releases Final Coverage Decision Memos on . . . Ornish . . . Pritikin . . . Intensive Cardiac Rehabilitation Programs
• A/B MAC for Jurisdiction 4 Posts Revised LCDs on . . . Colony Stimulating Factors . . . Non-Chemotherapeutic Drugs and Biologicals . . . Therapy Services 
• DME MACs Post Notice of 2 Revised Policy Articles, with Additional Detail Published on Covered Diagnoses for Oral Anticancer Drugs
• Humana Posts Revised Coverage Policies  (8/5)
• DME MAC Post Additional FAQs on Power Mobility Devices

First Sweep . . .
Aug 12, 2010

• CMS Files Proposed Information Collections on ESRD, Home Health, Nursing Home Value-Based Purchasing Demo, Medicare Health Outcomes Survey
• News, Blogs, Journals

Insurers . . .
Aug 11, 2010

• American Benefits Council Seeks Feds' Guidance on Definition of "Child" for Purposes of Required Coverage of Dependents
• NAIC Posts Medical Loss Ratio Comments of . . . AARP . . . Families USA
• NAIC Posts Summary of Session on Standard Definitions for Consumer Protections

Medicare & Medicaid . . .
Aug 11, 2010

• Stabenow Letter Probes Berwick on DMEPOS Competitive Bidding
• CMS Flow Chart Depicts Requirements for Eligible Professionals to Secure EHR Medicare and Medicaid Incentive Payments
• CMS Posts Updated 2010 Part D Formulary Reference File

Groups, Research, Resources . . .
Aug 11, 2010

• Study by Weiss Ratings Finds Health Reform Could Cost Insurers More Than Expected
• Moody's Analysis Finds FY 2011 Hospital Payment Policies "An Unambiguous Credit Negative" for Non-Profits
• McKinsey Backgrounders Address  . . . HIT Landscape for Insurers . . . Hospitals' HIT Investments
• Center for Health Value Innovation Names 21 Benefits Executives as Fellows
• National Governors Association Release Summary of Weekly HHS Health Reform Call with State Officials 
• National Association of Community Health Centers Posts Audio of Session on ARRA and Health Reform with Secretary Sebelius
• HHS Posts Presentation for Training Insurers on Certain Web Portal Requirements
• GAO Report Addresses Principles of Federal Appropriations Law

Individual Services . . .
Aug 11, 2010

• A/B MAC for Jurisdiction 12 Posts 2 Revised LCDs, 1 Revised Billing Article (August 11)
• BCBS of Tennessee Posts Revised Coverage Policy for Bevacizumab for Treatment of Neoplastic Disease
• NICE Releases Draft Guidance on Treatment Options for Hepatitis C
• NICE Draft Guidance Says Omalizumab Not Recommended for Certain Asthma Indications in Children
• Large Number of Services on Agenda for September 9 Session of NICE Advisory Committee on Interventional Procedures
• A/B MAC for Jurisdiction 12 Posts Minutes of Provider Advisory Group Session