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President Obama has signed into law legislation extending stimulus funding to states. One of the provisions in this bill includes 16.1 billon dollars in Federal Medical Assistance Percentages (FMAP) of which, Iowa is expected to receive approximately 128 million for the state’s Medicaid program.

This comes at a great time as it will give a six month extension to the FMAP assistance from the American Recovery and Reinvestment Act of 2009, which is expected to end on December 31, 2010. This legislation helps the states as they are all experiencing shortfalls in their economies and trying to balance their budgets at the same time. Many states were going to have to cut Medicaid funding without the passage of this bill.

More information from national pharmacy organizations:

NCPA

NACDS

APhA

A U.S. District Court Judge is refusing to dismiss a lawsuit challenging the new health care reform law, asserting that Congress exceeded its authority to regulate commerce by imposing the insurance mandate. The lawsuit was filed by Virginia’s Attorney General.  The lawsuit challenges a provision of the health care reform bill, which mandates that individuals buy health insurance or pay a penalty.

In response, the federal government believes that Congress did act within its constitutional authority. They are confident that the provision in the health care reform bill is constitutional and they will ultimately prevail.

Federal Judge Won’t Dismiss Virginia Challenge to New Health Care Law

Judge Permits Virginia Health Care Suit to Proceed

Cuccinelli Pleased with Health Ruling, While Feds Express Confidence in Case

This week Senators Hagan (D- NC) and Franken (D- MN) and Representative Ross (D- AR) issued Senate and House, Dear Colleague letters, in support of this legislation. Dear Colleague letters are influential letters used within Congress to educate about the benefits of a bill to help build peer-to-peer support. Contact Senators Harkin (D) and Grassley (R) and your Congressman (Braley (D-1), Loebsack (D-2), Boswell (D-3), Latham (R-4) or King (R-5) today and encourage them to co-sponsor S 3543/HR 3108.

This bill would expand Medicare beneficiary access to MTM services. The proposed changes include:

  • Expanding the list of conditions used to determine beneficiary eligibility for MTM services.
  • Requiring prescription drug plan (PDP) sponsors to establish processes for identifying individuals who are not targeted beneficiaries for MTM services and who a pharmacist or other qualified provider determines may benefit from MTM services, allowing any such individual to be treated as a targeted beneficiary.
  • Requiring any MTM program to offer both comprehensive and targeted medication reviews at the time of initial enrollment and of a transition of care, respectively, to individuals dually eligible for both Medicare and Medicaid (regardless of whether they are MTM-targeted beneficiaries).
  • Requiring PDP sponsors to offer any willing pharmacy in its network and any other health care provider the opportunity to provide MTM services.
  • Requiring PDP sponsors to reimburse pharmacies or other qualified health care providers furnishing MTM services based on the resources used and the time required to provide such services.
  • Directing the Secretary of HHS to: (1) establish measures and standards for data collection by PDP sponsors to evaluate performance of pharmacies and other entities in furnishing MTM services; and (2) support the continued development and refinement of performance measures.
  • Providing pharmacies and other entities that furnish MTM services with additional incentive payments based on their performance in meeting quality measures established under this Act.

Pharmacists can utilize Call to Action by NACDS to send an online letter!

Patients who enroll in a health insurance plan on or after September 23, 2010 will be eligible for a long list of free preventative health services when they are delivered by a network provider. This new rule is a provision of the Affordable Care Act, in order to make wellness and prevention services more affordable, accessible, and appealing to Americans. Insurance plans will be required to cover all evidence-based preventive services that are recommended by the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices. Some of the services included are: blood pressure, diabetes, and many cancer screenings. Also included are cholesterol tests, routine vaccinations, regular well-baby and well-child visits, tobacco cessation interventions, and much more.

Not everyone agrees with the intentions of this new rule. Some concern has been shown that these services might be offered, but the next challenge will be to convince Americans to take advantage of them. Others are concerned about an increase in insurance premiums as these out-of-pocket costs are eliminated.

Sources:

New Health Insurance Plans Required to Provide Free Preventive Health Care

The Affordable Care Act’s New Rules on Preventive Care and You

Health Plans to Provide Free Preventive Care

Earlier this year, Surescripts released its National Progress Report on E-Prescribing and now data regarding e-prescribing is available at the state level. Surescripts.com contains reports which track the growth of e-prescribing adoption and use in each state for the past three years.

Surescripts operates the nation’s largest e-prescription network. The network connects prescribers in all 50 states, through their choice of e-prescribing software, to the nation’s leading payers, chain pharmacies, and independent pharmacies.

Selected highlights of the Surescripts.com website:

• Downloads and webinars containing e-prescribing information

• Daily links to the latest e-prescribing headlines

• A new interactive map of e-prescribing incentive programs by state

• An enhanced prescriber software certification table that allows a visitor to search the Surescripts certification status of all e-prescribing software by vendor, product name, and software type

• Ability to search for healthcare providers in your area who e-prescribe

The Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT have now released regulation regarding meaningful use of EHR’s. This new regulation involves the first two years (2011-2012) of a multiyear incentive program. According to David Blumenthal, National Coordinator for Health Information Technology, “the goal of the Health Information Technology for Economic and Clinical Health Act was not adoption alone, but meaningful use of electronic health records – that is, their use by providers to achieve significant improvements in care.” The legislation ties provider payments to the achievement of advances in health care processes and outcomes.

There was not a lot of movement on the implementation of EHR’s until last year when Congress and the Obama administration passed the Health Information Technology for Economic and Clinical Health Act. This act authorized incentive payments to clinicians and hospitals for Medicare and Medicaid claims when they used EHR’s privately and securely to improve health care delivery.

One of the most important aspects of meaningful use regulation is how hospitals and providers must utilize EHRs in order to be considered meaningful users in 2011-2012. The final regulation consists of two sets of objectives. First is a set of core objectives, which are a starting point for meaningful use implementation, and the second is a menu of 10 additional important activities which providers will choose 5 to implement over the 2 years. For a complete listing of the objective and menu sets, please refer to The “Meaningful Use” Regulation for Electronic Health Records.

The American Hospital Association created a document highlighting how the Patient Protection and Affordable Care Act will impact hospitals and other employers. The four key areas employers will see significant changes in are:

1) Changes requiring employers to amend their employer health plans or the way they operate or administer their plans

Included in the Patient Protection and Affordable Care Act are some employer health plan amendments which could significantly change employer health plans and change the cost to provide coverage. New provisions may cause some employers to re-structure their employer health plans. The changes include a ban on annual and life-time benefit limits and pre-existing condition limitations for children under 19. Employers must also provide a number of preventative care benefits in the health care plan, including benefits for mental health and substance abuse. Lastly, there will be new regulations banning executive-only health insurance arrangements, and a new excise tax on Cadillac, or high premium, plans that will become effective in 2018. Generally no distinction is drawn between insured and self-insured plans.

2) Changes affecting the availability and cost of health insurance

Insurance market reforms bring changes affecting insurance companies. These reforms hope to make it easier for employers to obtain and afford a health plan for their employees. Two temporary insurance programs were implemented, a reinsurance program for early retirees and a high-risk insurance program for those with pre-existing conditions. It is not known how helpful these changes will be, as some are only available to small employers (no more than 25 full-time equivalent employees) or those that provide retiree health coverage.

3) The employer health insurance mandate

The employer mandate does not require employers to provide coverage to all employees or provide a minimum level of coverage. The employer health insurance mandate allows employers to receive financial incentives to provide coverage to at least lower-income full-time employees. Health insurance exchanges will be developed to allow employers and employees easy access to the coverage available.

4) Revenue provisions and other tax changes affecting employers

The provisions in the Patient Protection and Affordable Care Act allow employers to increase revenue, but they will also require time, effort, and other related expenses on behalf of the employer. Employers will be required to report the cost of all health coverage provided to an employee on their W-2 form. This will help to enforce the excise tax on “Cadillac” health plans.

For further information, including implementation dates see the AHA Legislative Advisory: Summary of the most Significant Health Reform Changes Affecting Hospitals and other Employers

AHA Health Care Reform Implementation Timeline

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