January 2010 Clinical Laboratory News: Regulatory Profiles

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January 2010: Volume 36, Number 1

CMS Now Covers HIV Screening

The Centers for Medicare & Medicaid Services (CMS) announced a final decision to cover HIV screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service. The decision became effective immediately.

Under the recently passed Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS now has the flexibility to add preventive screening tests to Medicare’s list of covered preventive services that Congress has not already deemed as covered or non-covered by law. Previously, the agency needed Congressional authorization to do so. Among other requirements, the new services must be “strongly recommended” or “recommended” by the U.S. Preventive Services Task Force. HIV screening received a “strongly recommended” for certain groups from the Task Force. More information about the new HIV screening benefit is available in CMS’s final decision memorandum on the CMS website.

Program to Validate Health IT

The Department of Health and Human Services (HHS) will make $235 million available to support a program that will seek to demonstrate the ability of health information technology to transform local healthcare systems and improve the performance of healthcare providers. HHS is hoping the program will help provide hard evidence that a health IT exchange can make a significant difference in the delivery and value of care.

The Beacon Community Program will include $220 million in grants to build and strengthen health IT infrastructure and health information exchange capabilities, including privacy and security measures for data exchange, within 15 communities. An additional $15 million will go toward technical assistance to the communities and to evaluate the success of the program.

Funded by the American Recovery and Reinvestment Act, the Beacon Community Program will aim to take the 15 communities to the cutting edge of electronic health record (EHR) adoption and health information exchange. The program will establish cooperative agreements with communities to build and strengthen their health IT infrastructure and health information exchange capabilities to improve healthcare quality, safety, efficiency, and population health. HHS expects the program to inform efforts throughout the U.S. to support the use of EHRs, the primary goal of the federal government’s new health IT initiative.

Obama Directs $600M to Community Health Centers

President Obama announced nearly $600 million in American Recovery and Reinvestment Act (ARRA) awards to support major construction and renovation projects at 85 community health centers nationwide and help networks of health centers adopt Electronic Health Records (EHR) and other Health Information Technology (HIT) systems. The awards are intended to create new job opportunities in construction and healthcare, and help provide care for about half a million additional patients in underserved communities. The President also announced a new demonstration initiative to support the delivery of advanced primary care to Medicare beneficiaries through community health centers.

To qualify for funding, a health facility must be a Federally Qualified “Community” Health Center. Grants of $508.5 million will be provided through the Facility Investment Program (FIP) program to tackle pressing health center facility needs. As much as $88 million of the money will go toward helping these providers move their medical records into electronic form. More information is available on the White House website.

Executive Order Aimed at Medicare Payment Errors

An executive order from President Obama announced a comprehensive set of policies aimed at reducing waste in federal programs, especially in Medicare. The order came on the heels of White House budget chief Peter Orzag’s announcement that Medicare and Medicaid paid out $54.2 billion in improper payments in fiscal 2009. Orzag also noted that the rate of Medicare fee-for-service errors more than doubled over the previous year, a group of providers that includes clinical labs. CMS reported a 2009 error rate of 7.8%—$24.1 billion—compared to 3.6% the year before.

Under Obama’s executive order, the director of the office of management and budget (OMB) will identify federal programs with the largest dollar amount of improper payments, then establish targets to reduce these improper payments. Other initiatives included in the order include publishing the names of government officials online who are responsible for areas with high improper payments, and establishing a working group of federal, state, and local officials to advise the director of OMB on reducing waste. A copy of the executive order is available from the White House website.

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