Utah Academy of Family Physicians

Free CME Opportunity for Members

2012-02-23T00:51:00.002-08:00

Are you looking for free CME opportunities?

Human Papillomavirus (HPV) is the most common sexually transmitted disease among females. Common and serious, HPV can cause cervical cancer. Indeed, one of 40 strains of HPV infects at least 50% of sexually active people.

Learn how to protect and treat your patients exposed to HPV and hear the latest recommendations for HPV vaccination. Watch this free AAFP webcast exclusively for AAFP members.
Human Papillomavirus (HPV)
Earn .5 Prescribed CME credit.

ICD-10 Implementation Date Delay

2012-02-23T00:44:00.001-08:00

HHS Secretary Kathleen Sebelius announced that the federal government will delay, for an unspecified time, the implementation date for the ICD-10 diagnostic and procedural coding system. The move from ICD-9 to ICD-10 was set for October 1, 2013.

The financial and administrative burdens from moving to ICD-10 will affect all physicians, especially those working in small practices. One of the biggest changes for members is in the number of diagnosis codes—going from about 14,000 in ICD-9 to 69,000 in ICD-10. The delay in implementation will allow additional time for AAFP and chapters to provide more help to members as they prepare for this change in their practices.

ICD-10 resources are available, including, but not limited to, a Delta Exchange webinar and a recent "Getting Paid Blog" post dated February 16. Additional resources can be found on the AAFP website.

UAFP Legislative Report 2012 - Week 4

2012-02-21T12:32:00.001-08:00

Week four has not seen a lot of new movement on boxcarbills. The bills outlined in previous weeks legislative reports have beenprogressing along slowly. There have been a lot of discussions resulting inamendments.

Now that all the bills are numbered and have a short title,we will list those bills for you to review at the end of each weekly report.Our report will address the activity of the bills listed. Not all bills willhave activity or activity worth noting. We will be sending these updates assoon as we have them. Currently we have 96 bills we are monitoring and will bewatching them carefully. Some of the boxcar bills will never move forward butwe will still be watching them carefully.

As you review the fourth week bill summary, feel free tosend us comments or give us a call with any ideas, concerns or otherinformation you feel you can give. Continue to watch for our summary reports.

The following are the bills we worked on or that have movedforward this past week. There was a lot of discussion and contacting ofcommittee members just to see where they were at on the bills. We will continueto be focusing some of the discussions about boxcar bills again this comingweek. There are about 16 days left in the session and things will begin to movefast.

Thanks for taking the time to review the bills and sharingyour thoughts.

House Bills

HB 25 -Patient Identity Validation – Rep Barlow

HighlightedProvisions:

This bill authorizes the Department of Health toestablish methods or measures for health care providers, public healthentities, and health care insurers to coordinate among themselves to verify theidentity of the individuals they serve; and includes in the description ofgovernmental function for immunity from suit, the establishment of the methods or measures forhealth care providers, public health entities, and health care insurers tocoordinate among themselves to verify the identity of the individuals theyserve.

Status: This bill passed and is awaiting the Governors signature

UAFP Position: Support

HB 43 -Barber, Cosmetology, Electrolysis, Esthetician, Nail Technician Act – Rep.Dunnigan

Highlighted Provisions:

This bill addsan exemption from licensure in the Barber, Cosmetologist, Barber, Esthetician,Electrolysis, and Nail Technical Licensing Act for a person assisting in the productionof a motion picture under certain circumstances.

Status: Bill has passed and sent to the Governor for signature.

UAFP Position: Watch

HB 46 - Electronic Personal Medical Records – RepMenlove

HighlightedProvisions:

This bill amendsthe duties of the state Medicaid plan to enroll Medicaid beneficiaries in the electronicexchange of clinical health records unless the individual opts out;

requires theDepartment of Health to submit a waiver for the state Medicaid plan andChildren's Health Insurance Program to require beneficiaries to enroll in the electronicexchange of clinical health records;

amends the duties of the Children'sHealth Insurance Program to enroll the members of the Children's HealthInsurance Program in the electronic exchange of clinical health records unlessthe individual opts out; and

amends the duties of the PublicEmployees Health Program to require the program to enroll members in theelectronic exchange of clinical health records.

Status:Bill passed committee 5-0 with amendments. The bill requires program to haveeveryone included and then opt-out as desired. Personal information protectionis the main discussion.

UAFPPosition: Support all in with opt out which will improve success andpurpose of the bill

HB 51 - MedicalSpecialty Practices Act Amendments – Rep. Vickers

HighlightedProvisions:

This bill amendsthe duties and functions of boards that govern certain medical professions;

requires a person who wants to amendcertain medical practice acts to submit the proposed amendment to the board;and

permits theboard to make a recommendation to the Legislature concerning the proposedamendment.

Status: Bill has passed and sent to theGovernor for signature

UAFPPosition: Support with amendments.

HB 54 - Prescription Drug Access in Rural Areas

Rep.Pitcher

HighlightedProvisions:

This bill amends provisions ofthe Pharmacy Practice Act to prohibit a third party payor of prescription drugbenefits from charging a patient higher copayments for a prescription drug ifthe patient resides in a rural area of the state and chooses not to use anout-of-state mail order pharmacy.

Status:Assigned to committee and awaiting hearing.

UAFP Position – Watch

HB 55 - Health CareAssociated Infection

Rep. Draxler

Highlighted Provisions:

This bill defines terms;

requires an ambulatory surgical facility, a general acute hospital, H.an end stage renal disease facility, .H and aspecialty hospital to share with the Department of Health data on health careassociated infections that the facility submits to the National HealthcareSafety Network in the Centers for Disease Control and Prevention pursuant torequirements of the Center for Medicare and Medicaid Services;

requires the Department of Health to prepare and publicly disclose areport on

healthcare associated infection rates;

establishes a protocol for the creation of the report;

permits the report of health care associatedinfections to include data that compares and identifies facilities;

states that the report H. [ ~~shall~~ ] may .H not be used asevidence in a criminal, civil, or administrative proceeding; and makestechnical changes.

Status: Passed the House committee 8-0 and passedon the House floor 48 – 22. The Senate passed it on 2^nd reading withone more vote to come.

UAFPPosition: Watch

HB 69 -Insurance Coverage for Autism Spectrum Disorders -
Rep. Menlove

HighlightedProvisions:

This bill definesterms;

requiresthat an accident or health insurance policy that provides a health insurance benefitshall provide coverage for treatment of autism spectrum disorders;

grantsrulemaking authority to the Insurance Commissioner;

describesminimum coverage amounts and limits for the insurance coverage required by thisbill;

provides forannual adjustment of the coverage amounts based on the Consumer Price Index;and limits the coverage if the Patient Protection and Affordable Care Act's

determinationof essential health benefits would require the state to pay premium subsidiesrelated to autism coverage.

Status: Bill is being held in rules committee pending discussion betweenparties. Balance of coverage vs. increase in healthcare costs. Limited benefitsalternative question.

UAFP Position: Soft support.

HB 126 - Physician and OsteopathicMedicine Amendments -- Barlow, S.

Highlighted Provisions: This bill: amends the temporary license laws; and

restrictsrepresentations made about medical specialization.

Status: House Consent Calendar

Position: Support

HB 144 - Health SystemReform Amendments – Rep. Dunnigan

HighlightedProvisions: This bill clarifiesthe role of the All Payer Claims Database and the Utah Health Exchange relatedto prospective and retrospective risk adjusting;

makes technical amendments to theHealth Department's reports that compare quality measures;

amends provisions related tosimplified Medicaid enrollment;

authorizes an actuarial analysis ofproviding coverage options to individuals from 133% to 200% of the federalpoverty level through a basic health plan beginning in 2014;

amendsprovisions related to the benchmark plan for the dental program in the Children'sHealth Insurance Program;

allows an insurer to provide a premiumdiscount to an employer group based on participation in a wellness program;

establishesthe Legislature as the entity to determine the benchmark for an essential healthbenefit plan for the state;

clarifiesthe fees that may be charged for the use of the call center for the Utah HealthExchange;

re-authorizesthe Health System Reform Task Force;

repeals provisions that require the state to implement multipayer demonstrationprojects; and makes technical amendments.

Status:Amended in House Committee.

Position: Support

HB 190 – Nurse Midwife Practice Act Amendments – D.Brown

HighlightedProvisions:

This bill amendsprovisions related to a practice plan with a consulting physician;

amends the definition of practice as acertified nurse midwife; and amends the unprofessional conduct provisions.

Status:Passed committee unanimously and put on Consent calendar.

Position:Support

HB 240 – Medical Retainer Amendments – Rep Ivory

HighlightedProvisions: This bill definesterms;

providesthat a medical retainer agreement in which a health care provider agrees to provideroutine health care services to a patient in exchange for a prepaid fee is not ahealth benefit plan subject to regulation by the Insurance Department; and permitsa health care provider to include limited services performed by a third party inthe retainer agreement.

Status: Passed committee 9-0 House circled.

Position: Support

HB 242 -Insurance Billing for Athletic Trainers – Rep. Ray

HighlightedProvisions:

This bill amendsthe scope of practice of athletic trainers to include an athletic trainer inthe definition of health care provider under the Insurance Code so that certainhealth benefit plans cannot unfairly discriminate between athletic trainers andother health care providers that offer similar covered services; and

preservesthe exceptions to the non-discrimination requirements in the Insurance Code forhealth maintenance organizations and certain preferred provider plans.

Status: Bill not assigned to committee waiting fiscal note. We spoke with thesponsor about scope of practice issues.

UAFP Position: Watch

HB 245- Amendment to Definition of Smoking in Indoor Clean Air Act - Rep Last

HighlightedProvisions:

This bill amends the definition ofsmoking to include e-cigarettes and heated tobacco products; and definese-cigarette.

Status:Held in committee.

UAFPPosition: Support

HB 247 - Cost Sharing for Smokers Enrolled in Medicaid- Rep Ray

HighlightedProvisions:

This bill requiresthe state Medicaid program to apply for a waiver to increase the cost sharingfor enrollees who use tobacco; and if a waiver is granted, requires the stateto implement the waiver by the following July.

Status: Bill is held by committee at request of the sponsor. Bill will go nofurther according to sponsor. Discussions will be held in interim in with thebill will focus on wellness issues.

UAFP Position: Watch

HB 257 – Controlled Substance Amendments – Rep Daw

HighlightedProvisions

This bill prohibits unauthorized use ofthe controlled substance database as a means of obtaining information fromother states or a federal drug monitoring program;

provides forthe designation by a practitioner of persons who are employed by the samebusiness as the practitioner to gain access to the database at the request ofthe practitioner;

provides a procedure for an emergencyroom employee to look up information in the database for a practitioner who istreating an emergency room patient; and authorizes practitioners who enter intopain management contracts with patients to provide a record of the contract tothe division to be entered in the database.

Status:Passed committee

Position:Support

HB 272 – Pilot Program for Autism Spectrum DisordersServices – Rep Menlove

Highlighted Provisions:

Thisbill provides a funding mechanism for the autism Medicaid waiver;

directsthe state Medicaid program to develop a Medicaid waiver to provide proven

effective services for children betweenthe ages of two to six with autism spectrum

disorder;

requiresthe department to convene a public process to develop the Medicaid

waiver;

requiresthe department to measure the cost and the effectiveness of the treatments

and services for autism spectrumdisorder;

requiresthe department to report to the Legislative Health and Human Services

Interim Committee by November 30, 2013;< amendsprovisions of the Autism Treatment Account to

updateterminology used for autism treatment options;

amendthe uses of the account to focus on diagnosis and treatment of children

between the ages of two to six yearsold with autism spectrum disorders;

createa mechanism to provide and pay for services for children and to evaluate

effectiveness of treatments;

establishesa pilot program for autism services for certain children of state

employees administered by the Public Employees' Benefit andInsurance Program.

Status: Returned to rules committee

Position: Watch

H.B. 278- Arrested Persons' Health Insurance Provisions -- Daw, B.

HighlightedProvisions:

This bill appliesto health maintenance organizations and other health insurers and prohibits ahealth benefit plan from cancelling coverage of an individual who is incarceratedpending disposition of the criminal charges; and does not prohibit thatcancellation of coverage under a health benefit plan for other reasonsspecified in the health benefit plan.

Status: Rules Committee

Position: Support

Senate Bills

SB 32 - Breast Cancer Prevention Amendments – Sen. Mayne

HighlightedProvisions:

This bill S.[ ~~requires~~ ] encourages .S a facilitythat performs screening or diagnostic mammography to provide a patient who hasdense breast tissue with notice of options for additional screening.

Status:Bill has passed both house and senate and will go to signature of Governor.

UAFPPosition: Note above the change from “ requires” to “encourages”. With theoriginal language, a physician would have been required to give notice thatwould have possible liability. Met with sponsor to amend. Senator Mayne was nothappy but knew it would not pass without amendment. With amendments there waslittle opposition.

SB 40 – Medical &Osteopathic Practice Act Amendments – Sen Knudson

HighlightedProvisions:

This bill defines cosmetic medicallaser procedure;

includescosmetic medical laser procedure in the definition of the practice of

medicine;

clarifiesthat the inclusion of an ablative procedure in the definition of cosmetic medicallaser procedure does not limit other professionals' scope of practice when "operate"or "surgery" is part of the professionals' practice act;

permits thedelegation of certain cosmetic medical laser procedures by a physician;

requires supervision by a physician ifthe cosmetic medical laser procedure is

delegated;

prohibitsthe delegation of supervision when supervision is required; and

makes technicalamendments.

Status:Held in Committee

Position:Support

SB 41 – Regulation ofTanning Facilities – Sen Jones

HighlightedProvisions:

This bill amendsdefinitions;

Amends tanningfacility permit requirements;

Prohibits a tanningfacility from allowing use of its tanning device unless the facility meetsspecified requirements;

amendsrestrictions on use of a tanning facility's tanning device by a person under 18years of age;

amends tanningfacility warning sign requirements; < amends rulemaking authority;

authorizes a local healthdepartment to create requirements for obtaining a permit to operate a tanningfacility in excess ofthe minimumrequirements specified

by theUtah Department of Health;

amendspenalties;

amends restriction on local tanning facility ordinances;and makes technical changes.

Status: In Committee

Position:Support

SB 111 – HealthAmendments for Legal Immigrant children – Sen Robles

Highlighted Provisions:

This bill exercises the option toremove the five-year residency requirement for a legal immigrant child to beeligible for coverage under Medicaid or the Utah Children's Health InsuranceProgram; and

directs the Department of Health toamend the state Medicaid plan and the Utah Children's Health Insurance Programto provide coverage to an eligible legal

immigrantchild, regardless of the length of time that the child has been in the

United States.

Status:Rules Committee

Position:Watch

SCR 002 – Concurrent resolution Encourage Adv. HealthCare directives - Sen Jones

HighlightedProvisions:

This bill exercisesthe option to remove the five-year residency requirement for a legal immigrantchild to be eligible for coverage under Medicaid or the Utah Children's HealthInsurance Program and directs the Department of Health to amend the stateMedicaid plan and the Utah Children's Health Insurance Program to providecoverage to an eligible legal immigrant child, regardless of the length of timethat the child has been in the United States.

Status: Rules Committee

Position: Support

Total Bill List

House Bills

HB 25 Barlow Patient Identity Validation Support

HB 39 Dunnigan Amend. To Utah Optometry Act Watch

HB 41 Painter Property Taxation of Support

Businesspersonal property

HB 43 Dunnigan Barber, Cosmetologist. Esthetician Watch

Electrologist,and Nail Technician Act

HB 46 Menlove Electronic personal Medical records Watch

HB 51 Vickers Medical Specialty Practices Act Watch

HB 54 Pitcher Prescription Drug Access in RuralUtah Watch

HB 55 Draxler Health care Associated Infections Watch

HB 69 Menlove Insurance for Autism Spectrum Disorder Watch

HB 126 Barlow Physicial & Osteopathic MedicineAmend. Support

HB 144 Dunnigan Health Care Reform Support

HB 199 D.Brown Nurse Midwife Practices Act Support

HB 240 Ivory Medical retainer Amendments Support

HB 242 Ray Insurance Billing for Athletictrainers Watch

HB 245 Last Amend definition of Smoking Watch

HB 247 Ray Cost Sharing for Smokers inMedicaid Watch

HB 254 Froerer Controlled Substances Amendments Watch

HB 257 Daw Controlled Substance Amendments Support

HB 272 Menlove Pilot Program for Autism Watch

HB 278 Daw Arrested Persons HealthInsurance Support

HB 306 Daw Disposal of Unused PrescriptionDrugs Watch

HB 313 Anderson Local Health regulations Boxcar

HB 335 Dougall Professional Licensing Amendments Boxcar

HB 361 Duckworth Assisted Outpatient Treatment for Boxcar

Patientswith History of Noncompliance

HB 396 Bird Health Care Amendments Boxcar

HB 399 Sandstrom Physician & Osteopathic Licensing AmendBoxcar

HB 409 M.Brown Health care Cost Control Commission Boxcar

HB 426 Greenwood Hospitol Insurance Billing Boxcar

HB 434 Vickers Pharmacy practice Act modifications Boxcar

HB 437 Daw Public employee Health Carebenefits Boxcar

HB 438 Ray Cigarette & Tobacco TaxAmendments Boxcar

HB 451 Sanpei Health Care Revisions Boxcar

HB 463 Wright Medicaid InspectorGeneral Boxcar

HB 475 Ray Medicaid Amendments Boxcar

HB 487 Herrod Hospice Pharmacy Dispensing of Meds Boxcar

HB 496 Ray Mental health practice ActAmendments Boxcar

HB 498 Butterfield Medicaid Amendments Boxcar

Senate Bills

SB 13 Christensen Medical Examiner Amendments Watch

SB 32 Mayne Breast Cancer Prevention Amendments Support

SB 40 Knudson Medical & Osteopathic Practices Act Watch

SB 41 Jones Regulation of Tanning Facilities Support

SB 53 Davis Recreational Therapy Practice Act Am. Watch

SB 55 Weiler Amendmentsd toAdoption Watch

SB 62 Hillyard Cigarette Tax Restricted Account Rev. Watch

SB 85 Christensen Medicaid Cost Control Amendments Watch

SB 88 Bramble Pharmacy Distribution Amendments Watch

SB 98 Hillyard Prohibited Use of Wireless Device & Drive Watch

SB 106 Hillyard Tobacco Settlement Account Funds Watch

SB 111 Robles Health Amendments for legal Support

ImmigrantChildren

SB 123 Knudson Pharmacy Practice Act Amendments Watch

SB 127 Jones Controlled Substaances Prescriber Support

Training

SB 128 Romero Wireless Phone Use restrictions Support

ForMinors in Vehicles

SB 138 Weiler Health insurance MandateAccountability Watch

SB 190 Valentine Sales & Use tax Exemptions for Boxcar

Research& Development

SB 208 Adams Healthcare Compact Boxcar

SB 220 Christensen Hospital & Health care Provider Amend Boxcar

SB 258 Hillyard Underage Drinking prevention Campaign Boxcar

SB 266 Urquhart Health Care Modifications Boxcar

SB 276 Neiderhauser Cigarette Tax Amendments Boxcar

SB 279 Osmond Health Funding Priorities Boxcar

SCR 2 Jones Res. Encourage Adv. Health careDirective Support

SCR 4 Mayne Resolution on breastCancer Screening Watch

Atlantic Health Partners Can Help Your Practice with the 2012-13 Flu Season

2012-02-16T09:11:00.000-08:00

Atlantic Health Partners offers Utah AFP members the overall best purchasing terms for Sanofi’s Fluzone, Merck’s Afluria, and MedImmune’s Flumist. As the leading vaccine buying group in the country, Atlantic can assist your practice with reserving flu doses for the upcoming flu season, including Sanofi’s High-Dose and Intradermal Fluzone.

Furthermore, Atlantic provides our members with the lowest costs for the complete spectrum of Sanofi and Merck vaccines. Thousands of physicians nationwide have seen how Atlantic can improve the financial and operational practice performance of providing immunizations to your patients.

In addition Atlantic offers a unique program that enables physicians to provide vaccines like Zostavax to Medicare Part D patients with fair and timely reimbursement.

We encourage you to contact Atlantic to determine how their program can be of benefit to your practice. You can reach Jeff or Cindy at 1-800-741-2044 (Eastern Time) or at info@atlantichealthpartners.com

UAFP Legislative Report 2012 - Week Two

2012-02-06T20:00:00.000-08:00

By legislative rule, all bills are now numbered. Most do not have any language but are listed by bill number and short title. The short title will inform us of what the subject is in the bill. This is commonly called a boxcar bill meaning no language is available. It can also be a signal to other legislators or industries that there may be intent to address another subject or if another bill already numbered fails, then there is another opportunity to get something passed.

Now that all the bills are numbered and have a short title, we will list those bills for you to review at the end of each weekly report. Our report will address the activity of the bills listed. Not all bills will have activity or activity worth noting. We will be sending these updates as soon as we have them. Currently we have 46 bills we are monitoring and will be watching them carefully.

As you review the second week bill summary, feel free to send us comments or give us a call with any ideas, concerns or other information you feel you can give. Continue to watch for our summary reports.

The following are the bills we worked on this past week. There was a lot of discussion and contacting of committee members just to see where they were at on the bills. We will be focusing some discussions about boxcar bills this coming week.

Thanks for taking the time to review the bills and sharing your thoughts.

House Bills

HB25 - Patient Identity Validation – Rep Barlow

Highlighted Provisions:

This bill authorizes the Department of Health to establish methods or measures for health care providers, public health entities, and health care insurers to coordinate among themselves to verify the identity of the individuals they serve; and includes in the description of governmental function for immunity from suit, the establishment of the methods or measures for health care providers, public health entities, and health care insurers to coordinate among themselves to verify the identity of the individuals they serve.

Status: This bill was a committee bill and has now had a Senate committee hearing. The bill was passed in the House 51-17 and is now in the Senate for vote.

UAFP Position: Support

HB41 - Property Taxation of Business Personal Property – Rep. Painter

Highlighted Provisions:

This bill increases and expands a property tax exemption for business personal property and makes technical and conforming changes. Provides that the first $25,000 of taxable tangible personal property of a taxpayer is exempt from taxation rather than only the first $3,500.

Status: Bill is being held in committee for possible amendments. Will impact what physicians pay on taxes for furnishings and equipment in your office.

UAFP Position: Support

HB43 - Barber, Cosmetology, Electrolysis, Esthetician, Nail Technician Act – Rep. Dunnigan

Highlighted Provisions:

This bill adds an exemption from licensure in the Barber, Cosmetologist, Barber, Esthetician, Electrolysis, and Nail Technical Licensing Act for a person assisting in the production of a motion picture under certain circumstances.

Status: Bill was a committee bill during interim. Bill passed the House 70-0. Bill passed committee and is now on the Senate 2^nd reading calendar.

UAFP Position: Watch

HB46 - Electronic Personal Medical Records – Rep Menlove

Highlighted Provisions:

This bill amends the duties of the state Medicaid plan to enroll Medicaid beneficiaries in the electronic exchange of clinical health records unless the individual opts out;

requires the Department of Health to submit a waiver for the state Medicaid plan and Children's Health Insurance Program to require beneficiaries to enroll in the electronic exchange of clinical health records;

amends the duties of the Children's Health Insurance Program to enroll the members of the Children's Health Insurance Program in the electronic exchange of clinical health records unless the individual opts out; and

amends the duties of the Public Employees Health Program to require the program to enroll members in the electronic exchange of clinical health records.

Status: Bill is being held in committee. Issues holding it up is whether the program should be to ask for op-in or to have everyone included and then opt-out as desired. Personal information protection is the main discussion.

UAFP Position: Support

HB51 - Medical Specialty Practices Act Amendments – Rep. Vickers

Highlighted Provisions:

This bill amends the duties and functions of boards that govern certain medical professions;

requires a person who wants to amend certain medical practice acts to submit the proposed amendment to the board; and

permits the board to make a recommendation to the Legislature concerning the proposed amendment.

Status: Passed out of committee 5-2 and passed the house floor 40-31 with 4 different amendments. It now passed the senate committee 3-0 and will go to the full Senate for vote.

UAFP Position: Watch

HB54 Prescription Drug Access in Rural Areas - Rep. Pitcher

Highlighted Provisions:

This bill amends provisions of the Pharmacy Practice Act to prohibit a third party payor of prescription drug benefits from charging a patient higher copayments for a prescription drug if the patient resides in a rural area of the state and chooses not to use an out-of-state mail order pharmacy.

Status: Awaiting fiscal note.

UAFP Position: Watch

HB55 Health Care Associated Infection - Rep. Draxler

Highlighted Provisions:

This bill defines terms;

requires an ambulatory surgical facility, a general acute hospital, H. an end stage renal disease facility, .H and a specialty hospital to share with the Department of Health data on health care associated infections that the facility submits to the National Healthcare Safety Network in the Centers for Disease Control and Prevention pursuant to requirements of the Center for Medicare and Medicaid Services;

requires the Department of Health to prepare and publicly disclose a report on

health care associated infection rates;

establishes a protocol for the creation of the report;

permits the report of health care associated infections to include data that compares and identifies facilities;

states that the report H. [ shall ] may .H not be used as evidence in a criminal, civil, or administrative proceeding; and makes technical changes.

Status: Passed the House committee 8-0 and passed on the House floor 48 – 22. It now goes on to the Senate committee.

UAFP Position: Watch

HB69 - Insurance Coverage for Autism Spectrum Disorders - Rep. Menlove

Highlighted Provisions:

This bill defines terms;

requires that an accident or health insurance policy that provides a health insurance benefit shall provide coverage for treatment of autism spectrum disorders;

grants rulemaking authority to the Insurance Commissioner;

describes minimum coverage amounts and limits for the insurance coverage required by this bill;

provides for annual adjustment of the coverage amounts based on the Consumer Price Index; and limits the coverage if the Patient Protection and Affordable Care Act's

determination of essential health benefits would require the state to pay premium subsidies related to autism coverage.

Status: Bill is being held pending discussion between parties. Balance of coverage vs. increase in healthcare costs. Limited benefits alternative question.

UAFP Position: Watch

HB242 - Insurance Billing for Athletic Trainers – Rep. Ray

Highlighted Provisions:

This bill amends the scope of practice of athletic trainers to include an athletic trainer in the definition of health care provider under the Insurance Code so that certain health benefit plans cannot unfairly discriminate between athletic trainers and other health care providers that offer similar covered services; and

preserves the exceptions to the non-discrimination requirements in the Insurance Code for health maintenance organizations and certain preferred provider plans.

Status: Bill not assigned to committee waiting fiscal note. We spoke with the sponsor about scope of practice issues.

UAFP Position: Oppose.

HB245 -Amendment to Definition of Smoking in Indoor Clean Air Act - Rep Last

Highlighted Provisions:

This bill amends the definition of smoking to include e-cigarettes and heated tobacco products; and defines e-cigarette.

Status: Held in committee. May come out in week 3.

UAFP Position: Support

HB247 - Cost Sharing for Smokers Enrolled in Medicaid - Rep Ray

Highlighted Provisions:

This bill requires the state Medicaid program to apply for a waiver to increase the cost sharing for enrollees who use tobacco; and if a waiver is granted, requires the state to implement the waiver by the following July.

Status: Bill is held by committee at request of the sponsor.

UAFP Position: Watch

Senate Bills

SB32 - Breast Cancer Prevention Amendments – Sen. Mayne

Highlighted Provisions:

This bill S. [ requires ] encourages .S a facility that performs screening or diagnostic mammography to provide a patient who has dense breast tissue with notice of options for additional screening.

Status: Bill has passed both house and senate and will go to signature of Governor.

UAFP Position: Support. Note above the change from “ requires” to “encourages”. With the original language, a physician would have been required to give notice that would have possible liability. Met with sponsor to amend. Senator Mayne was not happy but knew it would not pass without amendment. With amendments there was little opposition.

Total Bill List

House Bills

HB 25 Barlow Patient Identity Validation Support

HB 39 Dunnigan Amend. To Utah Optometry Act Watch

HB 41 Painter Property Taxation of Support

Business personal property

HB 43 Dunnigan Barber, Cosmetologist. Esthetician Watch

Electrologist, and Nail Technician Act

HB 46 Menlove Electronic personal Medical records Watch

HB 51 Vickers Medical Specialty Practices Act Watch

HB 54 Pitcher Prescription Drug Access in Rural Utah Watch

HB 55 Draxler Health care Associated Infections Watch

HB 69 Menlove Insurance for Autism Spectrum Disorder Watch

HB 242 Ray Insurance Billing for Athletic trainers Watch

HB 245 Last Amend definition of Smoking Watch

HB 247 Ray Cost Sharing for Smokers in Medicaid Watch

HB 254 Froerer Controlled Substances Amendments Watch

HB 306 Daw Disposal of Unused Prescription Drugs Watch

HB 313 Anderson Local Health regulations Boxcar

HB 335 Dougall Professional Licensing Amendments Boxcar

HB 361 Duckworth Assisted Outpatient Treatment for Boxcar

Patients with History of Noncompliance

HB 396 Bird Health Care Amendments Boxcar

HB 399 Sandstrom Physician & Osteopathic Licensing Amend Boxcar

HB 409 M.Brown Health care Cost Control Commission Boxcar

HB 426 Greenwood Hospital Insurance Billing Boxcar

HB 434 Vickers Pharmacy practice Act modifications Boxcar

HB 437 Daw Public employee Health Care benefits Boxcar

HB 438 Ray Cigarette & Tobacco Tax Amendments Boxcar

HB 451 Sanpei Health Care Revisions Boxcar

HB 463 Wright Medicaid Inspector General Boxcar

HB 475 Ray Medicaid Amendments Boxcar

HB 487 Herrod Hospice Pharmacy Dispensing of Meds Boxcar

HB 496 Ray Mental health practice Act Amendments Boxcar

HB 498 Butterfield Medicaid Amendments Boxcar

Senate Bills

SB 13 Christensen Medical Examiner Amendments Watch

SB 32 Mayne Breast Cancer Prevention Amendments Support

SB 40 Knudson Medical & Osteopathic Practices Act Watch

SB 55 Weiler Amendments to Adoption Watch

SB 106 Hillyard Tobacco Settlement Account Funds Watch

SB 111 Robles Health Amendments for legal Watch

Immigrant Children

SB 123 Knudson Pharmacy Practice Act Amendments Watch

SB 127 Jones Controlled Substaances Prescriber Support

Training

SB 128 Romero Wireless Phone Use restrictions Support

For Minors in Vehicles

SB 138 Weiler Health insurance Mandate Accountability Watch

SB 190 Valentine Sales & Use tax Exemptions for Boxcar

Research & Development

SB 208 Adams Healthcare Compact Boxcar

SB 266 Urquhart Health Care Modifications Boxcar

SB 276 Neiderhauser Cigarette Tax Amendments Boxcar

SB 279 Osmond Health Funding Priorities Boxcar

UAFP Legislative Report 2012 - Week One

2012-01-27T17:24:00.000-08:00

This year’s session started out like never before. Committee meetings began on Tuesday of this week and all the bills outlined below were ina committee or special meeting for discussion. I don’t remember any year wherethe committees were scheduled and reviewed so many bills so soon. Usually thereare a lot of cancelled committees waiting for assignments of bills.

The following are the bills we worked on the first 4 days ofthe session. There was a lot of discussion and contacting of committee membersjust to see where they were at on the bills.

As you review the first week bill summary, feel free to email or give us a call with any ideas, concerns or other information youfeel you can give. Continue to watch forour summary reports. There are another 35 to 40 more bills that are notnumbered yet and will be making their way out.

Thanks for taking the time to review them and your thoughts.

House Bills

HB 25 -Patient Identity Validation – Rep Barlow

HighlightedProvisions:

This bill authorizes the Department of Health toestablish methods or measures for health care providers, public healthentities, and health care insurers to coordinate among themselves to verify theidentity of the individuals they serve; and includes in the description ofgovernmental function for immunity from suit the establishment of the methods or measures forhealth care providers, public health entities, and health care insurers tocoordinate among themselves to verify the identity of the individuals theyserve.

Status: This bill was a committee bill and had committee hearings duringinterim. The bill was passed in the House 51-17 and is now in the Senate forvote.

UAFP Position: Support

HB 55- Healthcare Associated Infections – Rep. Draxler

HIghlightedProvisions:

This bill definesterms; requires an ambulatory surgical facility, a general acute hospital, an end stage renal disease facility, and a specialty hospital to sharewith the Department of Health data on health care associated infections that thefacility submits to the National Healthcare Safety Network in the Centers forDisease Control and Prevention pursuant to requirements of the Center for Medicareand Medicaid Services;

requires the Department of Health toprepare and publicly disclose a report on health care associated infectionrates;

establishesa protocol for the creation of the report;

permits thereport of health care associated infections to include data that compares and identifiesfacilities;

states thatthe report may not be used as evidence in a criminal, civil, or administrativeproceeding; and makes technical changes.

Status:Passed the House committee 8-0

UAFPPosition: Watch

HB 41 - Property Taxation of Business PersonalProperty – Rep. Painter

Highlighted Provisions:

This bill increasesand expands a property tax exemption for business personal property and makestechnical and conforming changes. Provides that the first $25,000 of taxable tangible personal property of ataxpayer is exempt from taxation rather than only the first $3,500.

Status: Bill is being held in committeefor possible amendments. Will impact what physicians pay on taxes forfurnishings and equipment in your office.

UAFP Position: Support

HB 43 - Barber,Cosmetology, Electrolysis, Esthetician, Nail Technician Act – Rep. Dunnigan

Highlighted Provisions:

This bill addsan exemption from licensure in the Barber, Cosmetologist, Barber, Esthetician, Electrolysis,and Nail Technical Licensing Act for a person assisting in the production of amotion picture under certain circumstances.

Status: Bill was a committee bill during interim. Bill passed the House 70-0.Bill is now over in the Senate.

UAFP Position: Watch

HB 46 - Electronic Personal Medical Records – RepMenlove

HighlightedProvisions:

This bill amendsthe duties of the state Medicaid plan to enroll Medicaid beneficiaries in the electronicexchange of clinical health records unless the individual opts out;

amends the duties of the PublicEmployees Health Program to require the program to enroll members in theelectronic exchange of clinical health records.

Status:Bill is being held in committee. Issues holding it up is whether the programshould be to ask for op-in or to have everyone included and then opt-out asdesired. Personal information protection is the main discussion.

HB 51 - MedicalSpecialty Practices Act Amendments – Rep. Vickers

HighlightedProvisions:

This bill amendsthe duties and functions of boards that govern certain medical professions;

requires a person who wants to amendcertain medical practice acts to submit the proposed amendment to the board;and

permits theboard to make a recommendation to the Legislature concerning the proposedamendment.

Status: Passed out of committee 5-2 and is now on the House calendar.

HB 69 -Insurance Coverage for Autism Spectrum Disorders - Rep.Menlove

HighlightedProvisions:

This bill defines terms;

requiresthat an accident or health insurance policy that provides a health insurance benefitshall provide coverage for treatment of autism spectrum disorders;

grantsrulemaking authority to the Insurance Commissioner;

describesminimum coverage amounts and limits for the insurance coverage required by thisbill;

provides forannual adjustment of the coverage amounts based on the Consumer Price Index;and limits the coverage if the Patient Protection and Affordable Care Act's

determinationof essential health benefits would require the state to pay premium subsidiesrelated to autism coverage.

Status: Billis being held pending discussion between parties. Balance of coverage vs.increase in healthcare costs. Limited benefits alternative question.

HB 24 -Insurance Billing for Athletic Trainers – Rep. Ray

HighlightedProvisions:

This bill amendsthe scope of practice of athletic trainers to include an athletic trainer in thedefinition of health care provider under the Insurance Code so that certainhealth benefit plans cannot unfairly discriminate between athletic trainers andother health care providers that offer similar covered services; and

preservesthe exceptions to the non-discrimination requirements in the Insurance Code forhealth maintenance organizations and certain preferred provider plans.

Status: Bill not assigned to committee yet. We spoke with the sponsor aboutscope of practice issues.

HB 242 -Amendmentto Definition of Smoking in Indoor Clean Air Act - Rep Last

HighlightedProvisions:

This bill amends the definition ofsmoking to include e-cigarettes and heated tobacco products; and definese-cigarette.

Status:Held in committee

HB 247 - Cost Sharing for Smokers Enrolled in Medicaid- Rep Ray

HighlightedProvisions:

This bill requiresthe state Medicaid program to apply for a waiver to incease the cost sharingfor enrollees who use tobacco; and if a waiver is granted, requires the stateto implement the waiver by the following July.

Status: Bill is held by committee.

Senate Bills

SB 13 - Medical Examiner Amendments - Sen. Christensen

SB 32 - Breast Cancer Prevention Amendments – Sen. Mayne

HighlightedProvisions:

Status:Passed Senate committee to Senate calendar as amended.

UAFPPosition: Note above the change from “ requires” to “encourages”. With theoriginal language, a physician would have been required to give notice whichwould have possible liability. Met with the sponsor to amend.

In the News Today - An Rx? Pay More to Family Doctors.

2012-01-27T16:00:00.000-08:00

A recent article from today's Wall Street Journal showed that one of America's largest health care providers is looking at providing a 10% pay increase to Primary Care doctors in anticipation that this will decrease the amount of emergency room visits and hospital stays. The article states

"Health-policy experts have long faulted the U.S. health-care system for placing too little value on traditional primary care, the front-line medical work that ranges from immunizing children to ensuring that diabetics get their blood-sugar tests. They also say that the current fee system, which sometimes fails to reward such services as planning outpatient care after a hospital stay, leads to bigger bills and worse results for patients."

Patient Centered Medical Home - Grand Rounds

2012-01-27T12:00:00.000-08:00

You are cordially invited to attend a special session of Family Medicine Ground Rounds, Wednesday, February 15, 2012, from 8 AM to 9 AM in the University Guest House Douglas Ballroom. The guest speaker will be Paul Grundy, MD, speaking on “Patient Centered Medical Home – 2012.” Please see the attached announcement and map for the event’s location and parking convenience.

University of Utah Health Care is preparing for health delivery and payment transformation. The Patient Centered Medical Home(PCMH) is a recognized part of health care delivery reform. Dr. Grundy is IBM Corporation’s Global Director, IBM Healthcare Transformation. He also serves as the President of the Patient Centered Primary Care Collaborative (PCPP). He is the premier leader nationally in advancing development of PCMH across the country.

As seating is limited, please reply to Gayle Kartchner (gayle.kartchner@hsc.utah.edu) to confirm your attendance by February 8^th.

ABFM Update Regarding 'Board Eligibility'

2012-01-25T23:53:00.000-08:00

The term ‘board eligible’ has never been recognized by member boards of the American Board of Medical Specialties (ABMS), including the American Board of Family Medicine (ABFM), but the term continues to be used by credentialing organizations and others to recognize non-certified physicians as having equivalent status. In practice, no limit exists on how long a non-certified physician could remain board eligible. The abuse of the board eligible term and status perpetuated the ability of poorly qualified physicians to practice outside of their initial certification with a risk to patients and resulted in a lack of relationship between the initial certifying examination and training as a concurrent/synergistic measure of physician competency.

In an effort to resolve this confusion for the credentialers and the patients, all member boards of the ABMS agreed to establish parameters under which non-certified physicians could actually be recognized as being board eligible and to further define the time limit for such board eligible status.

The ABFM Board of Directors decided at its meeting in October, 2011 that it would define board eligibility as the first seven years after loss of certification or the completion of an ACGME accredited residency training program. Therefore, beginning January 1, 2012, a physician will have seven years in which to successfully complete his or her initial certification examination after completing training or, if previously certified, will have seven years after the loss of certification to successfully complete the examination.

During this seven-year period, these board eligible physicians will have to continue to meet the ongoing requirements to sit for the examination and must maintain a full, valid, and unrestricted license. After this seven-year period, the physician will lose the ability to refer to himself or herself as board eligible and will need to re-enter training and complete at least one year of additional training in an ACGME accredited family medicine residency before he or she will be allowed to reapply to sit for the examination. This rule will be effective January 1, 2012, and as further details of the program are developed they will be published.

For questions regarding the board eligibility, Diplomates may contact the Support Center at 877-223-7437 orhelp@theabfm.org.

CMS Medicare FFS Provider e-News for Tue Jan 24

2012-01-24T18:07:00.000-08:00

The e-News for the week of Tue Jan 24 includes… National Provider Calls § Wed Jan 25 – National Provider Call: Medicare FFS Implementation of HIPAAVersion 5010 and D.0 Transactions – Last Chance to Register Announcements and Reminders § Third Anniversary of ICD-10 Rule § New Information on the Appeals Process for Medicare and Medicaid EHR Incentive Programs on the EHR Website § New Webcast for Round 2 and National Mail-Order Bidders Now Available § CMS to Release Comparative Billing Report on Advanced Diagnostic Imaging § Flu Season is Here! Get the Flu Vaccine – Not the Flu Claims, Pricer, and Code Updates § Medicare FFS Version 5010 Requirement Changes for Non-Specific Procedure Codes § Update to the Primary Care Incentive Payment Program for Critical Access Hospital Providers Paid Under Optional Method § Updates to “Intern and Resident Information System (IRIS)” Software § Outpatient Prospective Payment System CY2012 Pricer File Update § January 2012 Quarterly Provider-Specific Files Available Updates from the Medicare Learning Network ® § “Medicare Quarterly Provider Compliance Newsletter [Volume 2, Issue 2]” Released § “Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers” MLN Matters Article Released § “Additional HIPAA 837 5010 Transitional Changes and Further Modifications to COBA National Crossover Process” MLN Matters Article Revised § “Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims” MLN Matters Article Revised § “Medicare Physician Fee Schedule” Fact Sheet Revised § “Ambulatory Surgical Center Fee Schedule” Fact Sheet Revised § “Hospital Value-Based Purchasing Program” Fact Sheet Available in Hardcopy

*National Provider Call: Medicare FFS Implementation of HIPAA* Version 5010 and D.0 Transactions – Last Chance to Register** Wed Jan 25; 2-3:30pm ET CMS will host a special National Provider Call regarding the Medicare FFS implementation of HIPAA Version 5010 and D.0 transaction standards. Target Audience: Vendors, clearinghouses, and providers who need to make Medicare FFS-specific changes in compliance with HIPAA Version 5010 requirements. Agenda (there will be no slide presentation for this call): § HIPAA Version 5010 implementation update § Question & answer session If you would like to submit a question related to this topic in advance of, during, or following the call, please email your inquiry to the 5010 FFS Information resource mailbox at 5010FFSinfo@CMS.hhs.gov. Note that this resource box will only accept emails the day before, the day of, and the day after this call; your emailed questions will be answered as soon as possible, and may not be answered during the call. Registration Information: In order to receive the call-in information, you must register for the call. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early. For more details, including instructions on registering for the call, please visithttp://www.eventsvc.com/blhtechnologies.

Third Anniversary of ICD-10 Rule

Three years ago – on Fri Jan 16, 2009 – the US Department of Health and Human Services published final rules mandating that all organizations covered by HIPAA upgrade to Version 5010 by Sun Jan 1, 2012 and transition to ICD-10 coding sets by Tue Oct 1, 2013. As a result of the enforcement discretion period for Version 5010, all organizations must complete their Version 5010 upgrade by no later than Sat Mar 31, 2012. Upgrading to Version 5010 is an important step to take before transitioning to ICD-10, which is quickly approaching.

To help with this transition, CMS has developed a number of resources, which available on the CMS ICD-10 website. These resources include:

Factsheets, including Ensuring a Smooth Transition to Version 5010, ICD-10 Transition: An Introduction,ICD-10 Basics for Medical Practices, ICD-10 FAQS, and Talking to Your Vendors about the Transition to ICD-10.
An Implementation Widget, which outline the steps to take to ensure compliance with Version 5010 and ICD-10, available in a widget format. CMS encourages you to download or share the widget and take advantage of printer-friendly versions of the timelines available for small provider practices, large provider practices, payers, and vendors.
Timelines, including printer-friendly checklists that complement the widget and which are available for small providers, large providers, payers, and vendors.

Keep Up to Date on Version 5010 and ICD-10. Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!

New Information on the Appeals Process for Medicare and Medicaid EHR Incentive Programs on the EHR Website

CMS has added new information to the Attestation section of the EHR website about the appeals process for the Medicare and Medicaid Electronic Health Records (HER) Incentive Programs.

On Thu Dec 1, 2011, CMS began accepting appeals for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs). To help EPs, eligible hospitals, and CAHs, the CMS Office of Clinical Standards and Quality (OCSQ) is providing guidance on how to file an appeal. Note that the filing deadline for an eligibility appeal for an eligible hospital has been extended from Fri Dec 30, 2011, to Mon Jan 30, 2012.

OCSQ’s Division of Health Information Technology released the first informal review decision for the EHR Incentive Program on Mon Jan 19. Beginning in February, this informal review decision and other appeal decisions will be posted on the OCSQ Appeals website. Starting in March, providers may find their decisions by visiting the Appeals Portal.

For general questions and for information on how to file an appeal, EPs, eligible hospitals, CAHs, and Medicare Advantage Organizations may contact OCSQ’s designated appeal support contractor, Provider Resources Inc, at:

§ Toll-free number: 855-796-1515 (Between 9am and 5pm ET, Monday through Friday), or

§ Email: OCSQappeals@provider-resources.com

Want more information about the EHR Incentive Programs? Visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

New Webcast for Round 2 and National Mail-Order Bidders Now Available [↑]

A new educational webcast for the Round 2 and national mail-order competitions of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program is now available on the Competitive Bidding Implementation Contractor (CBIC) website at www.DMECompetitiveBid.com. This webcast, titled “How a Bid is Evaluated,” goes over each step of the bid evaluation process, from receipt of electronic bid data and hardcopy documents through awarding of contracts. The webcast also provides resources to assist you with bidding.

This webcast is available on demand to view at your convenience – 24 hours a day, seven days a week. There is no charge to view the webcast, and a transcript is also posted on the website. To view the webcast, please visit the CBIC website, select Bidding Suppliers: Round 2 & National Mail-Order, and choose Education Events.

We will be issuing more webcasts later in the bidder education program. Upcoming webcasts will address topics such as financial documentation requirements and how to submit a bid in the online bidding system, DBidS. As each webcast is posted, we will announce its availability with an email update. If you have not already done so, please register on the CBIC website to receive these announcements and other updates about the competitive bidding program.

If you have any questions or need assistance, please contact the CBIC customer service center toll-free at 877-577-5331 from 9am to 9pm (prevailing Eastern Time), Monday through Friday, throughout the registration and bidding periods.

CMS to Release Comparative Billing Report on Advanced Diagnostic Imaging

On Thu Feb 16, CMS will release a national provider Comparative Billing Report (CBR) addressing Advanced Diagnostic Imaging.

CBRs, produced by Safeguard Services under contract with CMS, contain actual data-driven tables and graphs with an explanation of findings that compare a provider’s billing and payment patterns to those of their peers located in their state and across the nation.

These reports are not available to anyone except the providers who receive them. To ensure privacy, CMS presents only summary billing information; no patient or case-specific data is included. These reports are an example of a tool that helps providers better understand applicable Medicare billing rules and improve the level of care they furnish to their Medicare patients. CMS has received feedback from a number of providers that this kind of data is very helpful to them and encouraged us to produce more CBRs and make them available to providers.

For more information and to review a sample of the Advanced Diagnostic Imaging CBR, please visit the CBR Services website at www.CBRservices.com or call the SafeGuard Services’ Provider Help Desk, CBR Support Team at 530-896-7080.

Flu Season is Here! Get the Flu Vaccine – Not the Flu

While seasonal flu outbreaks can happen as early as October, flu activity usually peaks in January. Remind your patients that annual vaccination is recommended for optimal protection. Medicare pays for the seasonal flu vaccine and its administration for seniors and others with Medicare with no co-pay or deductible. Healthcare workers, who may spread the flu to high-risk patients, should get vaccinated too. Don’t forget to immunize yourself and your staff. Protect your patients. Protect your family. Protect yourself.

Remember – The flu vaccine plus its administration are covered Part B benefits. CMS has posted the 2011-2012 seasonal flu vaccine payment limits at http://www.CMS.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp. Note that the flu vaccine is NOT a Part D-covered drug.

For more information on coverage and billing of the flu vaccine and its administration, as well as related educational provider resources, visit http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp andhttp://www.CMS.gov/immunizations.

Medicare FFS Version 5010 Requirement Changes for Non-Specific Procedure Codes [↑]

Medicare Fee-for-Service (FFS) has amended the Not-Otherwise-Classified (NOC) code set listing effective Mon Jan 16, 2012. Thus, it has been determined that anesthesia codes that include the phrase “not otherwise specified” in their code descriptors (procedure codes 00100 through 01996) do not meet the criteria of a non-specified procedure code and do not require a description to be supplied in the SV101-7/SV202-7 data elements. Anesthesia procedure code 01999, “Unlisted anesthesia procedure(s)” meets the requirements of a non-specified code and continues to require additional information to be supplied in the SV101-7 data element.

Additionally, various pathology and laboratory codes identified in procedure code section 8800 and a variety of other NOC codes have been removed. These codes do not meet the criteria of a non-specified procedure code and do not require a description to be supplied in the SV101-7/SV202-7 data elements.

The majority of procedure codes impacted and removed from the NOC code list are anesthesia codes, laboratory/pathology codes, and Physicians Quality Reporting System codes.

Medicare FFS’s complete listing of the NOC codes can be found athttp://www.CMS.gov/ElectronicBillingEDITrans/40_FFSEditing.asp. Medicare will be updating the code set, at minimum, on a quarterly basis (January, April, July, and October) as the NOC list is refined and the parent code sets are updated. Please check back to the website frequently for the most updated list.

For more information on Version 5010 and D.0, please visit http://www.CMS.gov/Versions5010andD0.

Ø Additional material related to HIPAA Version 5010 in today’s e-News… [next / previous]

Update to the Primary Care Incentive Payment Program for Critical Access Hospital Providers Paid Under Optional Method

On Tue Nov 15, 2011, CMS issued a listserv message with billing instructions for Critical Access Hospitals (CAHs) paid under the Optional Method regarding the Primary Care Incentive Payment (PCIP) Program. The message instructed CAH providers to continue submitting their National Provider Identifiers (NPIs) using the “other provider” field located in loop 2310C on the current electronic claim format.

After further research, CMS has determined that, in addition to reporting the NPI in loop 2310C, CAH providers will need to report the same NPI as well as the information that is required in loop 2310B defined as “operating physician.” This will ensure CAH claims submitted using the Accredited Standards Committee (ASC X12) version 5010A2 will continue to receive their PCIP bonus without any interruption.

Change Request 7686 has been created and will be implemented by contractors to update the Medicare systems to assign the PCIP bonus payments based on the NPI from loop 2310D, “rendering physician.” However, until the successful implementation of CR7686 – expected to take place in July – the reporting of the NPI for the PCIP bonus payments should continue as described above.

Updates to “Intern and Resident Information System (IRIS)” Software

The provider community and teaching hospitals shall take notice of three updated files (medical school codes, residency type codes, and IRISV3 Operating Instructions as of December 2011) in the IRIS software programs (IRISV3 and IRISEDV3) for collecting and reporting information on resident training in hospital and non-hospital settings:

§ CMS added sixty-two new IRIS residency type codes to the IRIS Residency Code Table; forty-seven of these codes are revised codes for forty-eight obsolete allopathic and osteopathic residency type codes. Providers may begin using the revised codes for cost reporting periods beginning before Sun July 1, 2012; however, these codes shall be used for cost-reporting periods beginning on or after Sun July 1, 2012.

§ CMS also added fifteen new IRIS medical school codes to the IRIS Medical School Code Table.

§ Providers may begin using the new medical school and residency type codes in the IRIS programs for cost reporting periods ending on or after Fri Sep 30, 2011.

The IRIS programs are available for download at http://www.CMS.gov/IRIS.

Outpatient Prospective Payment System CY2012 Pricer File Update

The Outpatient Prospective Payment System (OPPS) Pricer webpage was recently updated to include the January 2012 update for outpatient provider data. The updated files are ready for download from the Outpatient PPS Pricer webpage at http://www.CMS.gov/PCPricer/OutPPS/itemdetail.asp?itemID=CMS1255203.

January 2012 Quarterly Provider-Specific Files Available

The January 2012 Quarterly Provider-Specific Files (PSF) are now available on the CMS website. The SAS data files are available at http://www.CMS.gov/ProspMedicareFeeSvcPmtGen/04_psf_SAS.asp and the text data files (with name and address information at the end of the record) are available at http://www.CMS.gov/ProspMedicareFeeSvcPmtGen/03_psf_text.asp, both in the “Downloads” section. A new version of the text files has been added with name and address information at the end of the record.

From the MLN: “Medicare Quarterly Provider Compliance Newsletter [Volume 2, Issue 2]” Released

The new “Medicare Quarterly Provider Compliance Newsletter [Volume 2, Issue 2]” (ICN 907703) has been released in downloadable format. This educational tool is designed to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program, and highlights the top issues of the particular quarter. Please visithttp://www.CMS.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf to download, print, and search an archive of previously-issued newsletters.

From the MLN: “Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers” MLN Matters Article Released

MLN Matters Special Edition Article #SE1201, “Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers,” has been released in downloadable format. This article is designed to provide education on policy that says Medicare will only pay for specific items or services that are ordered or referred by providers or suppliers who are enrolled in Medicare and authorized to do so. It includes information about what providers should know before submitting a claim and limitations to the policy.

From the MLN: “Additional HIPAA 837 5010 Transitional Changes and Further Modifications to COBA National Crossover Process” MLN Matters Article Revised

MLN Matters Special Edition Article #SE1137, “Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process,” has been revised and is available in downloadable format. This article is designed to provide education on the HIPAA 5010 COBA National Crossover Process for supplemental payers, and includes important information and examples to assist providers with the transition. The article was revised to add a section to clarify the crossover impact for providers who are permitted to submit claims using the CMS 1500 or UB04 hardcopy formats.

From the MLN: “Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims” MLN Matters Article Revised

MLN Matters Special Edition Article #SE1138, “Non-Specific Procedure Code Description Requirement for HIPAAVersion 5010 Claims,” has been revised and is available in downloadable format. This article is designed to provide education on the requirements for non-specific procedure codes for HIPAA 5010 claims, as established in Change Request 7392. It includes guidance to help providers comply with the requirements and submit HIPAA-compliant claims for all non-specific procedure codes. The article was revised to clarify that claims will not be rejected if ‘Not Otherwise Classified’ is submitted as the code description.

From the MLN: “Medicare Physician Fee Schedule” Fact Sheet Revised

The “Medicare Physician Fee Schedule” fact sheet (ICN 006814) has been revised and is now available in downloadable format. It includes information on physician services, therapy services, Medicare Physician Fee Schedule (PFS) payment rates, and the Medicare PFS rates formula.

From the MLN: “Ambulatory Surgical Center Fee Schedule” Fact Sheet Revised

The “Ambulatory Surgical Center Fee Schedule” fact sheet (ICN 006819) has been revised and is now available in downloadable format. It includes information on the definition of an Ambulatory Surgical Center Fee Schedule (ASC), ASC payment, how payment rates are determined, and healthcare quality.

From the MLN: “Hospital Value-Based Purchasing Program” Fact Sheet Available in Hardcopy

The “Hospital Value-Based Purchasing Program” fact sheet (ICN 907664) is now available in hardcopy. This fact sheet is designed to provide education on the Hospital Value-Based Purchasing Program, and includes information on how Medicare will make incentive payments to hospitals in FY2013 based on performance and scoring of Clinical Process of Care Measures and Patient Experience of Care Dimensions. To order hardcopies of this fact sheet, visit http://www.CMS.gov/MLNProducts and click on ‘MLN Product Ordering Page’ under ‘Related Links Inside CMS’ at the bottom of the webpage.

AAFP News Now - AAFP Launches Renewed Push to Block Impending Medicare Payment Cut, Repeal SGR

2012-01-19T14:01:00.000-08:00

By AAFP News Staff

Posted: 1/18/2012, 1:15 p.m. -- The AAFP has declared Jan. 18 a day of action for Medicare payment reform and is urging its members to contact their representatives and senators in Washington via a Speak Outalert that supports fundamental reform to block an impending Medicare payment reduction by repealing the sustainable growth rate (SGR) formula.

Congress approved a bill at the end of last year that blocked a 27.4 percent payment cut scheduled to take effect on Jan. 1. However, that short-term fix is scheduled to expire on Feb. 29.

"Unless Congress acts, family physicians will receive nearly a third less in their Medicare payments," warns AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., in a letter sent to members. He urges them to join in telling Congress to repeal the SGR once and for all. "Help us paint a picture of how these short-term fixes are seriously affecting family medicine -- making it increasingly difficult to provide much-needed primary care medical care," Stream says.

Read this and more in the latest issue of AAFP New Now.

Latest AAFP News Now Issue

CMS information for the Medicare Fee-For-Service Provider Community for the week of January 17

2012-01-18T23:05:00.000-08:00

The e-News for the week of Tue Jan 17 includes¡œ

National Provider Calls

¡◊ Wed Jan 25 – National Provider Call: Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions – Register Now

¡◊ Video Slideshow Presentations from ICD-10 National Provider Calls Available on CMS YouTube Channel

¡◊ Video Slideshow Presentation from Thu Nov 3 ¡°Skilled Nursing Facility PPS MDS 3.0 and RUG-IV Policies and Clarifications¡± National Provider Call Available on CMS YouTube Channel

Announcements and Reminders

¡◊ January is National Glaucoma Awareness Month

¡◊ Upcoming Dates for the Medicare EHR Incentive Program and Information on the Payment Threshold for Eligible Professionals

¡◊ New Webcast for Round 2 and National Mail-Order Bidders Now Available

¡◊ Flu Season is Here! Get the Flu Vaccine – Not the Flu

Code, Pricer, and Claims Updates

¡◊ Clarification Concerning HIPAA 5010 and NCPDP D.0 Cut-Over and Impacts on Crossover Claims

¡◊ Information for Outpatient Prospective Payment System Providers Regarding the Billing of CPT Code 33249

¡◊ Skilled Nursing Facility FY2012 PC Pricer Revised

Updates from the Medicare Learning Network ¢ç

¡◊ ¡°Health Professional Shortage Area Bonus Payment Policy Reminders¡± MLN Matters Article Released

¡◊ New ¡°Medicare Coverage of Radiology and Other Diagnostic Services¡± Fact Sheet Released

¡◊ New Fast Fact on MLN Provider Compliance Webpage

¡◊ ¡°Acute Care Hospital Inpatient Prospective Payment System¡± Fact Sheet Revised

¡◊ ¡°Items and Services That Are Not Covered Under the Medicare Program¡± Booklet and ¡°Medicare Claim Submission Guidelines¡± Fact Sheet Now Available in Hardcopy

National Provider Call: Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions – Register Now

Wed Jan 25; 2-3:30pm ET

CMS will host a special National Provider Call regarding the Medicare FFS implementation of HIPAA Version 5010 and D.0 transaction standards.

Target Audience: Vendors, clearinghouses, and providers who need to make Medicare FFS-specific changes in compliance with HIPAAVersion 5010 requirements.

Agenda (there will be no slide presentation for this call):

¡◊ HIPAA Version 5010 implementation update

¡◊ Question & answer session

If you would like to submit a question related to this topic in advance of, during, or following the call, please email your inquiry to the 5010 FFS Information resource mailbox at 5010FFSinfo@CMS.hhs.gov. Note that this resource box will only accept emails the day before, the day of, and the day after this call; your emailed questions will be answered as soon as possible, and may not be answered during the call.

Registration Information: In order to receive the call-in information, you must register for the call. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early. For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/blhtechnologies.

Video Slideshow Presentations from ICD-10 National Provider Calls Available on CMS YouTube Channel

Is your organization preparing for a smooth transition to ICD-10 on Tue Oct 1, 2013? ICD-10 National Provider Calls, hosted by the CMS Provider Communications Group, can help you prepare for the US healthcare industry's change from ICD-9 to ICD-10 for diagnosis and inpatient procedure coding.

Video slideshow presentations from the following National Provider Calls are available on the CMS YouTube Channel. These video slideshows include the call slide presentation and audio with captions; each call includes presentations by CMS subject matter experts, followed by a question and answer session.

¡◊ ICD-10 Implementation Strategies and Planning – Thu Nov 17, 2011

The ICD-9-CM and ICD-10 Cooperating Parties – CMS, the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), and the Centers for Disease Control and Prevention (CDC) – discuss ICD-10 implementation strategies and planning, and the CMS Provider Billing Group discuss the Medicare FFS claims processing guidance issued in August 2011.

¡◊ ICD-10 Implementation Strategies for Physicians – Wed Aug 3, 2011

CMS subject matter experts discuss how physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding and provide updates on national ICD-10 implementation issues affecting all providers.

¡◊ CMS ICD-10 Conversion Activities – Wed May 18, 2011

CMS subject matter experts discuss the ICD-10 conversion process currently taking place within CMS, including a case study from the Coverage and Analysis Group on their transition to ICD-10 for the lab national coverage determinations (NCDs).

Podcasts, complete audio files, and complete written transcripts for these ICD-10 National Provider Calls are also available on the CMS ICD-10 webpage at http://www.CMS.gov/ICD10/Tel10/list.asp.

Available 24/7, YouTube video presentations and podcasts make learning about the ICD-10 transition easy and convenient. Check them out today.

Video Slideshow Presentation from Thu Nov 3 ¡°Skilled Nursing Facility PPS MDS 3.0 and RUG-IV Policies and Clarifications¡± National Provider Call Available on CMS YouTube Channel

CMS has posted a video slideshow presentation from the Thu Nov 3 National Provider Call on the ¡°Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Minimum Data Set (MDS) 3.0 and Resource Utilization Group-Version 4 (RUG-IV) Policies and Clarifications¡± to theCMS YouTube Channel.

During this National Provider Call, CMS subject matter experts provided an overview of the policies, along with clarifications on the SNF PPS FY2012 policies related to the MDS 3.0. The agenda included:

¡◊ Allocation of Group Therapy

¡◊ Changes to the MDS Assessment Schedule

¡◊ End of Therapy (EOT) Other Medicare Required Assessment (OMRA) Clarifications

¡◊ End Of Therapy with Resumption (EOT-R)

¡◊ Change of Therapy (COT) OMRA

¡◊ Question and answer session

For more information on SNF PPS and other available educational resources, please visit the SNF PPS FY2012 RUG-IV Education & Training webpage.

January is National Glaucoma Awareness Month

With January designated as National Glaucoma Awareness Month, we ask you to join CMS in promoting increased awareness of glaucoma and the glaucoma screening service covered by Medicare. Today, more than 2.2 million Americans age 40 and older have open angle glaucoma, the most common form of glaucoma, and at least half don't even know they have it. Through early detection and treatment, we can help prevent blindness.

Medicare provides coverage of an annual glaucoma screening for beneficiaries in at least one of the following high-risk groups:

¡◊ Individuals with diabetes mellitus

¡◊ Individuals with a family history of glaucoma

¡◊ African-Americans age 50 and older

¡◊ Hispanic-Americans age 65 and older

Medicare¡¯s coverage of glaucoma screening includes a dilated eye examination with an intraocular pressure (IOP) measurement and a direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination.

What Can You Do?

As a healthcare professional who provides care to seniors and others with Medicare, you can help protect the vision of your patients who may be at high-risk for glaucoma by educating them about their risk factors and reminding them of the importance of getting an annual glaucoma screening exam covered by Medicare.

For More Information:

¡◊ The CMS Glaucoma Screening Brochure

¡◊ The CMS Guide to Medicare Preventive Services (see Chapter 7)

¡◊ The MLN Preventive Services Educational Products Webpage

¡◊ The National Eye Institute

Thank you for joining CMS in promoting increased awareness of glaucoma and the glaucoma screening benefit covered by Medicare.

Upcoming Dates for the Medicare EHR Incentive Program and Information on the Payment Threshold for Eligible Professionals

As 2012 begins, CMS wants to remind eligible professionals (EPs) participating in the Medicare Electronic Health Record (EHR) Incentive Program of important deadlines approaching and what can still be completed in 2012 in order to receive an incentive payment for CY2011.

Important Medicare EHR Incentive Program Dates

On Sat Dec 31, 2011, the reporting year ended for EPs who participated in the Medicare EHR Incentive Program in 2011. What does this mean? For participating EPs, they must have completed their 90-day reporting period by the end of 2011.

However, EPs have until Wed Feb 29 to actually register and attest to meeting meaningful use to receive an incentive payment for CY2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System.

Payment Threshold Information Wed Feb 29 is also the deadline for EPs to submit any pending Medicare Part B claims from CY2011, as CMS allows 60 days after Sat Dec 31 for all pending claims to be processed. This means that EPs have 60 days in 2012 to submit claims for allowed charges incurred in 2011.

Medicare EHR incentive payments to EPs are based on 75% of the Part B allowed charges for covered professional services furnished by the EP during the entire payment year. If the EP did not meet the $24,000 threshold in Part B allowed charges by the end of CY2011, CMS expects to issue an incentive payment for the EP in April 2012 for 75% of the EP's Part B charges from 2011.

Note for Medicaid Participants: Medicaid incentives will be paid by the states, but the timing will vary according to state. Please contact your State Medicaid Agency for more details about payment.

Want more information about the EHR Incentive Programs? Visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

New Webcast for Round 2 and National Mail-Order Bidders Now Available

A new educational webcast for the Round 2 and national mail-order competitions of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program is now available on the Competitive Bidding Implementation Contractor (CBIC) website at www.DMECompetitiveBid.com. This webcast, titled ¡°Program Rules,¡± explains important rules detailed in the Request for Bids (RFB) Instructions that you should understand before you prepare your bids. The webcast also provides resources to assist you with bidding.

We will be issuing more webcasts later in the bidder education program. The upcoming webcasts will address topics such as financial documentation requirements, how bids are evaluated, and how to submit a bid in the online bidding system, DBidS. As each webcast is posted, we will announce its availability with an email update. If you have not already done so, please register on the CBIC website to receive these announcements and other updates about the competitive bidding program.

Flu Season is Here! Get the Flu Vaccine – Not the Flu

While seasonal flu outbreaks can happen as early as October, flu activity usually peaks in January. Remind your patients that annual vaccination is recommended for optimal protection. Medicare pays for the seasonal flu vaccine and its administration for seniors and others with Medicare with no co-pay or deductible. Healthcare workers, who may spread the flu to high-risk patients, should get vaccinated too. Don¡¯t forget to immunize yourself and your staff. Protect your patients. Protect your family. Protect yourself.

For more information on coverage and billing of the flu vaccine and its administration, as well as related educational provider resources, visithttp://www.CMS.gov/MLNProducts/35_PreventiveServices.asp and http://www.CMS.gov/immunizations.

Clarification Concerning HIPAA 5010 and NCPDP D.0 Cut-Over and Impacts on Crossover Claims

On Mon Dec 5, 2011, CMS issued a Special Edition MLN Matters Article (SE1137) entitled ¡°Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process.¡±  CMS issued this guidance for the benefit of physicians/practitioners, providers, and suppliers to help them understand why they were seeing greater instances of Medicare correspondence letters that made reference to error N22226 as the basis for why their patients¡¯ claims could not be crossed over.

CMS has since learned that concern exists in the provider community concerning whether billing of hardcopy CMS 1500 or UB04 claims orHIPAA version 4010A1 or National Council for Prescription Drug Programs (NCPDP) version 5.1 batch claims will result in Medicare being unable to cross those claims over to COBA supplemental payers that have cut-over to exclusive receipt of crossover claims in the version 5010 837 claim formats or NCPDP D.0 batch claim formats.  This is not true.

During the 90-day Version 5010 non-enforcement period (Sun Jan 1 through Sat Mar 31, 2012), Medicare will have the systematic capability to perform up- or down-version conversion of incoming claim formats (ie. convert incoming hardcopy formats to HIPAA equivalent claim formats and convert incoming version 4010A1 claim formats to 5010 formats and vice-a-versa), in accordance with external supplemental payer specifications concerning production claims format.  This practice will discontinue, however, at the conclusion of the 90-day non-enforcement period, with the exception below.  (This action is controlled by information that the Common Working File receives concerning individual supplemental payers¡¯ ability to accept HIPAA 5010 or NCPDP D.0 claim formats in ¡°production¡± mode.)

Note that physicians/practitioners, providers, and suppliers that have authorization under the Administrative Simplification Compliance Act (ASCA) to submit claims using a hardcopy format should know that Medicare has the systematic capability to convert keyed claims into outbound-compliant HIPAA 837 claim formats for crossover claim transmission purposes.  This is true at all times, not just during the 90-day non-enforcement period.

Information for Outpatient Prospective Payment System Providers Regarding the Billing of CPT Code 33249

CMS has identified that an update to the Integrated Outpatient Code Editor (I/OCE) is necessary to allow payment for CPT code 33249. CMS has provided direction to Medicare claims administration contractors to hold Outpatient Prospective Payment System (OPPS) claims containing CPT code 33249, effective Sun Jan 1, 2012, until the I/OCE is updated with this payment information. The held claims should be released on or about Mon Feb 6.

Skilled Nursing Facility FY2012 PC Pricer Revised

The Skilled Nursing Facility (SNF) FY2012 PC Pricer has been revised to correct an intermittent problem, and has been updated on the CMS website. If you use the FY2012 SNF PC Pricer, please visit http://www.CMS.gov/PCPricer/04_SNF.asp and download the revised file.

From the MLN: ¡°Health Professional Shortage Area Bonus Payment Policy Reminders¡± MLN Matters Article Released

A new MLN Matters¢ç Special Edition Article #SE1202, ¡°Health Professional Shortage Area (HPSA) Bonus Payment Policy Reminders,¡± has been released in downloadable format. This article is designed to provide education on the HPSA Bonus Payment Program, and provides information about the program and resources that providers can use to determine whether they are eligible to receive the bonus payment.

From the MLN: New ¡°Medicare Coverage of Radiology and Other Diagnostic Services¡± Fact Sheet Released

A new ¡°Medicare Coverage of Radiology and Other Diagnostic Services¡± fact sheet (ICN 907164) has been released in downloadable format. This fact sheet is designed to provide education on Medicare coverage and billing information for radiology and other diagnostic services, and includes specific information concerning billing and coding requirements and an overview of coverage guidelines.

From the MLN: New Fast Fact on MLN Provider Compliance Webpage

A new fast fact is now available on the MLN Provider Compliance webpage. This page provides the latest educational products designed to help Medicare Fee-For-Service providers understand – and avoid – common billing errors and other improper activities. Please bookmark this page and check back often as a new fast fact is added each month!

From the MLN: ¡°Acute Care Hospital Inpatient Prospective Payment System¡± Fact Sheet Revised

The ¡°Acute Care Hospital Inpatient Prospective Payment System¡± fact sheet (ICN 006815) has been revised and is available in downloadable format. This fact sheet includes information on payment background, the basis for the Acute Care Hospital Inpatient Prospective Payment System payment, payment rates, and how payment rates are set.

From the MLN: ¡°Items and Services That Are Not Covered Under the Medicare Program¡± Booklet and ¡°Medicare Claim Submission Guidelines¡± Fact Sheet Now Available in Hardcopy

The ¡°Items and Services That Are Not Covered Under the Medicare Program¡± booklet (ICN 906765), available now in hardcopy, includes information about the four categories of items and services that are not covered under the Medicare program and applicable exceptions to exclusions and the Advance Beneficiary Notice of Noncoverage.

The ¡°Medicare Claim Submission Guidelines¡± fact sheet (ICN 906764), available now in hardcopy as well, includes information about applying for a National Provider Identifier and enrolling in the Medicare program, filing Medicare claims, and private contracts with Medicare beneficiaries.

To access a new or revised product available for order in hardcopy format, visit http://www.CMS.gov/MLNProducts and click on ¡°MLN Product Ordering Page¡± under ¡°Related Links Inside CMS¡± at the bottom of the page.

Project ECHO Update - A New Model for Healthcare

2012-01-17T14:03:00.000-08:00

Come Learn about the Future of Medicine Surrounded by the Wonders of Utah’s Natural History Museum

Project ECHO

A New Model for Healthcare

Presented By:

Sanjeev Arora, MD, FACP

Founder and Director, Project ECHO New Mexico

Date: February 2, 2012

Utah Museum of Natural History- 5^th Floor Sky Deck

5:30-6:15 – Cocktail Reception

6:30 pm- 7:30 pm- Presentation

Sanjeev Arora, MD, FACP, FACG, is the Director of Project ECHO (Extension for Community Healthcare Outcomes). He is a tenured Professor of Medicine, in the Department of Internal Medicine at the University Of New Mexico Health Sciences Center (UNMHSC).He has been involved in management of viral hepatitis for over 15 years, and led the development and implementation of the Hepatitis C Disease Management Program at UNMHSC. Dr. Arora developed the Project ECHO model as a platform for service delivery, education and evaluation. Using video-conferencing technology and case-based learning, primary care providers from rural and underserved areas and prisons are trained and mentored by ECHO’s medical specialists to deliver best-practice management of complex health conditions in their communities or correctional institutions. A key component of the ECHO model is an innovation known as Knowledge Networks, in which the expertise of a single specialist is shared with numerous primary providers through telehealth clinics, thereby increasing access to care in rural areas without having to recruit, retain and fund additional providers

Please RSVP to: Susanne.cusick@hsc.utah.edu

Continuing Education Opportunity: Ovarian Cancer Management and Treatment

2012-01-13T13:13:00.000-08:00

In May 2007, physicians andhealth care providers across Utah came together for a conference entitledOvarian Cancer Dialogue for Action™. The purpose of the conference was toevaluate the status of ovarian cancer care in Utah and identify means by which mortalitycould be decreased. New data at the time showed a 25% increase in the survivalof ovarian cancer patients treated by providers who specialize in gynecologiccancers. Care providers in attendance called for the statewide dissemination ofinformation to providers on the latest research, advances in surgical care, andreferral protocols for ovarian cancer patients.

As a result of the Ovarian Cancer Dialogue forAction™, the Utah Cancer Action Network (UCAN)and Utah Department of Health brought together an obstetrician/gynecologist, a geneticscounselor, a medical oncologist, the deputy director of the Utah CancerRegistry, and two gynecologic oncologists to develop a DVD presentation toinform doctors, nurses, and other health care providers about ovarian cancerand steps they can take to increase patient survival.

Continuing educationcredits are available for those who view this free presentation. Please visit www.UCAN.cc/ovarianto view this presentation online, download the presentation to a personaldevice, or request a free DVD.

AHRQ Launches Regional Partnership Development Initiative to Promote Patient-Centered Outcomes Research

2012-01-10T16:07:00.000-08:00

The Federal Agency forHealthcare Research and Quality (AHRQ) recently launched efforts to promotepatient-centered outcomes research (PCOR) in patient and professionalcommunities in all 50 states, Washington, D.C., and the U.S. territories. AHRQhas established five Regional Partnership Development Offices that arecultivating sustainable partnerships with hospitals and health systems, patientadvocacy organizations, businesses, and other groups that serve clinicians,consumers and policymakers. You’re invited to learn more about PCOR and topartner with AHRQ by using and encouraging others to use free PCOR reports andmaterials, which support efforts to improve the quality of health care incommunities.

What is patient-centered outcomes research? PCOR, also known ascomparative effectiveness research, provides information that helps cliniciansand patients work together to treat an illness or condition. PCOR comparesdrugs, medical devices, tests, surgeries, or ways to deliver health care. Theresearch findings don’t tell clinicians how to practice medicine or whichtreatment is best, but theyprovide evidence-based information on theeffectiveness and risks of different treatments. Clinicians and patients canuse this information to make informed treatment decisions based on eachindividual’s circumstances.

AHRQ’s Effective Health Care Program works with researchers, researchcenters, and academic organizations to conduct the research and focuses on 14priority health conditions, including: cardiovascular and related diseases,diabetes, arthritis, mental health disorders, and pregnancy. The full researchreports are made available, and findings are translated into practical patientand clinician materials, that include:

· Patient Guides (English and Spanish)
· Clinician Guides
· Executive Summaries
· Faculty Slides
· CME/CE Modules
· Podcasts

Partners canparticipate in a range of scalable activities such as distributing guides atmeetings and in medical offices, placing articles in newsletters, and hostingWeb conferences that highlight PCOR findings. Organizations that are usingthese materials or the PCOR findings include Mayo Clinic, the American Academy ofNurse Practitioners, and AARP, among many others.

Findings from patient-centered outcomes research can be helpful toeveryone participating in health care decision-making:

Patients are often facedwith complicated decisions, such as which test is best, which medicine willhelp most with the least side effects, or whether surgery is the best option.Every patient is different, and each should make informed choices based onindividual needs. By providing Effective Health Care Program products thatsummarize evidence-based, patient-centered outcomes research findings, you canhelp patients work with their health care professionals to make a more informeddecision among many treatment options.

Healthcare professionals usePCOR to keep current on comparisons of medications and treatments. The productsdeveloped by the Effective Health Care Program help distill the information sohealth professionals and consumers can review treatment options together. Whenresearch is not available to answer clinical questions, AHRQ publicationshighlight research gaps.

Policymakers, business leaders,and others want to make health care policy decisions based on reliable, objectiveinformation about effectiveness. Patient-centered outcomes research helpsdecision makers plan evidence-based public health programs.

To learn more about PCOR, order free materials, access our freecontinuing education modules or to become part of this growing partnershipnetwork, please contact Kate Stabrawa in AHRQ’s Denver Regional PartnershipDevelopment Office at 303-382-2444 or kate.stabrawa@ahrq.hhs.gov. You can alsolearn more about patient-centered outcomes research by visiting www.effectivehealthcare.ahrq.gov.

Ask your representative to co-sponsor the GME pilot bill (H.R. 3667)

2012-01-05T11:48:00.000-08:00

Support Family Medicine’s GME Pilot

On December 14, Representative McMorris-Rodgers of Washington and Representative Thompson of California introduced the Primary Care Workforce Access Improvement Act of 2011 (H.R. 3667). The bill's introduction is the culmination of family medicine's efforts over the last three years to introduce reforms in the way Medicare funds graduate medical education. This bill is a budget-neutral way to test new models for the delivery of GME funding - the funding for the training of primary care physicians, particularly family physicians, will take a different path from traditional hospital GME payments. The pilot project introduced by this bill changes the stream of GME funding to make it directly available to medical education entities whose priority is training the primary care workforce. It provides a valuable opportunity to explore modern training techniques that could be useful for the production of the type of primary care physician needed now and for the future and allows for an increase in the number of primary care physicians.

It is of critical importance that you contact your representative on behalf of your program or department and ask him or her to cosponsor this bill. Enter your zip code in the "call now" box above to receive talking points and information on who to contact, as well as links to FAQs and background information.

Take Action

Information provided by the Society of Teachers of Family Medicine

CMS Announces Delay to the Prepayment Review and Prior Authorization for Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration

2011-12-30T13:59:00.000-08:00

On November 15, 2011, the Centers for Medicare & Medicaid Services (CMS) announced the Prepayment Review and Prior Authorization for Power Mobility Devices (PMD) demonstration and the Recovery Audit Prepayment Review demonstration. These demonstrations were scheduled to begin on January 1, 2012. However, the CMS received many comments/suggestions regarding these demonstrations and the CMS is carefully considering these comments. Therefore, CMS will delay implementation of these demonstrations. CMS will provide at least 30 days notice before the demonstrations begin.

The Part A to Part B rebilling demonstration remains on schedule and will begin on January 1, 2012.

Please continue to check http://go.cms.gov/cert-demos for updated information.

Project ECHO Update

2011-12-29T10:22:00.001-08:00

Project ECHO is a FREE partnership between Primary Care providers and specialist to provide specialty care where there is currently a lack. Project ECHO promotes the sharing of knowledge in real-time, exponentially boosting our ability to deliver specialty care to patients who lack access in their communities. By bridging the gap between primary and specialty care, Project

ECHO will provide healthcare without walls.

Using real-time learning, Project ECHO empowers primary care providers to safely and effectively treat and manage Hepatitis C infection within their rural clinics. Project ECHO also spreads information and use of new advances and treatments in the field of Hepatitis C.

Project ECHO, based on the model developed by the University of New Mexico, offers a new way to:

Deliver specialty care to all who need it,

Provide meaningful, case based continuing medical education

Disseminating, teaching, and reinforcing best practices in Hepatitis C

Project ECHO was launched at the University of Utah in October 2011 and we are enrolling new sites weekly. We currently have clinics participating from Montana, Utah, Colorado, Wyoming, and soon to be Idaho as well. We are very excited to be experiencing the rapid growth that we have seen this far.

If you are interested in learning more about ECHO or becoming a site please contact Susanne Cusick at Susanne.cusick@hsc.utah.edu for more information.

Pre-Session Legislative Report - December 2011

2011-12-29T10:09:00.000-08:00

Over the course of the year the legislature meets to discuss legislation for thecoming session. Ideas are shared and discussed reducing time during the session. Italso provides a more broad and thorough discussion of issues and gives a betteropportunity for public discussion.
As healthcare reform has moved forward, a basic outline and step-‐by-‐step processhas been proposed. Now that the legislature has decided what direction we areheading in, now comes the details. Now connecting the dots begin.

A couple of bills that were discussed during the interim sessions are highlightedbelow. They are part of the path of healthcare reform moving forward. Be assuredthat your UAFP staff has been involved in the discussions. This is a brief overview. Ifyou have questions, concerns or comments, please feel free to contact us.

Patient Identity Validation
This proposed bill would provide a verification process to verify healthcareinformation. The Health Department will be setting the standards of identitycoordination. A reduction in costs will result. Some of the benefits include accuracyof information, patient safety, reduce fraud, protect consumers and physicians.There will be no cost to implement the program because of a grant of $2.7 million.The ongoing cost will be covered by the State of $1.5 million annually, which will bea savings to the State if the bill is not implemented.

Clinical Health Information Exchange
This legislation creates personal health records for Medicaid and Public EmployeesHealth Program. Prior bills have created an information highway, now we need toput people on that highway. The discussions included whether individuals shouldopt-‐in or opt-‐out of the information exchange. The bill provides an opt-‐out option,which means most will be included.
Part of the unknown will be whether a person who opts out of the PEHP program orMedicaid information exchange should be allowed to continue to participate. Mostof the discussion leaned toward a person who opts out, whether they should not beallowed to participate in the exchange benefits. Discussions continued on whethergovernment should mandate this or not. Having the protection, cost savings andbenefits of the exchange is a positive health savings event that should move forward.

These two bills are just a sample of what will be coming during the legislativesession. There are a number of healthcare reform bills that have been pre-‐filed butdo not have any language available yet. Your UAFP will be providing a regular legislative update just before the session as well as throughout the session. Thesession begins on January 23rd and concludes at midnight March 8th. The session islimited to 45 consecutive days. We will be giving you a final report when theyconclude.

We encourage you to follow along during the session by using the state legislativewebsite at www.le.utah.gov. We will be at the Capitol Building every day during thesession working for the Academy. The legislative committee will be involved in adirect way as well, which may include opportunities to testify and/or in contactinglegislators. If you want to be involved with the legislative committee, please let staffknow or contact our Academy President.

University of Utah Family Medicine Grand Rounds 2012

2011-12-29T10:02:00.000-08:00

The schedule for the University of Utah Family Medicine Grand Rounds is out for January 2012. There is no scheduled Grand Rounds on January 4th. The first event of 2012 will be January 11th (Journal Club) with Utah Academy of Family Physician Past President Jennifer Leiser, MDAssociate Professor, and Joyce Pritchard, MD Family Medicine ResidentDepartment of Family & PreventiveMedicine.

January 2012 Grand Rounds Schedule
http://medicine.utah.edu/dfpm/GrandRounds/FM/PDFs/RoundsFlyer_January12.pdf

Schedule of Current and Past Grand Rounds
http://medicine.utah.edu/dfpm/GrandRounds/FM/index.htm

Teleconference on the Jurisdiction F Transition

2011-12-29T09:48:00.000-08:00

Please Join the Centers for Medicare & Medicaid Services (CMS) for our Teleconference on the Jurisdiction F Transition.

The CMS Western MAC Program Management Division (WMPMD) and the Medicare Division of Financial Management and Fee For Service Operations in Regions VIII and X are pleased to announce an educational conference call for the health care community impacted by the Jurisdiction F transition. This is your opportunity to hear the latest information on the transition from Jody Kurtenbach, the Director for WMPMD. We will allow ample time for a question and answer session at the end of the call.

Jurisdiction F Background

On August 22, 2011, CMS announced that Noridian Administrative Services (NAS) was awarded the Round 2 contract for A/B Medicare Administrative Contract (MAC) Jurisdiction F.

NAS is transitioning all A/B MAC activities and actively implementing Medicare processes in the

corresponding Jurisdiction F states. Jurisdiction F includes: Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming.

The current Jurisdiction 3 A/B MAC states of Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming along with Idaho Part B will be transitioned to the new Jurisdiction F system on February 1, 2012. The current NAS Legacy states of Alaska, Idaho Part A, Oregon and Washington will complete the transition to Jurisdiction F on February 27, 2012.

Call in Information

Registration for the call is not required. The session will accommodate 200 participants on a first come, first served basis. We ask that if several people are calling in from one location that they call in on one line.

Call Title: Information on the Jurisdiction F Transition

Date/Time: Wednesday, January 11, 2010 – 1:00-2:00 PM (CT)/ 12:00-1:00 PM (MT) / 11:00AM-12:00 PM (PT)

Audio Conference Line: 1-877-267-1577

Meeting ID: 4096

We appreciate your interest and participation.

Sincerely,

Jody Kurtenbach

Director, Western MAC Program Management Division, Medicare Contractor Management Group

Helpful Links

NAS Jurisdiction F Website – https://www.noridianmedicare.com/jurisdiction_f.html This link has detailed information on the Jurisdiction F transition.

CMS Website - https://www.cms.gov/MedicareContractingReform/downloads/MACFAwardFactSheet.pdf

This link has: Award of Part A/B Medicare Administrative Contractor (A/B MAC) Contract for Jurisdiction F.

Date-of-Service Claims for Services Paid Under the 2012 Medicare Physician Fee Schedule

2011-12-19T17:30:00.000-08:00

Attention Health Professionals: Information Regarding the Holding of 2012 Date-of-Service Claims for Services Paid Under the 2012 Medicare Physician Fee Schedule

The negative update under current law for the 2012 Medicare Physician Fee Schedule is scheduled to take effect on Sun Jan 1, 2012, eight business days from today. Consequently, as on numerous occasions in the past, CMS will instruct its Medicare claims administration contractors to hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first 10 business days of January 2012 (i.e., Sun Jan 1 through Tue Jan 17). The hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

Medicare Physician Fee Schedule claims for services rendered on or before Sat Dec 31 are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames.

The Administration is disappointed that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk. We continue to urge Congress to take action to ensure these cuts do not take effect.

CMS will notify you on or before Wed Jan 11, 2012, with more information about the status of Congressional action to avert the negative update and next steps regarding the claims hold.

Work Continues on SGR as House Passes Medicare Payment Bill

2011-12-15T12:27:00.000-08:00

Senate, Obama Administration Unlikely to Approve

By AAFP News Staff

Posted: 12/14/2011, 5:30 p.m. -- The House last night passed H.R. 3630 (at the THOMAS website, type "H.R. 3630" into the search field after selecting "Bill Number"), which would provide a 1 percent increase in the Medicare physician payment rate for the next two years and block a 27.4 percent payment reduction scheduled to go into effect on Jan. 1.

However, it is widely expected that the bill will not have enough support in the Senate to pass, creating a real possibility that Congress could adjourn for the holidays without preventing the pending Medicare physician payment cut called for by the sustainable growth rate, or SGR.

EHR Incentive Payment Program Articles

2011-12-13T21:15:00.000-08:00

CMS has developed several high-level, overview articles pertaining to the EHR Incentive Payment Program (general/hospitals, eligibility, registration, and the path to payment). Check out the documents now.

Who is Eligible for the Medicare and Medicaid EHR Incentive Programs?

http://www.utahafp.org/documents/12-13-11_Drop-in-Eligibility-EP-EH.PDF

Medicare and Medicaid EHR Incentive Programs for Hospitals

http://www.utahafp.org/documents/12-13-11_Drop-in-General-Act-Now.pdf

The Path to Payment for the Medicare and Medicaid EHR Incentive Programs

http://www.utahafp.org/documents/12-13-11_Drop-in-Path.pdf

http://www.utahafp.org/documents/12-13-11_Drop-in-Register-EP-EH.PDF