Kaiser Health News: Insurers Embrace ‘Virtual’ Doctor Visits
Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: “Insurers such as UnitedHealthcare, Aetna and Cigna, and large employers such as General Electric and Delta Air Lines are getting on board, pushing telemedicine as a way to make doctor “visits” cheaper and more easily available. Proponents also see it as an answer to a worsening doctor shortage. But some physician and consumer groups worry about the trend” (Galewitz, 5/7). Read the story or watch a related video.

Politico Pro reports
Step one: The health reform law boosts Medicaid pay for primary care physicians for two years. Step two: Everyone wants to be primary care physicians. Specialty physician groups are pressing CMS for a more expansive definition of primary care services, saying a broader definition is more consistent with the intent of the health care law, if not the actual legislative text. Lobbyists for the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists have urged CMS to include them under an Affordable Care Act provision that will allow primary care doctors to receive Medicare-level rates when they treat Medicaid patients (DoBias, 4/6).

Access FQHC Learning Portal. The FQHC Advanced Primary Care Practice (APCP) Demonstration Project is a CMS Innovation Center initiative which will assist 500 participating FQHC sites in transforming their practices into Patient Centered Medical Homes. The web portal will provide access to information, resources and technical assistance for participating sites and other interested safety net providers regarding primary care practice transformation and medical home status recognition.

The demonstration project will provide technical assistance and support to participating FQHC sites as they navigate and achieve NCQA Level 3 Medical Home status. This initiative is unique in that it represents a partnership forged to establish a national support network for the demonstration participants, consisting of the CMS Innovation Center staff and contractors, national partner organizations already supporting FQHCs, and a network of state and regional partners who will assist the 500 sites with timely, regional information and support.

Program Assistance Letter 2012-02 – FTCA Renewal Application
All currently deemed grantees must submit a FTCA renewal application for themselves and any subrecipients (as applicable) by April 05, 2012 in order to be eligible to be deemed for the entirety of CY 2013, without a gap in coverage. Grantees who fail to submit a renewal application for redeeming by the deadline date must reapply for coverage as an initial applicant and, as a result, put the renewal decision date at risk for CY 2013 FTCA coverage. Eligible entities (grantees and grantees on behalf of subrecipients) that miss submitting a renewal application by the April 05, 2012 deadline may experience a gap in anticipated FTCA coverage and should strongly consider purchasing private medical malpractice insurance.

Surely if we can find money to pay for wars we should be able to find funds to pay for universal health care. Just as President Johnson declared a war on poverty, we need to declare a war on the lack of health coverage for all.  We are almost there; Medicare, Medicaid, and CHIP are models for the solutions we seek. Issue one: Profit driven increase in health care costs. Issue two: Healthcare workforce equity. Issue three: Culture change that recognizes health care as a  basic human right.  Setting medical loss ratio, shared savings models, and open market health exchanges are but small partial answers to the current fragmented health care system until we implement the real long term solution: Universal Health Care.  We must lay the groundwork and lead the way, start talking to your Senators and Congresspeople today. Do it for yourself,do it for your children, do it for your grandchildren, do it for our future citizens. Let us be the greatest generation ever.  Advocate for Universal Health Care!

An Animated Conversation About ACOs.   Accountable Care Organizations are a continuing source of interest to both health care providers and consumers. Kaiser Health News calls them “the hottest three-letter word in health care.”  Now WBUR’s CommonHealth blog has put together a video animation that walks viewers through how ACOs work and what that means for consumers. The blog promises that this is only the first installment of what they’re calling “Wonk Cinema.” Enjoy.

The interactive tools includes a calculator that allows individuals and families to estimate how much they could receive in tax credits under the ACA to help pay for their insurance in the health insurance exchanges in 2014. The zip code interactive tool allows users to enter in their zip codes and see the percentage of people in their communities who could be helped by subsidies to help pay for private insurance or eligible for Medicaid starting in 2014 under the ACA.

The new analysis reveals wide variation across local communities in the share of the population that could benefit from coverage expansion in the Affordable Care Act (ACA) starting in 2014. In parts of Florida, New Mexico, Texas, Louisiana, and California, as much as 40% of the non-elderly population could benefit from the expansion of Medicaid or through tax credits to help purchase coverage in the new health insurance exchanges. By contrast, many parts of states such as Massachusetts, Hawaii, New York and Connecticut – which already have high levels of employer-sponsored insurance or reforms that make coverage more accessible and affordable – will see as little as 2% of the population benefitting from the ACA’s coverage expansion. More here

Modern Healthcare.com reports the acting head of the CMS on Tuesday signaled that the agency will extend the timeline on ICD-10 implementation. After speaking to attendees at the American Medical Association Advocacy Conference in Washington, acting CMS Administrator Marilyn Tavenner told reporters that the CMS will “re-examine the timeframe” through a rulemaking process. She did not say when that rulemaking process will begin but said the CMS would send details about the process in the coming days.

“There’s concern that folks cannot get their work done around meaningful use, their work around ICD-10 implementation and be ready for exchanges,” Tavenner said. “So we’re trying to listen to that and be responsive.”

The amount of an individual’s salary charged to a HRSA funded project is capped at $179,700 per year. While the announcement does not limit the salary amount paid by an organization from other funding sources, it does have implications for financial budgeting and reporting.  The announcement, implications, and recommendations follow.

As posted on the HRSA EHB: Per the Consolidated Appropriations Act, 2012 (P.L. 112-74) H.R. 2055 -297 enacted December 23, 2011, HRSA funds from this Act may not be used to pay the salary of an individual at a rate in excess of $179,700 per year (the Executive Level II salary of the Federal Executive Pay scale). If your organization has received HRSA funds from this Act and your HRSA project includes a salary that exceeds the rate of $179,700 per year, please contact the project officer and/or grants management specialist listed in your notice of award. Please note, the salary limitation also applies to personnel working part-time on a HRSA project. For example, if an individual works 50% of their time on the HRSA project, the salary rate limitation is $89,850.

Implications:

Total Budget concept. Currently Health Centers funding applications are structured using a “total budget” concept where the applicant specifies funds requested as both federal and non-federal revenue sources on forms 424 and 424A for the scope of project included in the application. Similarly, applicants are also required to identify all non- federal revenue sources indicated on the income analysis form (patient charges, third party revenues, and other sources). The expectation is that federal and non-federal revenues are utilized to cover the costs of the program operations. Given that there is not a clear delineation in the application of how those revenue sources (federal and non-federal) will be  applied to specific expenditures within the budget presented for the project scope, to date funded FQHCs have had some flexibility to allocate federal funds for specific costs associated with the program expenditures.

Recommended actions:

Independent of the “total budget” concept, these changes in the law will require health centers to demonstrate compliance with the new law regarding limitations on salaries charged to HRSA funded projects. Barring any changes HRSA may make to the Section 330 budget application, or subsequent reporting, it will be incumbent on FQHCs to ensure their auditor is aware of the changes in the law for compliance with circulars A-133 and A-122  of their annual financial audits. It is also recommended that FQHCs seek appropriate financial guidance with expert consultants to both ensure appropriate application of the law and documentation to demonstrate compliance.

For the Specific Language in the Law: H.R. 2055 -297 sec. 203

New Feb. 11, 2012 – Language Found in the Most Recent Service Area Competition (HRSA -12-169)  FY 2012 SAC AA

 iii. Budget  (page 19)

A complete budget presentation in HRSA EHB will include the following:

• SF 424A: Budget Information – Non-Construction Programs:

• Form 2 – Staffing Profile: Complete this form for the first year of the proposed project. See Appendix A for detailed instructions.

Salary Limitation:

The Consolidated Appropriations Act, 2012 (P.L. 112-74) enacted December 23, 2011, limits the salary amount that may be awarded and charged to HRSA grants and cooperative agreements. Award funds may not be used to pay the salary of an individual at a rate in excess of Executive Level II. The Executive Level II salary of the Federal Executive Pay scale is $179,700. This amount reflects an individual’s base salary exclusive of fringe and any income that an individual may be permitted to earn outside of the duties to the applicant organization. This salary limitation also applies to subawards/subcontracts under a HRSA grant or cooperative agreement.

As an example of the application of this limitation: If an individual’s base salary is $350,000 per year plus fringe benefits of 25% ($87,500) and that individual is devoting 50% of their time to this award, their base salary should be adjusted to $179,700 plus fringe of 25% ($44,925) and a total of $112,312.50 may be included in the project budget and charged to the award in salary/fringe benefits for that individual. See the breakdown below:

v. Staffing Plan and Personnel Requirements (page 20)

In HRSA EHB, staffing and personnel information will be provided through Form 2: Staffing Profile,

Reminder: Award funds may not be used to pay the salary of an individual at a rate in excess of Executive Level II or $179,700. An individual’s base salary, per se, is NOT constrained by the legislative provision for a limitation of salary. The rate limitation simply limits the amount that may be awarded and charged to HRSA grants and cooperative agreements. Please provide an individual’s actual base salary if it exceeds the cap. See the sample below.

*Actual annual salary = $350,000

“The fundamental problem all states face is that while Medicaid rolls continue to grow, federal support for the jointly-funded program is not keeping pace — and neither is state revenue. More than $100 billion in extra federal support under the 2009 stimulus program ran out last July. As a result, state Medicaid spending jumped 29 percent between budget years 2011 and 2012 to make up for the loss of federal funds.”  read more here