Health Care Policy Update


DMGS closely monitors Health Care Policy both at the Federal and State Level.

Feds Defend Plan for More Health E-Record Oversight

A proposal to directly oversee federal certified electronic health records is within the Office of the National Coordinator for Health IT’s authority, the new head of the agency said Sept. 19. As more hospitals and doctors adopt EHR systems and as the use of health IT becomes ingrained in more federal health programs, the ONC should take a more direct role in ensuring that the technologies doctors adopt are functioning properly, Vindell Washington, the national coordinator for health IT, told reporters during a policy briefing hosted by the agency. The ONC currently relies on a few designated organizations in the private sector to ensure certified EHRs are working properly.

“We have less than optimal oversight into the testing that goes into certification,” Washington said. Republican leaders of two influential congressional committees challenged whether the ONC had the authority to respond directly to complaints about certified EHR systems in a July letter to the agency. The ONC sought to change its role in certifying EHRs for the federal meaningful use program in a proposed rule published in March. The final rule could be released soon. The Office of Management and Budget started reviewing the final rule Aug. 16. 

Problems Stall Stricter Reviews for Medicare Home Care Claims

A CMS test project to impose tougher reviews on home health-care claims won’t be expanded as planned, the Medicare agency said recently. Based on the experience in Illinois with the project since it started Aug. 3, it won’t be expanded into other states yet, the Centers for Medicare & Medicaid Services said in suspending the pilot program’s expansion.

The somewhat unusual admission from the CMS that there are problems with the program in Illinois will delay wider implementation of the demonstration. Provider groups and some members of Congress have decried the pilot project, claiming it would be overly burdensome for home health agencies. The demo, which will continue in Illinois, imposes a requirement that prevents a beneficiary from receiving physician-directed home care until a CMS-approved intermediary has reviewed and approved the doctor’s order. The project had been set to start in Florida by Oct. 1.

HHS Can’t Delay Addressing Medicare Appeals Backlog

The HHS won’t get any more time to fix a backlog of 760,000 pending Medicare appeals before facing litigation filed by the American Hospital Association and others (Am. Hosp. Ass’n v. Burwell, 2016 BL 307248, D.D.C., No. 14-cv-851, 9/19/16). The U.S. District Court for the District of Columbia said the Department of Health and Human Services wasn’t making enough progress to reduce the huge backlog of Medicare appeals pending at the administrative law judge level of claim review. Judge James E. Boasberg said the measures outlined by the HHS to the court to address the backlog would only reduce the pace of backlog growth, and that he was obligated to deny the agency’s requested stay of litigation until Sept. 30, 2017, the close of the next federal appropriations cycle.

The court in particular singled out modifications to the Recovery Audit Contractor program (blamed by the AHA for the increase in Medicare appeals) as being insufficient to reduce the ALJ backlog despite the HHS’s discretionary authority to make more sweeping changes to the program. Boasberg’s focus on the modest changes to the RAC program (affecting only 7 percent of RAC appeals), as well as AHA’s concerns, could be a signal that the court plans to include changes to the RAC program in a future court order issued to the HHS. RACs are tasked with detecting and recovering Medicare overpayments and are paid by the government on a contingency-fee basis.

The court repeated its assertion that it was “loath to intervene” in what was essentially an executive and legislative issue, but said some legal action must be taken now given that administrative and congressional fixes appeared unlikely to bring the HHS into compliance with the statutory ALJ review deadline. Boasberg, however, didn’t grant the plaintiff’s request to order the HHS to come into immediate compliance with the statutory ALJ review deadline, but instead ordered the parties to appear on Oct. 3 to “discuss how next to proceed.”

More Patients Viewing Records Online

Nearly every U.S. hospital offers their patients the ability to view their health records online, representing a major policy victory for federal health IT regulators. The percentage of hospitals with the capability to share health records with their patients grew from 24 percent in 2012 to 95 percent in 2016, according to data presented to federal health IT policy advisers recently. The percentage of hospitals that allow patients to download and transmit a copy of their health records also grew during that time, from 10 percent in 2012 to 69 percent in 2016.

Giving patients more control over their health data has long been a goal of the Office of the National Coordinator for Health Information Technology, which advocated for the federal meaningful use program to include requirements for hospitals to give their patients online access to their own health records, the head of the ONC said during a Sept. 13 joint meeting of the Health IT Policy and Standards committees.

John Zang, DMGS Ohio, Contributed to This Report

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