News in brief - July 4, 2011

District judge blocks defunding of Planned Parenthood of Indiana

A federal district judge on June 24 approved an injunction against the enforcement of an Indiana law seeking to defund Planned Parenthood of Indiana.

The decision means that Planned Parenthood will be reimbursed for services billed to Medicaid patients while a lawsuit against the defunding measure is pending.

The Indiana law, which took effect in May, bars state agencies from entering into contracts or making grants with entities that perform abortions. Organizations impacted by the law may resume Medicaid funding by "ceasing or separating its operations that perform abortions," Indiana Gov. Mitch Daniels said in a statement.

In her ruling to block the law temporarily, U.S. District Judge Tanya Walton Pratt said the public interest tilts in favor of granting the injunction. The law will exact a "devastating financial toll on Planned Parenthood of Indiana and hinder its ability to continue serving patients' general health needs," she said.

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Texas doctors ask Medicare for e-prescribing extension

The Texas Medical Assn. warned the Centers for Medicare & Medicaid Services that the June 30 deadline to determine a 2012 pay penalty under Medicare's electronic prescribing program could have unintended consequences.

The association wants the agency to move the deadline for meeting e-prescribing requirements to Oct. 1, according to a June 22 letter to CMS Administrator Donald M. Berwick, MD. This year, CMS required eligible physicians and other health care professionals to report eligible e-prescribing activity at least 10 times by June 30. Those who failed to meet the threshold will be subject to a 1% decrease in payments for Medicare services in 2012.

The threat of a penalty has caused physicians to adopt e-prescribing technology temporarily instead of incorporating new systems to improve practices.

"Physicians are rushing into e-prescribing just to avoid the penalty," wrote Joseph Schneider, MD, chair of the TMA's committee on health information technology. "We have found that some are turning on free or cheap systems, meeting the 10 prescription requirement and then not using the system again. This will forever distort the number of active e-prescribers."

CMS has issued a proposed regulation that would exempt from the penalty physicians who claim one of several hardships by Oct. 1. The rule is expected to be finalized in August.

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Senate health fraud bill would require better physician verification

Bipartisan Senate legislation would eliminate tens of billions of dollars in Medicare and Medicaid fraud by creating stronger penalties and using technology to combat abuse and waste, proponents of the bill said. Sens. Tom Coburn, MD (R, Okla.), and Tom Carper (D, Del.) introduced the Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayer Dollars Act on June 22.

"There is no single solution that will solve our nation's current fiscal dilemma, but there are numerous steps we can take to rein in wasteful spending and begin to restore fiscal order," Carper said. "The FAST Act is one of those steps."

For instance, the legislation would require the Centers for Medicare & Medicaid Services to curb the theft of physician identities by improving verification systems that are used when physicians order services. Also, the bill would require CMS to track overpayments identified by recovery audit contractor reviews and implement solutions to prevent such payments from occurring.

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HHS limits health plan appeals process

Consumers will have less time to appeal coverage denials by their health insurers, but states will have more time to establish external appeals processes, according to an interim final rule published June 24 by the Depts. of Health and Human Services, Treasury, and Labor along with the Internal Revenue Service. The health system reform law for the first time mandates a standardized external appeals process for health plan denials, including for self-insured plans.

The agencies adjusted certain deadlines in the amended rule. Health plans will have 60 days to finish an internal appeal instead of the original 45 days. Enrollees will have 60 days to appeal a coverage denial instead of 120 days. The agencies also gave health plans until Jan. 1, 2012, to comply with the rule -- an additional six months.

The regulations apply only to health plans created or significantly altered after Sept. 22, 2010. HHS estimates that this will apply to plans covering 78 million people by 2013. The departments are accepting comments on the rule until July 25, three days after it takes effect. The rule is available online (www.gpo.gov/fdsys/pkg/FR-2011-06-24/pdf/2011-15890.pdf).

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