News in brief - Jan. 9, 2012

CMS moves Medicare participation deadline - Medicare prior authorization for scooters demo delayed - States receive $300 million for meeting children's enrollment goals

CMS moves Medicare participation deadline

The agency overseeing the Medicare program has extended its annual participation enrollment period through Feb. 14, the Centers for Medicare & Medicaid Services announced.

CMS moved the deadline for physicians to elect to continue Medicare participation or withdraw from the program because the agency anticipates congressional action in the coming weeks to address the 27.4% sustainable growth rate cut to physician pay this year. Congress approved only a two-month delay of the SGR cut on Dec. 23, 2011, a delay that will expire March 1.

If Congress appears that it will allow the steep reduction in Medicare rates to take effect, that could influence physician decisions to participate in the program during the 2012 year.

Medicare contractors have been instructed to process participation status changes that are postmarked by Feb. 14. The effective date for all changes will be Jan. 1 and remain in effect for the year.

Medicare prior authorization for scooters demo delayed

A demonstration that would require prior authorization for power wheelchairs in certain states has been delayed indefinitely after lawmakers urged the Centers for Medicare & Medicaid Services not to implement the project.

CMS had planned to require prior authorization for scooters and power wheelchairs in seven states -- California, Florida, Illinois, Michigan, New York, North Carolina and Texas -- starting Jan. 2. But the Medicare agency decided to delay the project after receiving comments from lawmakers and associations representing equipment suppliers.

The demonstration would prevent fraudulent medical equipment claims, CMS said when it announced the project on Nov. 15, 2011. But a month later, a bipartisan group of 22 House members sent a letter stating that the demo could harm seniors who depend on the equipment to live independently at home.

The American Assn. for Homecare, which represents equipment suppliers, had asked Congress to intervene. "Members of Congress should be worried about the impact of this program on many of the most vulnerable people in our society," said Tyler J. Wilson, the association's president and CEO.

States receive $300 million for meeting children's enrollment goals

The Centers for Medicare & Medicaid Services on Dec. 28, 2011, awarded more than $296 million in performance bonuses to 23 states for increasing access to and enrollment in their Medicaid and Children's Health Insurance Programs.

The bonuses ranged from $1.3 million for Idaho to $28.3 million for Maryland and were made available by the Children's Health Insurance Program Reauthorization Act of 2009. The law authorized the annual bonus payments from fiscal 2009 through fiscal 2013.

The size of the bonuses increased based on states' Medicaid enrollment gains. States whose enrollment increased by more than 10% received larger bonuses. To qualify, states must have implemented procedures to ease access to their Medicaid programs, such as ending in-person interviews for eligibility renewals and simplifying application and renewal forms.

"Despite serious fiscal challenges, today's awards show that children's health remains a top priority for states," said Cindy Mann, CMS deputy administrator.

All states that received bonuses in fiscal 2010 did so again in fiscal 2011. Seven additional states also qualified for bonuses in 2011. The 23 states receiving bonuses are: Alabama, Alaska, Colorado, Connecticut, Georgia, Idaho, Illinois, Iowa, Kansas, Louisiana, Maryland, Michigan, Montana, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, South Carolina, Virginia, Washington and Wisconsin.