Federal Health Care News



The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

CMS’s goal is to simplify the program, especially for small, independent, and rural practices, while ensuring fiscal sustainability and high-quality care within Medicare.

The Quality Payment Program, updated annually as part of MACRA, is designed to promote greater value within the healthcare system. Clinicians who participate in Medicare serve more than 57 million seniors. Clinicians can choose how they want to participate in the Quality Payment Program based on their practice size, specialty, location, or patient population.

The proposed rule would amend some existing requirements.  It contains new policies for doctors and clinicians participating in the Quality Payment Program that would encourage participation in either Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). Additionally, CMS has used clinician feedback to shape the second year of the program. If finalized, the proposed rule would further advance the agency’s goals of regulatory relief, program simplification, and state and local flexibility in the creation of innovative approaches to healthcare delivery.

Moreover, CMS is making it easier for rural and small providers to participate.

For a fact sheet on the proposed rule, please visit: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Proposed-rule-fact-sheet.pdf

The proposed rule (CMS-5522-P) can be downloaded from the Federal Register at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-13010.pdf

For more information about the Quality Payment Program, please visit: qpp.cms


The number of middle and high school students who say they are current tobacco users dropped from 4.7 million in 2015 to 3.9 million in 2016, according to new data published by the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration’s (FDA) Center for Tobacco Products.

The 2016 National Youth Tobacco Survey found the decline in use of tobacco products was primarily driven by a drop in e-cigarette use among middle and high school students from 3 million in 2015 to just under 2.2 million in 2016. In addition, declines were also seen during 2015-2016 among high school students who used two or more tobacco products, any combustible tobacco products, and hookah.

The study also found that many youth report using multiple tobacco products; 1.8 million middle and high school students reported using two or more tobacco products in the past 30 days. Among current tobacco users in 2016, 47.2 percent of high school students and 42.4 percent of middle school students used two or more tobacco products.

The report found that 20.2 percent of high school students and 7.2 percent of middle school students reported current use of any tobacco product. E-cigarettes remained the most commonly used tobacco product among youth for the third consecutive year, used by 11.3 percent of high school and 4.3 percent of middle school students. Although the data reflect a decline during 2015-2016, current use of any tobacco product did not change significantly during 2011–2016, because of the sharp increases in e-cigarettes and hookah during 2011–2014.

Key findings from this report on youth tobacco product use:

Among all high school students in 2016, the most commonly used products after e-cigarettes were: cigarettes (8.0 percent), cigars (7.7 percent), smokeless tobacco (5.8 percent), hookah (4.8 percent), pipe tobacco (1.4 percent), and bidis (0.5 percent).

Among all middle school students in 2016, the most commonly used products after e-cigarettes were: cigarettes (2.2 percent), cigars (2.2 percent), smokeless tobacco (2.2 percent), hookah (2.0 percent), pipe tobacco (0.7 percent), and bidis (0.3 percent).

Among non-Hispanic white and Hispanic high school students, e-cigarettes were the most commonly used tobacco product. Among non-Hispanic black high school students, cigars were most commonly used.

Cigarette use was higher among non-Hispanic whites than among non-Hispanic blacks; smokeless tobacco use was higher among non-Hispanic whites than other races.

To learn more about quitting and preventing youth from using tobacco products, visit www.BeTobaccoFree.gov.



The Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT) released state-level health care spending data for the period 1991-2014.

The data shows that while most states experienced faster growth in 2014 due to Medicaid expansion and enrollment in Exchange plans, per capita health spending in Medicaid expansion and non-expansion states grew at similar rates. The report also found that the most recent economic recession, which ended in 2009, and modest recovery since then, had a sustained impact on health spending and health insurance coverage. Every state experienced slower growth in per capita personal health care spending from 2010-2013 than experienced during the period 2004-2009.

The report finds recent economic and health sector factors have had clear impacts by state, both by payer and in the rates of overall per capita personal health care expenditure growth; however, during the 2009 to 2014 period, the variation in spending between the lowest and highest states was virtually unchanged.

The report offers vital context for understanding how health spending varies across states. The analysis updates previous estimates published in 2011 and examines personal health care spending (or the health care goods and services consumed) through a resident-based view. These estimates are also presented both by type of goods and services (such as hospital services and retail prescription drugs) and by major payer (including Medicare, Medicaid, and private health insurance) for the individuals who reside in a state.

The study found the state with the highest per enrollee Medicare spending in 2014 was New Jersey ($12,614) with spending levels roughly 15 percent above the national average ($10,986).  In 2014, Montana was the state with the lowest per enrollee Medicare spending, at $8,238 per enrollee (25 percent below the national average per enrollee). 

Total Medicaid spending increased 12.3 percent from 2013 to 2014 for states that expanded Medicaid, compared with 6.2 percent for states that did not expand Medicaid.  However, on a per enrollee basis Medicaid spending declined considerably for the expansion states (-5.1 percent) in 2014, because of the enrollment of relatively less expensive enrollees, whereas per enrollee Medicaid spending in the non-expansion states increased 5.1 percent. 

Per enrollee private health insurance spending was $4,551 in 2014, an average annual increase of 3.3 percent since 2009 ($3,872).  Total private health insurance spending grew more rapidly in states that did not expand Medicaid eligibility by 2014 than in states that did expand eligibility, at rates of 6.8 percent and 4.6 percent, respectively.

A majority of this difference reflects faster private health insurance enrollment growth in non-expansion states (3.2 percent) compared to that for expansion states (1.9 percent).

The OACT data and analysis will appear at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsStateHealthAccountsResidence.html


The U.S. Department of Health and Human Services officially changed the name of AIDS.gov, the federal government’s leading source for information about HIV, to HIV.gov.

The announcement coincides with the 36th anniversary of the Centers for Disease Control and Prevention’s first report of the initial cases of what would become known as AIDS. The name change reflects major scientific advances that have transformed an almost universally fatal disease to a condition that, if diagnosed and treated early and continuously, can be controlled and prevented from progressing to AIDS. In fact, there are more people living with HIV in the United States now than people living with AIDS.

In 2016, more than 8 million people used the AIDS.gov website and its social media channels to find information about HIV or to find HIV-related programs and services, including HIV testing, medical care and treatment. The name change also embraces the way most people now search online for information about the disease. “HIV” is a much more common Internet search term than “AIDS.”



The Department of Health and Human Services announced the availability of over $70 million over multiple years to help communities and healthcare providers prevent opioid overdose deaths and provide treatment for opioid use disorder, of which $28 million will be dedicated for medication-assisted treatment (MAT).

Opioid overdoses claimed more than 33,000 lives in 2015, but preventive actions, treatment for addiction, and proper response to overdoses can help. Money from two grant funding opportunities, recently authorized by the Comprehensive Addiction and Recovery Act (CARA), will expand access to lifesaving overdose reversal medications and train healthcare providers to refer patients to appropriate follow-up drug treatment; funds from a third grant funding opportunity will provide for medication-assisted treatment of opioid use disorders.

Administered through the Substance Abuse and Mental Health Services Administration (SAMHSA), these funds will be made available through the following three grants:

Medication-Assisted Treatment and Prescription Drugs Opioid Addiction: Up to $28 million to 5 grantees to increase access of medication-assisted treatment for opioid use disorder. Medication-assisted treatment combines behavioral therapy and FDA-approved medication.

First Responders: Up to $41.7 million over 4 years available to approximately 30 grantees to train and provide resources for first responders and members of other key community sectors on carrying and administering an FDA approved product for emergency treatment of known or suspected opioid overdose.

Improving Access to Overdose Treatment: Up to $1 million over 5 years to one grantee to expand availability to overdose reversal medications in healthcare settings and to establish protocols to connect patients who have experienced a drug overdose with appropriate treatment.

Additionally, on May 4, SAMHSA released two other Comprehensive Addiction and Recovery Act-related funding opportunities. These funding opportunities will be open through July 3, 2017:

State Pilot Grant Program for Treatment for Pregnant and Postpartum Women: Up to $3.3 million to support a range of family-based services for pregnant and postpartum women with substance use disorder.

Building Communities of Recovery: Up to $2.6 million to mobilize resources within and outside of the recovery community to increase the prevalence and quality of long-term recovery support from substance abuse and addiction.

Please review the funding opportunity announcements at SAMHSA’s 2017 grant announcements page. Applicants with questions about program issues should contact the program person listed in the funding announcement. The deadline to apply may differ depending on the funding announcement. For questions on grants management issues contact Eileen Bermudez at (240) 276-1412 or FOACSAP@samhsa.hhs.gov or FOACSAT@samhsa.hhs.gov.



The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars.

The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019.

CMS is kicking-off a multi-faceted outreach campaign to help providers get ready for the new MBI.

Providers and beneficiaries will both be able to use secure look up tools that will support quick access to MBIs when they need them. There will also be a 21-month transition period where providers will be able to use either the MBI or the HICN further easing the transition

Personal identity theft affects a large and growing number of seniors. People age 65 or older are increasingly the victims of this type of crime. Incidents among seniors increased to 2.6 million from 2.1 million between 2012 and 2014, according to the most current statistics from the Department of Justice. Identity theft can take not only an emotional toll on those who experience it, but also a financial one: two-thirds of all identity theft victims reported a direct financial loss. It can also disrupt lives, damage credit ratings and result in inaccuracies in medical records and costly false claims.

Work on this important initiative began many years ago, and was accelerated following passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS will assign all Medicare beneficiaries a new, unique MBI number which will contain a combination of numbers and uppercase letters. Beneficiaries will be instructed to safely and securely destroy their current Medicare cards and keep the new MBI confidential. Issuance of the new MBI will not change the benefits a Medicare beneficiary receives.  

CMS is committed to a successful transition to the MBI for people with Medicare and for the health care provider community. CMS has a website dedicated to the Social Security Removal Initiative (SSNRI) where providers can find the latest information and sign-up for newsletters. CMS is also planning regular calls as a way to share updates and answer provider questions before and after new cards are mailed beginning in April 2018.

For more information, please visit: https://www.cms.gov/medicare/ssnri/index.html

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