Draft HHS Report Backs Nonpharmacological Pain Management, Calls for Better Payer Coverage of Physical Therapy

Much like an APTA white paper on opioids and pain management published in the summer of 2018, a draft report from the US Department of Health and Human Services (HHS) says that it’s time to address the gaps in the health care system that make it difficult to follow best practices in addressing pain—including improved access to and payment for physical therapy. APTA provided comments to the HHS task force that created the report.

The draft “Report on Pain Management Best Practices” now available for public comment aims to identify “gaps, inconsistencies, updates, and recommendations for acute and chronic pain management best practices” across 5 major interdisciplinary treatment modalities: medication, restorative therapies including physical therapy, interventional procedures, behavioral health approaches, and complementary and integrative health. The entire report is predicated on a set of “key concepts” that emphasize an individualized biopsychosocial model of care that employs a multidisciplinary approach and stresses the need for innovation and research.

Full story at APTA

Short-Term Insurance Rule Adds More Uncertainty to Care

As APTA continues to advocate for the maintenance of essential health benefits (EHBs) in insurance offered through Affordable Care Act (ACA) marketplaces, the association and other stakeholders are facing another potential challenge to patient access to care: private insurer short-term, temporary health plans that can skirt many ACA requirements around EHBs, preexisting conditions, and continued coverage.

Earlier this month, the Department of Health and Human Services (HHS) adopted a final rule on the short-term plans, allowing the policies to provide 1 year of coverage, renewable for up to 3 years. Previously, the plans could only be used for a maximum of 3 months.

The plans are intended to offer a cheaper insurance alternative than plans available through the ACA (although most individuals who purchase insurance through the ACA marketplaces receive subsidies that lower the out-of-pocket costs). But they are not required to comply with many of the consumer protections included in ACA plans. Instead, the plans are able to deny coverage of a preexisting condition, drop coverage should a customer’s health status change, and refuse coverage for services such as mental health, prescription drugs—and, possibly, physical therapy.

Full story at APTA

New Round of HIPAA Audits Will Include Business Associates

Get ready for a new round of Health Insurance Portability and Accountability Act (HIPAA) audits—and this time, they’re going to be even broader in scope to include not just providers and other entities, but also the “business associates” that handle patient data. And just like the first phase of audits completed in 2012, the process includes onsite visits.

The new round of audits, conducted by the Department of Health and Human Services’ (HHS) Office of Civil Rights (OCR), is aimed at a “wide range of health care providers, health plans, health care clearinghouses, and business associates,” according to information from HHS. The audits will not include entities currently under investigation or under compliance review.

The audit process will begin with entity desk audits, conducted electronically, followed by a second round of desk audits of that entity’s business associates. OCR hopes to complete this phase of the process by the end of December 2016.

Full story of HIPAA audits and business associates at APTA

Medicare Reaches Value-Based Payment Goal a Year Ahead of Schedule

Medicare’s march toward payment systems that are tied to value and not volume has been moving along at a faster-than-expected clip, according to the Department of Health and Human Services (HHS), which says that Medicare has reached its goal to tie 30% of all payments to value-based systems nearly 1 year ahead of schedule.

According to an HHS announcement, growth of alternative payment models including accountable care organizations (ACOs) and bundled payment systems have allowed Medicare to shift $117 billion out of a projected $380 billion away from fee-for-service payments. HHS says that this shift has resulted in better care and greater savings, including $411 million savings in 2014 attributed to ACOs participating in the Medicare Shared Savings and Pioneer ACO programs.

The move away from quantity was a major feature of the Affordable Care Act (ACA), which created programs such as Medicare Shared Savings and the Center for Medicare and Medicaid Innovation.

Full story of Medicare’s payment system goal at APTA