In late December, the Centers for Medicare and Medicaid Services (CMS) issued a number of announcements.

On December 21, the agency announced that it will delay a new policy requiring a doctor’s signature on requisitions for clinical diagnostic lab tests for three months, in order to ensure that the policy is more thoroughly known and understood in the medical community. In conjunction with the three-month delay, CMS stated that it would begin an outreach program in order to bring physicians and practitioners up to speed on the new requirement.


On December 29, CMS issued its final rule that will implement a quality incentive program (QIP) in order to advance high-quality services in end-stage renal dialysis facilities by linking payments to such facilities with performance standards.

The program – which will be fully implemented by January 1, 2012 – will require end-stage renal dialysis providers to meet three quality measures, including two that reflect whether patients are receiving appropriate anemia treatments and one that will reflect the urea reduction ratio of patients.

Failure to meet such requirements will result in reimbursement reductions of up to two percent – marking the first pay-for-performance program in the Medicare fee-for-service program, according to CMS. The agency estimates that roughly one quarter of end-stage renal dialysis facilities will see payment reductions averaging 0.19 percent, while only 30 providers will likely have their reimbursements reduced by the full two percent.


CMS also recently announced that it is delaying for three months the enforcement of a new requirement for certifying the eligibility of home health and hospice patients in a face-to-face manner. The new provision requires that physicians and those non-physician practitioners authorized to make certification decisions must document that face-to-face meetings occurred with all existing and new home health and hospice patients before certifying them as eligible for services.

CMS made the decision to delay enforcement for three months in order to ensure that facilities have sufficient time to establish the protocols necessary for compliance. Following the delay, face-to-face meetings – which can occur via video conference in rural settings – must take place at least 90 days prior to the beginning of home health service, or 30 days after such service has started, and no more than 15 days before the beginning of hospice service.


In other healthcare news, the Employee Benefits Security Administration (EBSA) within the Department of Labor released an updated Frequently Asked Questions portion of its website before the holidays, including answers to questions about the new healthcare reform law and earlier laws (such as the mental health parity law).

The FAQs address topics such as preventative care, automatic enrollment, participant notifications regarding health plan modifications, grandfathered statuses of certain plans, coverage of young adults up to age 26, mental health parity and Health Insurance Portability and Accountability Act (HIPAA) requirements regarding group health plans. The guidance was prepared by the EBSA in conjunction with the Department of Health and Human Services (HHS) and the Treasury Department.

The updated FAQs and related information can be found here.


The 112th Congress convened on January 5, 2011, at which time control of the House of Representatives shifted from Democratic to Republican control. Following the procedural matters of officially electing its Speaker and adopting a rules package, the House quickly turned to the issue of healthcare reform.

As promised repeatedly on the campaign trail, Republican leaders brought forth legislation that would repeal the healthcare reform package (Public Laws 111-148 and 111-152) that President Obama signed into law last year. A simple two-page document, the legislation – H.R. 2 – would fully repeal both laws. It was expected to pass the House by a comfortable margin this week, though the effort would be purely symbolic, as it will not advance through the Senate which remains in Democratic control.

The weekend’s tragic events in Tucson, Arizona caused House leaders to postpone all legislative business for the week – including the healthcare vote – in order to give Members time to grieve and honor the victims of the mass shooting.


As the first session of the 112th Congress gets underway, we continue to follow news from Capitol Hill. In addition, we continue to monitor HHS/CMS and other agencies, as the implementation of healthcare reform and other matters move forward. We will bring you timely updates as new developments occur.