ADEA Washington Update

Supreme Court Rules Providers Cannot Sue States for Higher Medicaid Reimbursement Rates

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The Supreme Court ruled that private health care providers could not sue the state in federal court to force a state to raise its Medicaid reimbursement rates. In its 5 4 ruling in Armstrong v. Exceptional Child Center, the Court

CMS Updates “Meaningful Use” Rule in Final Stage of HITECH Act

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The third and final rule of the HITECH Act, the six year old law designed to create a nationwide health care IT infrastructure, has been released by the Department of Health and Human Services (HHS). The Stage 3 rule, released

Office of National Coordinator Releases “Roadmap” for Interoperability

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A roadmap detailing the path to reach an “interoperable health IT ecosystem” by 2024 was released by the coordinator of the government’s health information technology effort.

Federal Health IT Strategic Plan Released

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draft version of the Federal Health IT Strategic Plan 2015-2020 released last month emphasizes, among other things, that new information about health care delivery be shared “quickly, securely, and efficiently.”

New CMS Rule Could Improve Accountable Care Organizations

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The Centers for Medicare and Medicaid Services (CMS) is seeking public comment on five adjustments the agency wants to make to the Shared Savings Program used by Accountable Care Organizations (ACOs).

Senators Seek to Stop Medicaid Payments to Dental Clinics that Circumvent Oversight Regulations

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Senate Finance Committee Chairman Max Baucus (D-MT) and Sen. Chuck Grassley (R-IA), Ranking Member of Judiciary Committee, are calling on the U.S. Department of Health and Human Services (HHS) to ban dental clinics from participating in the Medicaid program if the dental clinics circumvent state laws designed to ensure only licensed dentists own dental practices. The request by the senators comes in the wake of a year-long investigation into allegations of abusive treatment of children in clinics controlled by corporate investors rather than dentists. The report, “Joint Staff Report on the Corporate Practice of Dentistry in the Medicaid Program” released by Sens. Baucus and Grassley focuses on dental management companies organized as a corporation or limited liability company that works with dentists in multiple states. The investigation found a failure to meet quality and compliance standards, including the unnecessary treatment on children, the improper administration of anesthesia, providing care without proper consent, and overcharging the Medicaid program. According to the report, while many clinics technically meet state-level rules requiring their owners to be licensed dentists, the clinics nonetheless have placed control of their operations in the hands of corporate investors and the result is a system that “places profits above patient care.” Twenty-two states and the District of Columbia ban corporate dentistry. Investigators looked at five dental chains that allegedly used deceptive business models which gave managers, rather than dentists, control over the clinics. They included the following: Church Street Health Management (Small Smiles) ReachOut HealthCare America NCDR (Kool Smiles) Heartland Dental Care Aspen Dental Management The report focused on CSHM (Small Smiles) and ReachOut HealthCare America (RHA), because both companies treat Medicaid children almost exclusively. Sens. Baucus and Grassley urged the Inspector General for the U.S. Department of Health and Human Services to take action to stop taxpayer reimbursement of dental management companies that operate in this manner. “When states can’t hold owners accountable to maintain a professional standard of care, then clinics are more likely to fail to meet basic quality and compliance standards, putting the children who should be helped at risk,” according to the report.

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