Healthcare Update: Administration Delays Online Enrollment for Small Businesses; CMS Issues Four CY2014 Final Rules



    On November 27, 2013, the Centers for Medicare & Medicaid (CMS) announced its plan to delay online enrollment in the Small Business Health Options Program (“SHOP”) Marketplace until November 2014. According to CMS, this will allow the agency to continue making improvements to HealthCare.gov. In the interim, employees will be able to enroll over the phone, with coverage taking effect on January 1, 2014.

    The SHOP Marketplace is a Federally-facilitated health insurance exchange for employers with 50 or fewer full-time equivalent employees.


    On November 27, 2013, CMS released the CY2014 Medicare hospital outpatient prospective payment system (OPPS) final rule. Significantly, the OPPS rule finalizes CMS’ plan to create a single billing code for care provided at clinics, but does not change the payment model for hospital emergency departments. In addition, CMS released the CY2014 Medicare physician fee schedule final rule. The PFS final rule reduces physician payment rates by 20.1% under the sustainable growth rate (SGR) formula. Although this is less than the 24.4% reduction included in the proposed rule, it is still likely that Congress will override this payment adjustment. Congress has suspended the SGR every year since 2003. The rule also finalizes extra payments for certain primary care services related to chronic care management and implementation of the physician value-based payment modifier. Both rules will be published in the Federal Register on December 10, 2013.

    On December 2, 2013, published the End-Stage Renal Disease (ESRD) final rule and the Home Health Prospective Payment System (HH PPS) final rule. The ESRD final rule will, in effect, keep the 2014 rates the same as the 2013. The HH PPS final rule reduces payments by 1.05% and adds two new quality measures that will require home health agencies to report hospital readmissions that occur within the first 30 days of home health and use of an emergency department within the first 30 days of home health.


    Edwards Wildman’s Healthcare Practice Group will continue to monitor healthcare news from Capitol Hill, CMS, HHS, and other federal and state agencies, and will bring you timely updates as new developments occur.


    Edwards Wildman Palmer LLP is pleased to provide regular updates on issues affecting the Healthcare industry. Our lawyers not only provide sophisticated legal services to a broad array of clients in the healthcare industry, we also monitor and analyze federal and state legislative and regulatory processes to ensure that our clients are informed of government actions and initiatives.

    Should you have any questions on the content of this advisory, or wish to discuss any other healthcare related issue, please contact those linked above or call the Edwards Wildman Palmer LLP attorney responsible for your affairs.

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