Introduction

The Tribal Technical Advisory Group (TTAG) is a group of elected tribal leaders, or an appointed representative from their Area, who are nominated from the twelve areas of the Indian Health Service (IHS) delivery System. The TTAG serves as an advisory committee to the Centers for Medicare & Medicaid Services (CMS) on important health care matters associated with the Medicare, Medicaid, and State Children Health Insurance Programs (SCHIP). There is a Principal Member and an Alternate from each of the twelve service areas. These areas are: Alaska, Aberdeen, Albuquerque, Bemidji, Billings, California, Nashville, Navajo, Oklahoma, Phoenix, Portland, and Tucson. In addition to these twelve areas, there is representation from the four Washington, DC based advocacy organizations: Tribal Self Governance Advisory Committee (TSGAC), National Indian Health Board (NIHB), National Congress of American Indians (NCAI) and National Council of Urban Indian Health (NCUIH).

The TTAG is divided into TTAG Smaller Subcommittees (Adobe Acrobat PDF) to analyze major Medicare and Medicaid topics effecting AI/ANs in greater detail. Individual TTAG and MMPC members along with employees from the CMS and IHS are subcommittee members. These subcommittees include, but are not limited to: Across State Borders, Long Term Care, Data, Outreach & Education, Affordable Care Act Policy and Behavioral Health.

For more information about the TTAG and the MMPC Technical Advisors, please refer to the document Tribal Technical Advisory Group Membership (PDF).

cms to cover new technology for medicare patients with heart valve damage

May 1, 2012
The Centers for Medicare & Medicaid Services (CMS) will now cover transcatheter aortic valve replacement (TAVR) for Medicare patients under certain conditions. The coverage decision announced today by CMS Acting Administrator Marilyn Tavenner offers important new technology to some of Medicare’s sickest patients.

Aortic valve replacements are used in patients whose aortic heart valves are damaged, causing the valve to narrow – a condition known as “aortic stenosis.” Once patients experience symptoms of aortic stenosis, treatment is critical to improve their chances of survival.  Until recently, aortic stenosis has been treatable only through invasive surgery. In contrast, TAVR allows doctors to replace a patient’s aortic valve through a small opening in the leg. This less invasive procedure gives patients who cannot undergo open heart surgery a new way to repair their damaged heart valve.

“We are pleased with this decision and the increased access to treatment options it will provide,” said Acting Administrator Tavenner. “This decision is particularly important as it highlights cooperative efforts among CMS, the Food and Drug Administration (FDA), the Agency for Healthcare Research and Quality, medical specialty societies, and the medical device industry.”

This final national coverage decision is one of the first coverage decisions completed under a mutual memorandum of understanding between CMS and the FDA, a joint effort aimed at getting sometimes lifesaving, new technology to patients sooner.

Because this technology is still relatively new, it is important that these procedures are performed by highly trained professionals in optimally equipped facilities.  Therefore, this decision uses “coverage with evidence development,” which, as a condition of coverage, will require certain provider, facility, and data collection criteria to be met.  Such requirements are important to ensure beneficiaries receive the safest and most appropriate care.

The decision can be found here.

HHS announces new Affordable Care Act options for community-based care

Medicaid and Medicare introduce greater flexibility for beneficiaries to receive care at home or in settings of their choice

April 26, 2012
New opportunities in Medicaid and Medicare that will allow people to more easily receive care and services in their communities rather than being admitted to a hospital or nursing home were announced today by Health and Human Services Secretary Kathleen Sebelius.

HHS finalized the Community First Choice rule, which is a new state plan option under Medicaid, and announced the participants in the Independence At Home Demonstration program. The demonstration encourages primary care practices to provide home-based care to chronically ill Medicare patients.

Both are made possible by the Affordable Care Act. Studies have shown that home- and community-based care can lead to better health outcomes.

“We know that people frequently prefer to receive services in their own homes and communities whenever possible. The rule and demonstration announced today give people choice and provide states with flexibility to design programs that better meet the needs of beneficiaries,” Secretary Sebelius said. “Prior to passage of the Affordable Care Act, many families had few choices beyond nursing homes or other institutions for their loved ones. The actions taken today will help change that and can lead to better health for these individuals.”

The final rule released today on the Community First Choice Option provides states choosing to participate in this option a six percentage point increase in federal Medicaid matching funds for providing community-based attendant services and supports to beneficiaries who would otherwise be confined to a nursing home or other institution. 

Also today, the first 16 organizations that will participate in the new Independence at Home Demonstration were announced. They will test whether delivering primary care services in the home can improve the quality of care and reduce costs for patients living with chronic illnesses. These 16 organizations were selected from a competitive pool of more than 130 applications representing hundreds of health care providers interested in delivering this new model of care.                                                           

The Independence at Home demonstration, which is voluntary for Medicare beneficiaries, provides chronically ill Medicare beneficiaries with a complete range of in-home primary care services.  Under the demonstration, the Centers for Medicare & Medicaid Services (CMS) will partner with primary care practices led by physicians or nurse practitioners to evaluate the extent to which delivering primary care services in a home setting is effective in improving care for Medicare beneficiaries with multiple chronic conditions and reducing costs. Up to 10,000 Medicare patients with chronic conditions will be able to get most of the care they need at home.

The demonstration is scheduled to begin on June 1, 2012, and conclude May 31, 2015.

HHS is also seeking comment on a proposed rule that describes a separate Home and Community-Based Services state plan option, which was originally authorized in 2005 then enhanced by the Affordable Care Act. Like the Community First Choice Option, this benefit will make it easier for states to provide Medicaid coverage for home and community-based services.

“Our goal is to provide person-centered support to every Medicare and Medicaid beneficiary, regardless of their physical ability or chronic health conditions,” Acting CMS Administrator Marilyn Tavenner said. “These services and programs will help keep these individuals’ health stable, and keep them home where they want to be, while giving us even more tools to achieve better care for the patient, better health for the population, all at lower costs.”

The announcements made today are one part of the Obama administration’s efforts to help people with disabilities and those living with chronic illness stay in their own homes when they wish to do so.  Earlier this month, Secretary Sebelius announced the creation of the new Administration for Community Living, bringing together key HHS organizations and offices dedicated to improving the lives of Americans with functional needs into one coordinated  and stronger entity. This new agency will work on increasing access to community supports and achieving full community participation for seniors and people with disabilities.

For more information on the Administration for Community Living visit:
http://www.hhs.gov/acl/

For more information on the Community First Choice Option visit:
http://www.cms.gov/apps/media/fact_sheets.asp

For more information on the Independence at Home demonstration and the organizations selected to participate visit:
http://innovation.cms.gov/initiatives/independence-at-home

The rules may be viewed at:
www.ofr.gov/inspection.aspx

medicare proposed payment rule would promote improved inpatient care

Proposed rule would strengthen tie between payment and quality improvement

April 24, 2012
The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update Medicare payment policies and rates for inpatient stays to general acute care hospitals paid under the Inpatient Prospective Payment System (IPPS) and long-term care hospitals (LTCHs) paid under the LTCH Prospective Payment System (PPS). This proposed rule would is a continuation of our efforts to promote improvements in hospital care that will lead to better patient outcomes while slowing the long-term health care cost growth.

“The proposed rule would implement key elements of the Affordable Care Act’s value-based purchasing program as well as the hospital readmissions reduction program. It also establishes the groundwork for extending Medicare’s quality reporting programs beyond general acute care hospitals to other types of facilities,” said CMS Acting Administrator Marilyn Tavenner.  “It is part of a comprehensive strategy to use Medicare’s payment systems to foster better care and better value in all settings, thereby reducing overall Medicare spending.”

CMS is projecting that payment rates to general acute care hospitals will increase by 2.3 percent in FY 2013.  The 2.3 percent is a net update after inflation, improvements in productivity, a statutory adjustment factor, and adjustments for hospital documentation and coding changes.  CMS projects that the rate increase, together with other policies in the proposed rule and projected utilization of inpatient services, would increase Medicare’s operating payments to acute care hospitals by approximately 0.9 percent in FY 2013.  After taking into account the expiration of certain statutory provisions that provided special temporary increases in payments to hospitals,  and other proposed changes to IPPS payment policies, CMS projects that total Medicare spending on inpatient hospital services will increase by about $175 million in FY 2013.

Also, in this rule, CMS is proposing: 

• Improving Patient Care
• Documentation and Coding
• Expiration of Medicare, Medicaid, and SCHIP Extension Act Moratorium 

To read the full CMS press release issued today (4/24) click here:
http://www.cms.gov/apps/media/press/release.asp?Counter=4344

CMS will accept comments on the proposed rule until June 25, 2012, and will respond to all comments in a final rule to be issued by August 1, 2012.  The proposed rule can be downloaded from the Federal Register at:
https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-09985.pdf

The proposed rule will appear in the May 11, 2012 Federal Register.

Additional information can will be found in the CMS Fact Sheets issued here:
http://www.cms.gov/apps/media/fact_sheets.asp