Value Based Purchasing and Health Care Reform

HHS Releases CO-OP Proposed Rule

The U.S. Department of Health and Human Services has released a proposed rule that would implement the Consumer Operated and Oriented Plan (CO-OP) program under Section 1322 of the Patient Protection and Affordable Care Act.  The proposed rule would provide loans to foster the creation of consumer-governed, private, nonprofit health insurance issuers to offer qualified health plans in the Affordable Insurance Exchanges.  The purpose of the program is to create a new CO-OP in every State in order to expand the number of health plans available in the Exchanges with focus on integrated care and greater plan accountability.   

CMS will accept comments on the proposed rule until September 16, 2011.

For additional information, please see the following:

CMS Press Release: NEW PRIVATE NONPROFIT HEALTH PLANS WILL INCREASE COMPETITION, GIVE CONSUMERS AND SMALL BUSINESSES MORE HEALTH INSURANCE CHOICES (7/18/2011)

Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan (CO-OP) Program - Proposed Rule (as published in Federal Register on July 20, 2011)

HHS Announces Hospital Value-Based Purchasing Program Final Rule

Administration Implements Affordable Care Act Provision to Improve Care, Lower Costs, Value-Based Purchasing Will Reward Hospitals Based on Quality Care to Patients (HHS Press Release 4/29/2011)

Read the Rule:

Medicare Program; Hospital Inpatient Value-Based Purchasing Program - Final Rule (published in Federal Register 5/6/2011)

Medicare Program; Hospital Inpatient Value-Based Purchasing Program - Proposed Rule (published in Federal Register 1/13/2011)

CMS Releases Proposed Changes to Hospital and Physician Payment Systems for 2012

For additional information, see the following:

CMS PROPOSES POLICY AND PAYMENT CHANGES FOR OUTPATIENT CARE IN HOSPITALS AND AMBULATORY SURGICAL CENTERS (Centers for Medicare & Medicaid Services Press Release 7/1/2011)

Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2012 (Proposed Rule 7/1/2011).  Scheduled to be published in Federal Register on July 19, 2011.

CMS PROPOSES POLICY, PAYMENT RATE CHANGES FOR THE PHYSICIAN FEE SCHEDULE IN 2012 (Centers for Medicare & Medicaid Services Press Release 7/1/2011) 

Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical Center Payment; Hospital Value-Based Purchasing Program; Physician Self-Referral; and Provider Agreement Regulations on Patient (Proposed Rule 7/1/2011).  Scheduled to be published in Federal Register on July 18, 2011. 

HHS Releases Proposed Health Insurance Exchange Rules

For additional information, see the following:

After Much Scrutiny, HHS Releases Health Insurance Exchange Rules (Kaiser Health News 7/11/2011)

Affordable Insurance Exchange Announcement (HHS Speech 7/11/2011)

Read the Proposed Rules:

Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans (7/11/2011) 

Patient Protection and Affordable Care Act; Standards Related to Reinsurance; Risk Corridors and Risk Adjustment (7/11/2011)