Federal Independent Dispute Resolution (IDR) Portal Launched

April 15, 2022, the Centers for Medicare & Medicaid Services opened the Federal Independent Dispute Resolution (IDR) process for providers (including air ambulance providers), facilities, and health plans and issuers to resolve payment disputes for certain out-of-network charges.

To start a dispute, an initiating party will need:

• Information to identify the qualified IDR items or services;  
• Dates and location of items or services;
• Type of items or services such as emergency services and post-stabilization services; 
• Codes for corresponding service and place-of-service;  
• Attestation that items or services are within the scope of the Federal IDR process; and
• The initiating party’s preferred certified IDR entity. A list of certified entities can be found here. 

At the end of the 30-business-day open negotiation period, initiating parties have 4 business days to initiate a dispute via the portal. As a result of the recent decision in Texas Medical Ass’n, et al. v HHS, the Departments will give disputing parties whose open negotiation period expired before today, April 15, 2022, 15 business days to file an initiation notice via the IDR Portal.

Even after starting the Federal IDR process, disputing parties can continue to negotiate until the IDR entity makes a determination. If the parties reach an agreement on the out-of-network payment rate, they should email the certified IDR entity and the Departments (at [email protected]).

If the disputing parties experience extenuating circumstances during the IDR process that prohibit them from complying with deadlines to submit information, they may email the Departments (at [email protected]) to receive a Request for Extension Due to Extenuating Circumstances form and instructions for next steps.

To learn more about the independent dispute resolution process, including to read guidance materials, FAQs, and model notices, visit www.cms.gov/nosurprises

Where the Director of the Center for Medicare Wants to See Care Go

Home Health Care News / By Patrick Filbin
 
One of the most important Centers for Medicare & Medicaid Services (CMS) leaders – Dr. Meena Seshamani – is optimistic about the future of the home health care industry.
 
She detailed why last month at Home Health Care News’ Capital+Strategy event, pointing to more care taking place outside of traditional facilities, innovative care models and the shift to value-based care in general.
 
“We in Medicare are looking to increase our footprint in value-based care and in holistic care models where you’re really encouraging that team-based approach to care,” Seshamani said. “You’re enabling providers to come together to take accountability for cost and quality.”
 
Seshamani is the deputy administrator at CMS and the director of the Center for Medicare. In a value-based-care model, the shared goal of keeping patients healthy and out of the hospital drives smarter spending, she said. More importantly, it will ideally put providers, payers and other stakeholders in a position where they’re all “rowing in the same direction.”
 
“When something works in innovation, we have data, we have transparency,” she said. “As you align the various models that are out there, as you grow those models, that enables some of the flexibility to be able to address the needs of people that you are caring for.”
 
Once the data is there and innovative projects and alignments prove successful, Seshamani said the next step is to scale it.
 
An example of a successful pilot model is the Home Health Value-Based Purchasing (HHVBP) Model. A Center for Medicare and Medicaid Innovation (CMMI) creation, the model is being expanded nationwide next year.
 
According to Seshamani, there are two questions that CMS has to ask before it launches any model: whether it improves quality and whether it saves Medicare money.
 
HHVBP is one that met both of those criteria. Seshamani said CMS is now scaling it in order to bring it to more people.

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Congress is Back from Recess – What’s Next?

Congress is returning from a two week recess, with the Senate reconvening today, and the House reconvening tomorrow.  Axios reported that Sen. Kyrsten Sinema (D-AZ) told donors that advancement of a Build Back Better (BBB) reconciliation package is unlikely given other policy priorities at the forefront of the Congressional agenda. Although it could be revisited as soon as this Spring, there is not a current plan to revive BBB. 

Policymakers are expected to focus their efforts on advancing a $10 billion supplemental COVID-19 funding bill, resolving the differences between the House and Senate China competition bills, and considering an insulin drug pricing bill in the Senate.

Earlier this month, Rep. Fred Upton (R-MI) announced his retirement from Congress.  The Congressman is the lead Republican sponsor of the Cures 2.0 Act, and his departure could give momentum to the legislation or its key components. The homecare industry is lobbying to change the EVV provision in the Act that would prohibit the use of global positioning systems (GPS) and biometrics within electronic visit verification (EVV) systems.

First Complete Sequence of a Human Genome

National Institutes of Health

The Human Genome Project, completed in 2003, covered about 92% of the total human genome sequence. The technologies to decipher the gaps that remained didn’t exist at the time. But scientists knew that the last 8% likely contained information important for fundamental biological processes.

Since then, researchers have developed better laboratory tools, computational methods, and strategic approaches. The final, complete human genome sequence was described in a set of six papers in the April 1, 2022, issue of Science. Companion papers were also published in several other journals.

The work was done by the Telomere to Telomere (T2T) consortium. T2T is led by researchers at NIH’s National Human Genome Research Institute (NHGRI), the University of California, Santa Cruz, and the University of Washington, Seattle. NHGRI was the primary funder.

“Short-read” technologies were originally used to sequence the human genome. These provide several hundred bases of DNA sequence at a time, which are then stitched together by computers. Such methods still leave some gaps in genome sequences. 

Over the past decade, two new DNA sequencing technologies emerged that can read longer sequences without compromising accuracy. The PacBio HiFi DNA sequencing method can read about 20,000 letters with nearly perfect accuracy. The Oxford Nanopore DNA sequencing method can read even more—up to 1 million DNA letters at a time—with modest accuracy. Both were used to generate the complete human genome sequence.

In total, the new project added nearly 200 million letters of the genetic code. This last 8% of the genome includes numerous genes as well as repetitive DNA sequences, which may influence how cells function. Most of the newly added sequences were in the centromeres, the dense middle sections of chromosomes, and near the repetitive ends of each chromosome.

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