Statement from HHS Secretary Kathleen Sebelius on American Heart Month

“February 1^st marked the beginning of American Heart Month, a time to think about what you can do to take care of your heart.

“The Department of Health and Human Services is working with public and private partners to help Americans take care of their hearts and raise awareness of heart disease through our various research efforts and programs. Million Hearts is a national initiative to prevent 1 million heart attacks and strokes by 2017, by educating the public and health care professionals and bringing together diverse partners from across the country to fight heart disease and stroke.

“There are also a number of important programs aimed at reaching women with critical heart disease information. The Heart Truth and First Lady Michelle Obama’s Let’s Move! initiatives provide adults and children with resources and tips to make heart healthy changes in their lives.

“We are also reaching out to Latinas with Haga La Llamada. ¡No Pierda Tiempo!, which builds on the Make the Call. Don’t Miss a Beat campaign. The new Spanish-language campaign aims to educate and encourage Spanish-speaking women to call 9-1-1 when they or their mothers, sisters and friends, experience any symptom of a heart attack.

“Heart disease is the number one killer of women and men in the United States. In fact, it claims the lives of more women than chronic obstructive pulmonary disease, diabetes, Alzheimer’s disease, and lung cancer combined.

“But the good news for women and men is that most risk factors for heart disease—including high blood pressure, high cholesterol, physical inactivity, obesity, and smoking—are preventable and controllable. Controlling these risks could reduce your risk of a heart attack by 80 percent. That's why the Affordable Care Act is making preventive services such as blood pressure and cholesterol screening, smoking cessation, and obesity counseling more accessible than ever and at no out-of-pocket cost to millions of Americans with private health insurance and those with Medicare.                                                                                                                                                                  
“Having the security of quality, affordable health insurance is vital in the fight against heart disease. We are working with states to create Health Insurance Marketplaces, where uninsured and underinsured Americans can compare affordable health plans based on price, benefits, quality, and other important features and choose one that best suits their needs. Enrollment begins Oct. 1, 2013, but you can sign up now to receive the latest updates. If you need health insurance or know someone who does, see www.HealthCare.gov and learn what you can do now to prepare for the new Marketplace.      
“February is not just a time when many people fondly think of those close to their heart. It is also a time to take care of your heart.”

New Influenza Vaccine Manufactured with Novel Technology

(Health and Human Services) -- Our nation has reached a landmark in influenza vaccine history with the U.S. Food and Drug Administration’s approval of a new seasonal flu vaccine, called Flublok, made with novel technology. This method uses recombinant DNA and a modified baculovirus (a virus that infects insects) to produce a safe and effective human flu vaccine. The approval yesterday of the new vaccine produced with this modern technology stands as one of the most significant improvements in flu vaccine technology in the past 50 years. I am honored that such a remarkable advancement came through a public-private partnership between ASPR’s Biomedical Advanced Research and Development Authority and Protein Sciences Corporation.
Since its inception in 2006, BARDA has worked steadily with private industry to advance influenza vaccine technology and develop flu vaccines with these modern technologies that are FDA approved, ultimately providing more domestic pandemic vaccine capacity. As part of these national pandemic preparedness efforts, the National Institute of Allergy and Infectious Diseases supported early stage development of this vaccine and in 2009, when the vaccine reached an advanced development stage, BARDA began a partnership with Protein Sciences Corporation to reach the results we are seeing today: a new flu vaccine made with modern technology.
Demand for influenza vaccine can increase with little warning in a pandemic and in years when the flu is especially widespread. The method used to manufacture Flublok may help meet the increased demand for flu vaccine quickly because it has the potential for faster start-up of the manufacturing process than traditional egg-based vaccine methods. The process is nimble enough to be used for seasonal as well as potentially for pandemic flu vaccine because the technology does not depend on an egg supply or on the availability of modified influenza virus for production like traditional egg-based vaccine manufacturing does.
This new way of making flu vaccine is an example of the Obama administration partnering with industry to move innovative technology forward to the market. Our goal in ASPR is to drive innovative development of effective and cost-efficient vaccines, drugs, diagnostics, and medical equipment to protect public health during emergencies. Many of these innovations also hold potential day-to-day uses, as is often the case with seasonal and pandemic flu technology.
BARDA also worked with its partners to achieve FDA approval for the first flu vaccine manufactured using a cell-based technology and, through a public-private partnership, opened the first cell-based flu vaccine manufacturing plant in the United States. This past year, BARDA engaged private partners around the country in a new way through three Centers for Innovation in Advanced Development and Manufacturing that will support pandemic as well as biodefense readiness.
This HHS record of progress shows the power of public-private partnership. By working together – industry, non-government organizations and all levels of government – we can help save lives, improve public health preparedness and potentially increase health security for our nation. FDA approval of Flublok is an important step toward that goal.

Health care law delivers higher payments to primary care physicians

Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the final rule implementing the part of the health care law that delivers higher payments to primary care physicians serving Medicaid beneficiaries.  The new rule raises rates to ensure doctors are paid the same for treating Medicare and Medicaid patients and does not raise costs for states.
“The health care law will help physicians serve millions of Americans across the country,” Secretary Sebelius said.  “By improving payments for primary care services, we are helping Medicaid patients get the care they need to stay healthy and treat small health problems before they become big ones.”
The final rule implements the Affordable Care Act’s requirement that Medicaid pay physicians practicing in family medicine, general internal medicine, pediatric medicine, and related subspecialists at Medicare levels in Calendar Years 2013 and 2014.
This payment increase goes into effect in January of 2013.
In addition to payment improvements, the health care law includes numerous initiatives designed to bolster primary care and strengthen the primary care workforce, including an expansion of medical residency positions for primary care physicians, new investments in physician assistant and nurse practitioner training, and an unprecedented expansion of the National Health Service Corps, which provides scholarships and loan repayments to primary care providers who practice in underserved areas.

For more information about today’s final rule visit:http://www.cms.gov/apps/media/fact_sheets.asp
To view a copy of today’s final rule visit: www.ofr.gov/inspection.aspx

Obama administration issues new rules to cut red tape for doctors and hospitals, saving up to $9 billion

Health and Human Services (HHS) Secretary Kathleen Sebelius announced today the release of a new rule that will cut red tape for doctors, hospitals, and health plans. In combination with a previously issued regulation, the rule will save up to $9 billion over the next ten years. The regulation adopts operating rules for making health care claim payments electronically and describing adjustments to claim payments.
“These new rules will cut red tape, save money and ensure doctors spend more time seeing patients and less time filling out forms,” said Secretary Sebelius.
Studies have found that the average physician spends three weeks a year on billing and insurance related tasks, and, in a physician’s office, two-thirds of a full-time employee per physician is necessary to conduct these tasks. Many physician practices and hospitals receive and deposit paper checks, and manually post and reconcile the health care claim payments in their accounting systems. By receiving payments electronically and automating the posting of the payments, a physician practice and hospital’s administrative time and costs can be decreased.
The operating rules build upon industry-wide health care electronic fund transfer (EFT) standards that HHS adopted in January of this year. Together, the previously issued EFT standards and the EFT and electronic remittance advice (ERA) operating rules announced today are projected to save between $2.7 billion and more than $9 billion in administrative costs over ten years by reducing inefficient manual administrative processes for physician practices, hospitals, and health plans.
Operating rules include best business practices on how electronic transactions are transmitted and often target obstacles that physician practices and health insurers have with using electronic transactions. For instance, the rule announced today requires insurers to offer a standardized, online enrollment for EFT and ERA so that physicians and hospitals can more easily enroll with multiple health plans to receive those transactions electronically.  The rule also requires health plans to send the EFT within a certain amount of days of the ERA, which helps providers reconcile their accounts more quickly.
Today’s rule, Administrative Simplification:  Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions were developed through extensive discussions with industry stakeholders. The rule adopts the Council for Affordable Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE) Phase III EFT & ERA Operating Rule Set, including the CORE v5010 Master Companion Guide Template, with the exception of Requirement 4.2 of the Phase III CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule.   Collectively, these rules are referred to as the EFT & ERA Operating Rule Set.
The regulation announced today may be viewed at www.ofr.gov/inspection.aspx and will be effective upon its publication in the Federal Register on Aug. 10, 2012.  The comment period closes on Oct. 9, 2012.
The compliance date for operating rules for the health care electronic funds transfers and remittance advice transaction is Jan. 1, 2014.
A fact sheet with technical information on the rule is found at http://www.cms.gov/apps/media/fact_sheets.asp.

Affordable Care Act funds will create jobs and target health improvement, local capacity building

HHS Secretary Kathleen Sebelius today awarded up to $137 million, partly supported by the Affordable Care Act, to states to strengthen the public health infrastructure and provide jobs in core areas of public health. Awarded in nearly every state, the grants enhance state, tribal, local and territorial efforts to provide tobacco cessation services, strengthen public health laboratory and immunization services, prevent healthcare-associated infections, and provide comprehensive substance abuse prevention and treatment.

“More than ever, it is important to help states fight disease and protect public health,” said Secretary Sebelius. “These awards are an important investment and will enable states and communities to help Americans quit smoking, get immunized and prevent disease and illness before they start.”

The grants will fund key state and local public health programs supported through the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA). Most of these grant dollars come from the Prevention and Public Health Fund created by the Affordable Care Act. Additional SAMHSA dollars supplement this investment.

“CDC supports state and local public health departments which are key to keeping America safe from threats to health, safety, and security from this country or anywhere in the world,” said Centers for Disease Control and Prevention Director Dr. Thomas Frieden. “With these funds, CDC is strengthening our ability to prevent and combat diseases and keep Americans safe against expensive and dangerous health threats.”

“These funds will allow us to bolster public health services to communities and build on successful programs that have helped people lead healthier lives. Today’s investments will help us prevent future health care costs from problems such as tobacco-related illness and substance abuse,” said Pamela Hyde, administrator of SAMHSA.

The awards include:

• $1 million to further enhance the nations’ public health laboratories by hiring and preparing scientists for careers in public health laboratories, providing training for scientists, and supporting public health initiatives related to infectious disease research.
• Nearly $5 million to help states and territories enhance and expand the national network of tobacco cessation quitlines to increase the number of tobacco users who quit. Quitlines are the toll-free numbers people can call to obtain smoking cessation treatments and services.
• More than $42 million to support: improvements to the Immunization Information Systems (registries) and other immunization information technologies; development of systems to improve billing for immunization services; planning and implementation of adult immunization programs; enhancement of vaccination capacity located in schools; and evaluations of the impact on disease of recent vaccine recommendations for children and adolescents.
• $2.6 million to the Emerging Infections Programs around the country to continue improvement in disease monitoring, professional development and training, information technology development, and laboratory capacity.
• $9.2 million to eight national non-profit professional public health organizations to assist state, tribal, local, and territorial health departments in adopting effective practices that strengthen their core public health systems and service delivery. They will also enhance the workforce by providing jobs in critical disciplines of epidemiology and informatics, thus attracting new talent to public health.
• $1.5 million to evaluate and prevent ventilator-associated pneumonia to reduce cases of Methicillin-resistant Staphylococcus aureus (MRSA) infections and protect Americans from healthcare-associated infectious diseases.
• Up to $75 million to fund nine Screening, Brief Intervention, Referral and Treatment programs over the next five years. These programs will allow communities throughout the nation to provide more comprehensive substance abuse screening, secondary prevention, early intervention and referrals to treatment for people at higher risk for substance abuse. The actual award amounts may vary, depending on the availability of funds and the performance of the grantees.

Today’s announcement is another part of the Obama Administration’s broader effort to improve the health and well-being of our communities through initiatives such as the President’s Childhood Obesity Task Force, the First Lady’s Let’s Move! campaign, the National Quality Strategy, and the National Prevention Strategy. Similar to the Obama Administration’s Partnership for Patients which aims to make hospitals safer, more reliable and less costly, today’s announcement is also an important step in improving the quality of health care for all Americans.

A full list of grantees is available at: http://www.hhs.gov/news/press/2011pres/08/state_prevention_grants.html

Approximately $40 million in Affordable Care Act funds for statewide chronic disease prevention programs

The U.S. Department of Health and Human Services announced today the availability of approximately $40 million to strengthen and better coordinate activities within state and territorial health departments aimed at preventing chronic diseases and promoting health. Created by the Affordable Care Act, this initiative targets the nation’s five leading chronic disease-related causes of death and disability: heart disease, cancer, stroke, diabetes, and arthritis. “Chronic diseases are responsible for 7 out of 10 deaths among Americans each year, and they account for about three-fourths of the more than $2.5 trillion our nation spends annually on medical care,” said HHS Secretary Kathleen Sebelius. “Fortunately, many chronic diseases are preventable, and these new resources will assist states and territories in the implementation of proven prevention and wellness programs that will save lives and lower health care costs for all Americans.”
This announcement is one part of the first-ever Prevention & Wellness Month, as the Obama Administration is highlighting announcements, activities, and tips that will help Americans get healthy and stay healthy. The new initiative will support the implementation of public health programs, surveillance of chronic diseases, translation of research into public health practice, and development of tools and resources for health workers and other leaders at the national, state, and community levels.
State and territorial health activities will focus on reducing age-adjusted mortality due to chronic diseases and reducing the prevalence of disabling chronic diseases. In addition, the initiative will aim to improve health and quality of life by promoting environmental and policy changes related to nutrition, physical activity, and clinical preventive services and by promoting education and management skills for people diagnosed with or at high risk for chronic diseases.
“Many chronic diseases share common risk factors, afflict similar population groups the hardest, and can be effectively addressed by the same public health strategies,” said Dr. Thomas Frieden, director of HHS’ Centers for Disease Control and Prevention, which oversees the initiative. “That’s why it’s so important to help state and territorial health departments develop the organizational capacity and management approaches to deal with chronic diseases holistically, not just as separate conditions.”
CDC expects to award funds for 3-year coordinated statewide chronic disease programs to all 58 U.S. states and territories, with approximately $40 million available for the first 12-month budget period. As a critical requirement, successful grantees will create or update statewide plans that demonstrate coordinated approaches to addressing the leading causes of chronic disease deaths and their associated risk factors, including but not limited to heart disease, cancer, stroke, arthritis, diabetes, nutrition, physical activity, and obesity. Tobacco use, a leading risk factor for chronic diseases, is not part of the initiative but will continue to be addressed through CDC’s other statewide prevention programs.
State and territorial health departments interested in submitting proposals for the Prevention and Public Health Fund Coordinated Chronic Disease Prevention and Health Promotion Program can find more information at www.grants.gov. The application deadline is July 22, 2011.

New Affordable Care Act support to improve care coordination for nearly 200,000 people with Medicare

Today, the Department of Health and Human Services (HHS) announced the Federally Qualified Health Center Advanced Primary Care Practice (FQHC APCP) demonstration project, a new Affordable Care Act initiative that will pay an estimated $42 million over three years to up to 500 FQHCs to coordinate care for Medicare patients. This demonstration project, operated by the Centers for Medicare and Medicaid Services (CMS) in partnership with the Health Resources Services Administration (HRSA), will test the effectiveness of doctors and other health professionals working in teams to improve care for up to 195,000 Medicare patients. This initiative is part of a broader effort by the Obama Administration, made possible by the Affordable Care Act, to improve care and lower costs.
“FQHCs provide essential primary care services to seniors and others in underserved communities”, said CMS Administrator Donald Berwick. “This project will go a long way toward creating comprehensive and coordinated healthcare opportunities for the many people with Medicare who rely on FQHCs as their primary medical providers.”
The FQHC Advanced Primary Care Practice demonstration will show how the patient-centered medical home (PCMH) model can improve quality of care, promote better health, and lower costs. Participating FQHCs are expected to achieve Level 3 PCMH recognition, help patients manage chronic conditions, as well as actively coordinate care for patients. To help participating FQHCs make these investments in patient care and infrastructure, they will be paid a monthly care management fee for each eligible Medicare beneficiary receiving primary care services. In return, FQHCs agree to adopt care coordination practices that are recognized by the National Committee for Quality Assurance (NCQA). CMS and HRSA will provide technical assistance to help FQHCs achieve these goals.
“The transformation to a patient-centered medical home is designed to improve the coordination of care for Medicare beneficiaries by helping doctors and other health professionals work in teams”, said Dr. Mary Wakefield HRSA Administrator. “FQHCs in this project can increase access to important primary care services and thus reduce the need for costly hospitalizations or emergency department visits.”
The FQHC APCP project is just one part of a wide-ranging effort by the Obama Administration to improve the quality of health care for all Americans, using important new tools provided by the Affordable Care Act. In addition to this demonstration, the Partnership for Patients is bringing together health care providers and other key stakeholders committed to keeping patients from getting injured or sicker in the health care system and to improving transitions between care settings. CMS will invest up to $1 billion to help drive these changes. Also, CMS has proposed rules to allow Medicare to pay new Accountable Care Organizations (ACOs) to improve coordination of patient care that would be expected to result in better care and lower costs.
FQHCs that have provided medical services to at least 200 Medicare beneficiaries in the previous 12-month period will be invited by letter to apply to participate in the demonstration. Applications for the project will be accepted from June 6, 2011 through August 12, 2011, and the demonstration will be conducted September 1, 2011 through August 31, 2014.
Details about the demonstration and the application process can be found on the CMS web site at: www.cms.gov/DemoProjectsEvalRpts/MD/ and linking to the demonstration web page or by visiting the CMS Innovation Center website at http://innovations.cms.gov/
Questions about this CMS demonstration should be directed to: fqhc_med_home@cms.hhs.gov

HHS agencies to provide ongoing support for communities impacted by Joplin disaster

U.S. Department of Health and Human Services personnel from the National Disaster Medical System (NDMS) began returning to their home states today after deploying to assist in mass fatality operations in the aftermath of a devastating tornado in Joplin, Mo. HHS will provide ongoing assistance with additional aspects of response and recovery.
NDMS, within the HHS Office of the Assistant Secretary for Preparedness and Response, provides medical, victim identification, and veterinary personnel, equipment and supplies to augment state and local resources in disaster response. Similar to military reservists, NDMS personnel come from private sector jobs around the country to respond as intermittent federal employees during disasters. In the tornado response, the state of Missouri requested NDMS support in victim identification.
This response represents the largest number of NDMS mass fatality personnel deployed to a domestic disaster since Hurricane Katrina in 2005. More than 100 personnel from NDMS Disaster Mortuary Operational Response Teams and Family Assistance Center Teams assisted the local coroner’s office in identifying victims of the tornado. This NDMS support for 24-hour efforts in Missouri helped the coroner’s office reunite all victims with their loved ones as quickly as possible in a dignified, respectful manner.
“We’re honored to help state and local authorities bring some sense of closure to the families who lost family members to this storm,” said Dr. Nicole Lurie, assistant secretary for preparedness and response. “Although the situation in Joplin is still difficult, we’ve witnessed a tremendous amount of pride and resilience in the community. HHS will continue to work closely with state and local officials on the ongoing need for social services as the community recover.”
State, federal, and nonprofit partners are collaborating to meet the child care needs of Joplin families. The HHS Administration for Children and Families, in partnership with the Missouri Department of Social Services, convened a task force to address emergency child care needs as well as the recovery of the community's child care capacity. The tornado destroyed 19 child care centers with combined capacity to serve approximately 600 children.
The HHS Substance Abuse and Mental Health Services Administration (SAMHSA) is working with the state to bring the National Crisis Counseling Program to the impacted counties. The program supports short-term interventions to help disaster survivors in their recovery process. Immediately after the tornado, SAMHSA provided stress and grief materials to state and local agencies for use in counseling programs, primary care sites and other areas from which survivors are likely to seek help. With 20 of the area’s 25 mental health facilities destroyed, SAMHSA is also providing technical assistance to the state in restoring this behavioral health infrastructure.
To ensure that sufficient health care items and services are available to meet the needs of Medicare, Medicaid and Children’s Health Insurance Program beneficiaries in the affected area, the Centers for Medicare and Medicaid Services (CMS) is monitoring the status of health care facilities. CMS will waive or modify certain federal requirements as necessary and in accordance with the law for these facilities, such as allowing critical access hospitals to take more than the statutorily mandated limit of 25 patients and not count the expected longer lengths of stay for evacuated patients against the 96-hour average.
The Centers for Disease Control and Prevention is supporting the Joplin health department on restaurant inspections and on-going public health monitoring. CDC is also providing information on how to prevent illnesses and injuries as the community cleans up and clears debris from the tornado.
To ensure the safety of products regulated by the Food and Drug Administration, the FDA worked last week with state and local health departments to complete inspections of food processing facilities and pharmaceutical and medical device manufacturers that were located in the affected area.
For information on HHS support for response and recovery efforts in Missouri, visit www.phe.gov.

HHS Secretary Declares Public Health Emergency for Missouri

U.S Department of Health and Human Services Secretary Kathleen Sebelius has declared a public health emergency for Missouri in the aftermath of severe storms and tornadoes which struck the state Sunday night. The action will enable the Secretary to ensure that beneficiaries of the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP), continue to receive services during this emergency.

“Our hearts go out to the people of Joplin and the surrounding communities affected by last night’s tornadoes,” said Secretary Sebelius. “We are working closely with our state partners and community organizations to provide the support needed to respond to this disaster and in the ongoing flood recovery in the region.”

The public health emergency is declared under section 319 of the Public Health Service Act and is necessary so that HHS may waive or modify certain Medicare, Medicaid and CHIP requirements under section 1135 of the Social Security Act. The state can submit waiver requests through Centers for Medicare & Medicaid Services (CMS) Regional Office.

Under section 1135, HHS may permit affected health care facilities in Missouri to relax certain operating procedures temporarily so health care services can be delivered, such as allowing critical access hospitals to take more than the statutorily mandated limit of 25 patients and not count the expected longer lengths of stay for evacuated patients against the 96-hour average.

HHS agencies are working with state agencies and regional networks to respond to public health and medical needs of impacted communities. The HHS Assistant Secretary for Preparedness and Response is providing National Disaster Medical System assets to support the state and local health agencies in responding to the disaster.

A Disaster Mortuary Operational Response Assessment Team has deployed to Missouri to work with the state and local coroners and medical examiners in determining the full extent of federal mortuary resources that may be needed. A Disaster Mortuary Operational Response Team and a Family Assistance Center Team will provide assistance to coroners, medical examiners and families in identifying victims and returning remains to their loved ones. In addition, ASPR will provide a Disaster Portable Morgue Unit to support local mortuary operations.

An incident management team from the U.S. Food and Drug Administration (FDA) is working with state and local health departments to assist with inspections of FDA-regulated industries, such as food processing facilities and pharmaceutical and medical device manufacturers, impacted by the tornadoes to ensure the safety of FDA-regulated products.

An Incident Response Coordination Team will make sure federal public health and medical teams have what they need to assist the state at this critical time. This team is the “on the ground” command-and-control for federal public health and medical assets.

Information on steps to protect health immediately after a tornado or to prepare for disasters is available at http://www.phe.gov. Today’s Public Health Emergency declarations are available at http://www.hhs.gov/secretary/phe05232011.html.

Affordable Care Act prevention benefits increasing access, lowering costs for people with Medicare

Today, the Department of Health and Human Services (HHS) released a new report showing that in less than two months, more than 150,000 seniors and others with Medicare have received an annual wellness visit. This is a preventive benefit now covered by Medicare free of charge when obtained by a participating health care professional, thanks to the Affordable Care Act, along with many other recommended preventive services. The report also shows that this enhanced preventive benefits coverage will lower costs, including lowering Medigap premiums for employers, states and people with Medicare. Many more people with Medicare are expected to receive annual wellness visits and other recommended preventive services thanks to the Affordable Care Act.

“The Affordable Care Act is bringing new preventive benefits and savings to millions of Medicare beneficiaries this year,” said Secretary Sebelius. “Seniors and others with Medicare are already taking advantage of these important preventive services and wellness visits, which can help lower costs, prevent illness, and save lives.”

The report released today shows that, thanks to the Affordable Care Act, an average of 2,800 people with Medicare have received an annual wellness visit per day between January 1 and February 23, 2011. Because Congress has eliminated the part B coinsurance and deductibles for the annual wellness visit and many other preventive services, the report says that the use of these services should increase.

This will make a big difference for people with Medicare who, like most Americans, tend to use preventive services at roughly half the recommended rate. For example, only 43 percent of women with Medicare received a mammogram in 2008. The Affordable Care Act encourages beneficiaries to use more preventive services by waiving the usual coinsurance and deductible requirements for services recommended by the United States Preventative Services Task Force (USPSTF) as well as for an annual wellness visit. If those recommended services are obtained from qualified and participating health care providers, there are no out of pocket costs. For example, cancer screenings such as mammograms and colonoscopies as well as tobacco cessation counseling may now be obtained free of charge. To learn more about the new Medicare benefits in 2011, visit www.HealthCare.gov/news/factsheets/new_medicare_benefits.html.

In addition to improving the use of preventive services and creating additional savings for beneficiaries, Medicare’s enhanced prevention benefits will lead to lower premiums for employers who now fill this gap in coverage. The same is true with states that fill-in Medicare’s benefit gaps and cost sharing for low-income seniors through Medicaid. Lastly, many seniors buy Medigap insurance to cover Medicare’s cost sharing. With Medicare now paying for annual wellness visits and the part B cost sharing for many preventive services, Medigap premiums should be lower.

This is just one of the many ways the Affordable Care Act is helping improve the Medicare program. The law helps Medicare beneficiaries directly by taking on the rising cost of prescription drugs and providing important relief for beneficiaries who fall into the coverage gap – also known as the “donut hole.” In addition, Medicare’s use of the new tools provided by the Affordable Care Act and better management of the program have stabilized premiums for Medicare’s coverage of prescription drugs (Part D) and increased the number of prescription drug plans that voluntarily help fill the donut hole. Along with other efforts to improve care for people with Medicare, the Affordable Care Act will generate billions of dollars in savings for Medicare, extend the life of the Medicare Trust Fund by 12 years, and help cut costs for seniors and keep them healthy.

To read the report, visit www.HealthCare.gov/center/reports/prevention03162011a.html

Departments of Justice and HHS team up to crack down on health care fraud

Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius visited Detroit today to participate in the fifth regional health care fraud prevention summit. These summits bring together a wide array of federal, state and local partners, beneficiaries, providers and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system.

The summits are part of a larger effort on behalf of the Obama Administration to root out waste, fraud and abuse within the U.S. health care system. In Detroit, the joint efforts of the Departments of Justice (DOJ) and HHS have achieved significant results in an area with major health care fraud problems. Since May 2009, this collaboration has resulted in charges against 120 defendants, in 18 separate criminal cases, for fraud schemes totaling approximately $120 million in taxpayer funds. So far, eight of these individuals have been convicted at trial and 63 have pleaded guilty.

"Here in Detroit and communities across this region, many of you have witnessed the devastating effects of health care fraud," said Attorney General Holder. "Through a collaborative DOJ-HHS effort, we are working in partnership with government, law enforcement and industry leaders to protect taxpayer dollars, control health care costs and ensure the strength and integrity of our most essential health care programs. The results are clear: thanks to our efforts, health care fraud schemes throughout this region and across the country are being aggressively and permanently shut down. And as we renew our commitment to this work today, I am committed to building on the progress we've made, continuing to collaborate with each of you, and seeking new ways to expand our operations to fight health care fraud."

"Thanks to provisions in the Affordable Care Act, the prospects for a criminal thinking about targeting our health care system have gotten a lot gloomier," said Secretary Sebelius. "Here in Detroit, we are honoring our commitment to America's seniors, meeting our obligation to taxpayers, and standing up to criminals who, in the past, have gotten away with far too much." In addition to remarks by the Attorney General and the Secretary, the summit featured three educational panels aimed at identifying best practices for providers, law enforcement and beneficiaries in preventing health care fraud.

The summits are integral to the overall health care fraud-fighting effort undertaken jointly by DOJ and HHS through the Health Care Fraud Prevention and Enforcement Action Team (HEAT). As one part of HEAT's efforts, Medicare Fraud Strike Force operations have expanded from South Florida and Los Angeles to a total of nine health care fraud hot spots including Houston, T.X.; Detroit, M.I.; Brooklyn, N.Y.; Baton Rouge, L.A..; Tampa, F.L.; Chicago, I.L.; and Dallas, T.X.. The Strike Force is a partnership between the Criminal Division's Fraud Section, U.S. Attorneys' Offices, HHS' Office of Inspector General, Federal Bureau of Investigation (FBI) and other federal, state and local law enforcement partners.

Since their inception in 2007, Strike Force operations have charged more than 1,000 defendants for Medicare fraud involving more than $2.3 billion in claims. In addition, the Affordable Care Act provides new tools and resources to fight fraud in federal health care programs by providing an additional $350 million over the next 10 years through the Health Care Fraud and Abuse Control Account. The law toughens sentencing for criminal activity, enhances screenings and enrollment requirements, encourages increased sharing of data across government, expands overpayment recovery efforts and provides greater oversight of private insurance abuses.

For information on the Health Care Fraud and Abuse Control Program Report for Fiscal Year 2010, please visit: http://oig.hhs.gov/publications/docs/hcfac/hcfacreport2010.pdf. For a summary of new tools and resources the Affordable Care Act has put in place to help fight fraud, visit: www.HealthCare.gov/news/factsheets/fraud03152011a.html. Investments in fraud detection and enforcement have been shown to pay for themselves many times over, and the Administration's tough stance against fraud is already yielding results. In FY 2010, more than $4 billion was returned to the Medicare Health Insurance Trust Fund, the U.S. Department of the Treasury and others as a result of enforcement activities targeting false claims and fraud perpetrated against government health care programs. This was an increase of $1.4 billion, or 56 percent, over FY 2009.

The $4 billion recovered in FY 2010 includes recoveries from the $2.5 billion in settlements and judgments obtained in FY 2010 by the Department of Justice in False Claims Act matters alleging health care fraud. This is an unprecedented level of funds obtained in a single year and represents a 53 percent increase over FY 2009, in which $1.63 billion was obtained. On June 8, 2010, President Obama announced this nationwide series of regional fraud prevention summits as part of a multi-faceted effort to crack down on health care fraud. The Detroit summit was the fifth in a series, with additional summits to follow in the coming months. Previous summits were held in Miami (July 16, 2010), Los Angeles (Aug. 26, 2010), Brooklyn, N.Y. (Nov. 5, 2010) and Boston (Dec. 16, 2010).

Obama Administration takes new steps to support innovation, empower states

Building on President Obama's commitment to ensure states have the power and flexibility to innovate and implement the health care solutions that work best for them, the Departments of Health and Human Services (HHS) and Treasury today proposed new rules outlining the steps states may pursue in order to receive a State Innovation Waiver under the Affordable Care Act. The Affordable Care Act gives states the flexibility to receive a State Innovation Waiver so they may pursue their own innovative strategies to ensure their residents have access to high quality, affordable health insurance. Under the law, State Innovation Waivers are available in 2017.

President Obama supports bipartisan legislation that would make waivers available to states beginning in 2014. "Innovation Waivers empower states to take the lead on implementing the Affordable Care Act," said HHS Secretary Kathleen Sebelius. "Today's announcement demonstrates the flexibility available to states as they continue to move forward on fixing our broken health insurance marketplace." State Innovation Waivers are designed to allow states to implement policies that differ from those in the Affordable Care Act so long as they: Provide coverage that is at least as comprehensive as the coverage offered through Health Insurance Exchanges – new competitive, private health insurance marketplaces. Make coverage at least as affordable as it would have been through the Exchanges. Provide coverage to at least as many residents as otherwise would have been covered under the Affordable Care Act. Do not increase the Federal deficit. Under the Affordable Care Act, states have significant flexibility in implementing the law, from how they design Exchanges to cracking down on the worst of insurance company abuses. They also have new resources to improve and lower costs in their Medicaid programs. For example, if states choose to operate their own Exchange, they are eligible for grants to help design them and determine the rules, including whether to allow all companies to offer insurance in the Exchange or to select only plans that improve the quality and affordability of the choices.

To read more about new resources and flexibilities for states under the Affordable Care Act, visit www.HealthCare.gov/center/reports/states02252011a.pdf. States could use a variety of strategies to innovate through a waiver, provided they meet the above requirements. For example, they could develop a new system for providing tax credits, which links small business tax credits to the tax credits for moderate-income families. Or they could change the benefit levels or add new benefit levels for health plans offered in the Exchanges, providing consumers and employers even more choices. The proposed regulation announced today describes the content of the waiver application and how such proposals may be disclosed to the public, monitored, and evaluated. The Administration welcomes suggestions for improving this process from States, patients, health care providers, and the general public. As the President said in his State of the Union address, he is open to ideas on how to improve the Affordable Care Act. To read the new regulations, visit www.ofr.gov/inspection.aspx.

FACT SHEET: Preparing for Innovation: Proposed Process for States to Adopt Innovative Strategies to Meet the Goals of the Affordable Care Act Building on President Obama's commitment to give states the flexibility to innovate and implement the health care solutions that work best for them, the Departments of Health and Human Services (HHS) and Treasury today proposed new rules outlining the steps states may pursue in order to receive a State Innovation Waiver under the Affordable Care Act. The proposed regulation describes the content of the waiver application and how such proposals may be disclosed to the public, monitored, and evaluated. Because this rule is a proposed regulation, the Administration welcomes suggestions for improving this process from states, patients, health care providers, and the public. This action underscores President Obama's commitment to providing states the flexibility to find the health care solutions that work best for them. The Affordable Care Act gives states the flexibility to receive a State Innovation Waiver so they may pursue their own innovative strategies to ensure their residents have access to high quality, affordable health insurance.

Under the law, State Innovation Waivers are available in 2017. President Obama supports bipartisan legislation that would make waivers available to states beginning in 2014. The "Empowering States to Innovate Act," is sponsored by Senators Ron Wyden, Scott Brown, Mary Landrieu, Ben Nelson, Joe Manchin, and Patrick Leahy. State Innovation Waiver Criteria In order to apply for a waiver, states must enact a law and comply with Federal regulations that ensure appropriate public notice and transparency.

States must also demonstrate that, if the waiver is approved, the state's plan will provide coverage that: Is at least as comprehensive as the coverage that would have been provided under the Affordable Care Act. Is at least as affordable as the coverage and cost sharing protections under the Affordable Care Act. Covers at least as many residents as would have otherwise been covered under the Affordable Care Act. Will not increase the Federal deficit. Already, under the law, most insurance companies: Cannot impose lifetime limits on the dollar amount they spend on health benefits. Must offer young adults without access to job-based coverage the option of remaining on their parent's plan until their 26th birthday. Must cover recommended preventive services without cost sharing. Must allow patients to choose their own doctor in their network. Cannot drop your coverage because you get sick. Must spend at least 80 percent of premium dollars on health care, rather than executive salaries and administrative costs. And starting in 2014, insurance companies cannot charge more, carve-out benefits, or deny coverage because of a pre-existing health condition.

States that receive a State Innovation Waiver would be required to maintain these important consumer protections that prevent insurance companies from denying, capping or limiting care. Currently, the Affordable Care Act allows State Innovation Waivers beginning in 2017. States could use a variety of strategies to innovate through a waiver, provided they meet the above requirements. For example, they could develop a new system for providing tax credits, which links small business tax credits to the tax credits for moderate-income families. Or they could change the benefit levels or add new benefit levels for plans offered in the Exchanges. State Innovation Waivers are provided for up to five years, with the option of renewal.

Today's proposed rule outlines a process and asks for public input on how states can apply for an Innovation Waiver, as well as how the Administration will monitor and evaluate such waivers. Specifically, the proposed rule contains information on:

Public Notice: At the State and Federal level, the law ensures an opportunity for public input. The proposed regulation outlines how public notice and comment should work, including public hearings, to ensure a meaningful level of public involvement, input, and transparency.

Content of the Application: Consistent with what is required by the law, the proposed rule says that an application must include: The provisions of law that the state seeks to waive; An explanation of how the proposed waiver will meet the goals related to coverage expansion, affordability, comprehensiveness of coverage, and costs; A budget plan that does not increase the Federal deficit, with supporting information; Actuarial certifications and economic analysis to support the state's estimates that the proposed waiver will comply with the comprehensive coverage requirement, the affordability requirement and the scope of coverage requirement; and Analyses of the waiver's potential impact on provisions that are not waived, access to health care services when residents leave the state, and deterring waste, fraud, and abuse.

Periodic Reports: Under the proposed regulations, states with waivers would submit quarterly and annual reports. They would track measures in the four key areas: affordability, comprehensiveness of coverage, the number of people covered, and impact on the Federal deficit.

Post-Award Evaluation: The proposed regulations suggest criteria that could be used in the evaluation of the waivers while they are in place, covering such topics as: Choice of health plans for individuals and employers; Stability of coverage for individuals and employers; Small businesses, individuals with pre-existing conditions, and the low-income population; The overall health care system in the state; and Other states and the Federal government. Public comment is welcome on the State Innovation Waiver process outlined in this proposed regulation. To find the proposed regulation, visit www.ofr.gov/inspection.aspx.

Report: Affordable Care Act controls costs for early retiree coverage in Missouri

State and local governments, private employers in Missouri receive $6,207,825 in 2010 to help protect coverage for retired Americans Health and Human Services Secretary Kathleen Sebelius today released a new report showing that the Early Retiree Reinsurance Program (ERRP) created by the Affordable Care Act is reducing health care costs for early retirees. As of December 31, 2010 in Missouri, 138 employers had been accepted into ERRP, and more than $6,207,825 in health benefit costs have been reimbursed through the program. Nationally, as of December 31, 2010, more than 5,000 employers had been accepted into ERRP, and more than $535 million in health benefit costs have been reimbursed through the program. This funding provides financial assistance for health plan sponsors – including state and local governments, for-profit companies, schools and other educational institutions, unions, religious organizations and other non-profits – to help early retirees and their families maintain access to quality, affordable health coverage. The largest share of 2010 reimbursements went to governments, including state and local governments, school districts and other local agencies. A list of approved plan sponsors, updated on January 27, 2011, is available online at www.HealthCare.gov/law/provisions/retirement. "The Early Retiree Reinsurance Program is helping to control health care costs and protect coverage for early retirees and their families in Missouri," said HHS Secretary Kathleen Sebelius. "This program is providing critical financial relief to help states, private employers and other organizations preserve access to affordable health coverage for millions of Americans." The percentage of large firms providing workers with retiree health coverage dropped from 66 percent in 1988 to 29 percent in 2009. Many Americans who retire before they are eligible for Medicare without employer-sponsored health coverage see their life savings disappear because of medical bills and exorbitant rates in the individual health insurance market. Health insurance premiums for older Americans are over four times more expensive than those for young adults, and the deductible these enrollees pay is, on average, almost four times that in a typical employer-sponsored insurance plan. ERRP reimburses participating plan sponsors for a portion of health coverage costs for early retirees and their spouses, surviving spouses, and dependents. In 2010, ERRP-issued reimbursements helped pay the high costs of care for nearly 61,000 people. Sponsors receiving the largest ERRP reimbursements – totaling approximately 58 percent of the funding disbursed in 2010 – reported that program payments will benefit, either directly or indirectly, more than 4.5 million retirees, spouses, dependents, and active workers. The program allows plan sponsors to either reduce costs of health care for plan participants or the costs to the plan sponsor to help them keep their coverage. For example, approximately 80 percent of plans that received reimbursements are using some or all of those dollars to lower the cost of health care for plan participants. The reimbursements helping to lower plan participant costs account for 97 percent of funds disbursed in 2010. The report also provides new information about how ERRP-participating plans are working to generate cost savings for people with chronic and high-cost conditions. For example, many sponsors, including a teachers' retirement plan and a major telecommunications corporation, are providing disease management programs for people with conditions such as coronary artery disease, chronic obstructive pulmonary disease, diabetes, asthma, and osteoarthritis. Other programs are helping patients and doctors work together to manage their prescription drug treatments. Overall, the 2010 report demonstrates that ERRP is already having a meaningful impact on employers and unions as well as millions of early retirees, their families and other plan participants. The program has seen robust participation from all major sectors of the economy, with additional sponsors applying to participate every day. To read the report, visit www.HealthCare.gov/center/reports/retirement03022011a.pdf. To find more information about companies participating in ERRP in your state visit www.HealthCare.gov/law/provisions/retirement.

Opinion: More Americans Are Keeping their Coverage under Affordable Care Act

By Steve Larsen, CCIIO Director

Thanks to the Affordable Care Act, teachers in Montana will have the comfort of knowing that their health insurance will be there for them when they retire.
Retirement is supposed to be your “golden years.” But in the current economic downturn, many retirees are struggling to make ends meet. This can be a particular challenge for early retirees who are not yet eligible for Medicare.
Early retirees – those between the ages of 55 and 64 – can face some of the highest costs trying to purchase coverage in the individual health insurance market. And employers are struggling to continue to afford to health insurance for their retirees.
The Affordable Care Act is already working to help those retirees and employers through the Early Retiree Reinsurance Program. This program provides a total of $5 billion in financial assistance to sponsors of employment based health plans to help them maintain coverage for early retirees and their spouses, surviving spouses, and dependents. Read about how the Early Retiree Reinsurance Program helped this early retiree in Pennsylvania.
Today, we announced that a total of 5,000 companies, small governments, non-profits and other employers have been accepted into the Early Retiree Reinsurance Program – an increase of 1,400 since October 28, 2010.
One of those organizations accepted into this program is the Montana Unified School Trust – which provides cost-effective health benefits to many employees in school districts and school-related organizations across Montana. Many school districts were accepted into the program, including seven each in Michigan and Idaho, nine in Wisconsin, and 24 in Missouri.
Through the Early Retiree Reinsurance Program, the Montana Unified School Trust is going to get help covering the cost of care for early retirees with very high medical bills. This financial help is going to translate into direct benefits for all former school employees and their families enrolled in the insurance plan. The Trust is planning to use the dollars to help keep premiums down as well as invest in the long-term stability of the plan.
Other local governments and service providers will receive help – including the Tulsa Firefighters in Oklahoma and the Santa Ana Police Officers in California. In Florida, Broward County and two cities joined the 84 local and state government entities in that state already accepted into the Early Retiree Reinsurance Program.
The result? Thanks to the Affordable Care Act, more and more Americans who are relying on health coverage from their former employers will have the peace of mind that their coverage will continue to be there for them and their families if they need it. And employers will know they can keep the promise of health coverage to those former employees.

Report finds lower insurance premiums, more choices in 2014 for families, businesses under Affordable Care Act

Secretary of Health and Human Services Kathleen Sebelius today released a new report showing how much families and businesses can save on health insurance premiums and out-of-pocket costs under the Affordable Care Act in 2014 – each year, a low-income family of four could save up to $14,900 and businesses will benefit from the savings and tax credits in the new law.

“For too long, skyrocketing health care costs have made it hard for businesses to provide coverage for employees and have made it difficult for families to afford coverage,” said Sebelius. “The Affordable Care Act is providing families and businesses with more freedom, choices, and savings in their health care coverage. Without the Affordable Care Act, consumers and businesses would face higher premiums, fewer insurance choices, and rapidly rising health care costs.”

The report finds that, compared to what they would have paid without the law:

• Middle-class families purchasing private insurance in the new State-based Health Insurance Exchanges could save as much as $2,300 per year in 2014.
• Tax credits provided by the Affordable Care Act will lead to even greater savings. For example, in 2014, a family of four with an income of $33,525 could save as much as $14,900 per year since they will also qualify for tax credits and reduced cost sharing.
• In 2014, Small businesses, on average, could save up to $350 per family policy and many may be eligible for tax credits of up to 50 percent of their premiums.
• The tax credits are already available to small businesses, and cover 35 percent of their premiums. For example, a firm with 10 workers who earn an average of $20,000 annually could currently receive credits of $35,000 annually. These tax credits could save small businesses $6 billion in 2010 and 2011.
• All businesses will likely see lower premiums of $2,000 per family by 2019, which could generate millions of dollars in savings.

These savings are in sharp contrast to the rising insurance costs families and businesses have experienced over the previous decade. From 1999 to 2009 premiums more than doubled, rising by over $7,500 for the average family that gets insurance through an employer. The high cost of health care made it difficult for many small businesses to offer insurance to their workers. The percentage of small employers offering health insurance dropped from 65 to 59 percent between 1999 and 2009.

The report outlines several of the provisions of the Affordable Care Act that HHS has already begun to implement that will help create these savings, including provisions to increase transparency in the health insurance marketplace. In 2011, most health insurance companies will be required to spend at least 80 percent of premium dollars on health care and quality improvements, rather than overhead and administrative costs. States have received new resources to improve review of proposed health insurance premium rate increases, and HHS has proposed that, in 2011, any proposed rate increase above 10 percent should be reviewed.

In addition, businesses are receiving new resources to help meet rising health care costs for employees and retirees. Many small businesses are already eligible for tax credits that cover up to 35 percent of insurance costs for their employees. And more than 5,000 sponsors have been accepted into the Early Retiree Reinsurance Program, which is designed to provide financial relief to help early retirees and their families continue to have quality, affordable health coverage.

The report also emphasizes the important changes coming in the future. Starting in 2014, State-based Exchanges will make it easier for people to compare benefits and services and enable individuals and small businesses to pool together and use their market strength to buy coverage at a lower cost.

The report can be found at: http://www.healthcare.gov/center/reports/premiums01282011a.pdf

Affordable Healthcare Act Tools to Help Combat Health Care Fraud

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and U.S. Associate Attorney General Thomas J. Perrelli today announced a new report showing that the government’s health care fraud prevention and enforcement efforts recovered more than $4 billion in taxpayer dollars in Fiscal Year (FY) 2010. This is the highest annual amount ever recovered from people who attempted to defraud seniors and taxpayers. In addition, HHS today announced new rules authorized by the Affordable Care Act that will help the department work proactively to prevent and fight fraud, waste and abuse in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

These findings, released today, in the annual Health Care Fraud and Abuse Control Program (HCFAC) report, are a result of President Obama making the elimination of fraud, waste, and abuse a top priority in his administration. The success of this joint Department of Justice (DOJ) and HHS effort would not have been possible without the Health Care Fraud Prevention & Enforcement Action Team (HEAT), created in 2009 to prevent waste, fraud and abuse in the Medicare and Medicaid programs and to crack down on the fraud perpetrators who are abusing the system and costing American taxpayers billions of dollars. These efforts to reduce fraud will continue to improve with the new tools and resources provided by the Affordable Care Act, including the new rules announced today.

“President Obama has made it very clear that fraud and abuse of taxpayers’ dollars are unacceptable. And for too long, our fraud prevention efforts have focused on chasing after taxpayer dollars after they have already been paid out,” said Sebelius. “Thanks to the President’s leadership and the new tools provided by the Affordable Care Act, we can focus on stopping fraud before it happens.”

“Our aggressive pursuit of health care fraud has resulted in the largest recovery of taxpayer dollars in the history of the Justice Department,” said Perrelli. “These actions are in large part because of the great work being led by the Health Care Fraud Prevention and Enforcement Action Team. Through this initiative, we are working in partnership with government, law enforcement and industry leaders, and the public to protect taxpayer dollars, control health care costs, and ensure the strength and integrity of our most essential health care programs.”

Health Care Fraud and Abuse Control Program Report

More than $4 billion stolen from federal health care programs was recovered and returned to the Medicare Health Insurance Trust Fund, the Treasury, and others in FY 2010. This is an unprecedented achievement for the Health Care Fraud and Abuse Control Program (HCFAC), a joint effort of the two departments to coordinate Federal, State, and local law enforcement activities to fight health care fraud and abuse.

The Affordable Care Act provides additional tools and resources to help fight fraud that will help boost these efforts, including an additional $350 million for HCFAC activities. The Administration is already using tools authorized by the Affordable Care Act, including enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts, and greater oversight of private insurance abuses.

HHS and DOJ have enhanced their coordination through HEAT and have expanded Medicare Fraud Strike Force teams since 2009. HHS and DOJ hosted a series of regional fraud prevention summits around the country, and sent letters to state attorneys general urging them to work with HHS and Federal, state and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud. During FY 2010, HEAT and the Medicare Fraud Strike Force expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud.

In FY 2010, the total number of cities with Strike Force prosecution teams was increased to seven, all of which have teams of investigators and prosecutors dedicated to fighting fraud. The Strike Force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers. Strike Force enforcement accomplishments in all seven cities during FY 2010 include:

• 140 indictments involving charges filed against 284 defendants who collectively billed the Medicare program more than $590 million;
• 217 guilty pleas negotiated and 19 jury trials litigated, winning guilty verdicts against 23 defendants; and
• Imprisonment for 146 defendants sentenced during the fiscal year, averaging more than 40 months of incarceration.

Including Strike Force matters, federal prosecutors opened 1,116 criminal health care fraud investigations as of the end of FY 2010, and filed criminal charges in 488 cases involving 931 defendants. A total of 726 defendants were convicted for health care fraud-related crimes during the year.

In addition to these criminal enforcement successes, 2010 was a record year for recoveries obtained in civil health care matters brought under the False Claims Act—more than $2.5 billion, which is the largest in the history of the Department of Justice.

The HCFAC annual report can be found here, oig.hhs.gov/publications/hcfac.asp. For more information on the joint DOJ-HHS Strike Force activities, visit: http://www.StopMedicareFraud.gov/.

New Affordable Care Act Rules to Fight Fraud

Today, HHS also announced new rules authorized by the Affordable Care Act which will help stop health care fraud. The provisions of the Affordable Care Act implemented through this final rule include new provider screening and enforcement measures to help keep bad actors out of Medicare, Medicaid and CHIP. The final rule also contains important authority to suspend payments when a credible allegation of fraud is being investigated.

“Thanks to the new law, CMS now has additional resources to help detect fraud and stop criminals from getting into the system in the first place," CMS Administrator Donald Berwick, M.D. said. “The Affordable Care Act’s new authorities allow us to develop sophisticated, new systems of monitoring and oversight to not only help us crack down on fraudulent activity scamming these programs, but also help us to prevent the loss of taxpayer dollars across the board for millions of American health care consumers.”

Specifically, the final rule:

• Creates a rigorous screening process for providers and suppliers enrolling Medicare, Medicaid and CHIP to keep fraudulent providers out of those programs. Types of providers and suppliers that have been identified in the past as posing a higher risk of fraud, for example durable medical equipment suppliers, will be subject to a more thorough screening process.
• Requires new enrollment process for Medicaid and CHIP providers. Under the Affordable Care Act, States will have to screen providers who order and refer to Medicaid beneficiaries to determine if they have a history of defrauding government. Providers that have been kicked out of Medicare or another State’s Medicaid or CHIP will be barred from all Medicaid and CHIP programs.
• Temporarily stops enrollment of new providers and suppliers. Medicare and State agencies will be on the look out for trends that may indicate health care fraud – including using advanced predictive modeling software, such as that used to detect credit card fraud. If a trend is identified in a category of providers or geographic area, the program can temporarily stop enrollment as long as that will not impact access to care for patients.
• Temporarily stops payments to providers and suppliers in cases of suspected fraud. Under the new rules, if there has been a credible fraud allegation, payments can be suspended while an action or investigation is underway.

A copy of the regulation is on display today at the Federal Register and may be downloaded from the following link: www.ofr.gov/inspection.aspx. Several days after the regulation is published, the preceding link will be deactivated and the published version of the regulation will be available on the National Archives website at www.archives.gov/federal-register/news.html. CMS will continue to take public comments on limited areas of this final rule for 60 days.

More information can be found at www.HealthCare.gov, a web portal made available by the U.S. Department of Health and Human Services. A fact sheet on the new rules is available at www.HealthCare.gov/news/factsheets.

71,995 Medicare Beneficiaries Have Received Prescription Drug Relief

U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced that 71,995 Medicare beneficiaries in Missouri, and three million people nationwide, have received prescription drug cost relief through the Affordable Care Act. To date, three million eligible beneficiaries who fell into the drug coverage gap known as the “donut hole” during 2010 have been mailed a one-time, tax-free $250 rebate check.

“For too long, many seniors and people with disabilities have been forced to make impossible choices between paying for needed prescription medication and necessities like food and rent,” said Secretary Sebelius. “The Affordable Care Act offers long overdue relief by lowering prescription drug costs each year until the donut hole is closed.”

Eligible beneficiaries who fell into the coverage gap during 2010 are continuing to automatically receive rebate checks. These checks are only the first step in how the Affordable Care Act will reduce prescription drug costs for beneficiaries in the donut hole each year until it is closed in 2020. Starting this year, eligible beneficiaries in the coverage gap will receive a 50-percent discount on covered brand name medications while in the donut hole. In addition, in 2011 Medicare will begin paying 7-percent of the price for generic drugs during the coverage gap.

Also today, Secretary Sebelius released a new video message on the new benefits the Affordable Care Act provides in 2011 for people on Medicare. You can watch the video message here.

The closing of the donut hole is just one of the ways seniors benefit from the Affordable Care Act. In addition to savings on prescription drugs, the law provides new benefits to Medicare beneficiaries when they visit their doctor starting this year:

• As of January 1, 2011, Original Medicare no longer charges out-of-pocket costs for the “Welcome to Medicare” physical exam and, for the first time since the Medicare program was created in 1965, Original Medicare now covers an annual wellness visit with a participating doctor, also at no cost.
• In addition to these annual wellness visits, most people with Medicare can now receive critical preventive services, including certain cancer screenings such as mammograms and colonoscopies, for free.
• Also this year, the Affordable Care Act will provide qualifying doctors and other health care professionals providing primary care to people on Medicare a 10-percent bonus for primary care services. This will help ensure that those primary care providers can continue to be there for Medicare patients.

People with Medicare can learn more about these new benefits, search for participating doctors in their area, and find other helpful information by contacting a trained customer service representative toll-free at 1-800-MEDICARE (1-800-633-4227) or visiting www.Medicare.gov

Additionally, the Affordable Care Act makes Medicare stronger and more secure for all beneficiaries. These provisions under the new law increase benefits to beneficiaries and help to extend the life of the Medicare Trust Fund by 12 years.

• An analysis issued by the Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher – as much as $12,300 over the next 10 years – for seniors and people with disabilities who have high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary in the donut hole, estimated total savings increase from $553 in 2011 to $2,217 in 2020.
• The Affordable Care Act establishes a new Innovation Center that will research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patient with Medicare, Medicaid or Children’s Health Insurance Program (CHIP) coverage. Innovations that are found to work can be rapidly expanded and applied more broadly—helping to transform the health care system into one that provides better care at lower cost.
• The Affordable Care Act contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. The law strengthens the screenings for health care providers who want to participate in Medicare, Medicaid, or CHIP, enables enforcement officials to see health care claims data from around the country in a searchable database, and strengthens the penalties for criminal wrongdoing. The reduction in waste, fraud, and abuse returns savings to the Medicare Trust Fund to strengthen the program into the future. Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information or suspected fraud, waste, or abuse, or go to www.StopMedicareFraud.gov.

For more information on how the Affordable Care Act benefits seniors, visit www.HealthCare.gov.

HHS announces new resources to help states implement Affordable Care Act

Today, Health and Human Services (HHS) Secretary Kathleen Sebelius announced a new funding opportunity for grants to help states continue their work to implement a key provision of the Affordable Care Act – Health Insurance Exchanges.

When the Affordable Care Act is fully implemented in 2014, Health Insurance Exchanges will provide individuals and small businesses with a “one-stop shop” to find and compare affordable, high-quality health insurance options.

“States are moving forward, implementing the Affordable Care Act and making reform a reality,” said Sebelius. “These grants will help ensure states have the resources they need to establish exchanges and ensure Americans are no longer on their own when shopping for insurance.”

Health Insurance Exchanges will bring new transparency to the market so that consumers will be able to compare plans based on price and quality and will offer all Americans the same insurance choices members of Congress will have. By increasing competition among insurance companies and allowing individuals and small businesses to band together to purchase insurance, Exchanges will also lower costs.

The Exchange establishment grants announced today recognize that states are making progress toward establishing Exchanges but doing so at different paces. States that are moving ahead on a faster pace can apply for multi-year funding. States that are making progress in establishing their Exchange through a step-by-step approach can apply for funding for each project year. Moving forward, states will have multiple opportunities to apply for funding as they progress through Exchange establishment. This process gives states maximum flexibility and ensures that states can move forward on their own timetables as they work to build an Exchange.

States can use the Exchange establishment grants for a number of different activities including conducting background research, consulting with stakeholders, making legislative and regulatory changes, governing the exchange, establishing information technology systems, conducting financial management and performing oversight and ensuring program integrity.

States are already taking their first steps toward 2014 when Health Insurance Exchanges will be operational. For example, California signed first-in-the-nation legislation to implement a Health Insurance Exchange under the Affordable Care Act on September 30, 2010. Maryland’s Health Reform Coordinating Council has already carried out research to understand the state’s health insurance marketplace and health expenditures, as well as how to make health care costs and quality more transparent. Colorado is holding regular community forums on issues around developing an Exchange, as well as conducting extensive research and economic analyses on the state’s health insurance market.

Many of those activities have been funded by the $49 million in Exchange planning grants awarded by HHS in July of 2010. States applied to use those grants for a number of important planning activities including research to understand their insurance markets, efforts to obtain the legislative authority to create Exchanges, and steps to establishing the governing structures of Exchanges.

The Exchange establishment funding announcement can be found at www.Grants.gov by searching for CFDA number 93.525. More information can be found at http://www.healthcare.gov/news/factsheets.