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Offshore Outsourcing of Administrative Functions by State Medicaid Agencies

April 18, 2014 Comments off

Offshore Outsourcing of Administrative Functions by State Medicaid Agencies
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
Outsourcing occurs when State Medicaid agencies enter into agreements with contractors to perform administrative functions. Outsourcing can occur inside the United States (domestic outsourcing) or outside (offshore outsourcing) and can be direct (when a Medicaid agency contracts with an offshore contractor) or indirect (when a Medicaid agency’s contractor subcontracts to an offshore contractor). There are no Federal regulations that prohibit the offshore outsourcing of Medicaid administrative functions. However, the Health Insurance Portability and Accountability Act (HIPAA) requires covered entities to have business associate agreements (BAAs) to protect personal health information (PHI).

HOW WE DID THIS STUDY
We conducted a survey of 56 Medicaid agencies, including those of the District of Columbia and the U.S. territories. We asked Medicaid agencies (1) whether they had any policies, Executive Orders, State laws, or contract requirements (collectively, “requirements”) addressing the outsourcing of administrative functions offshore and (2) whether they directly or indirectly outsourced administrative functions offshore. For Medicaid agencies with outsourcing requirements, we asked whether these requirements address PHI and whether the Medicaid agencies monitor contractors’ compliance with the requirements. We reviewed the Medicaid agencies’ requirements and BAAs. For the Medicaid agencies that outsource offshore, we asked what types of administrative functions are outsourced offshore.

WHAT WE FOUND
Only 15 of 56 Medicaid agencies have some form of State-specific requirement that addresses the outsourcing of administrative functions offshore. The remaining 41 Medicaid agencies reported no offshore outsourcing requirements and do not outsource administrative functions offshore. Among the 15 Medicaid agencies with requirements, 4 Medicaid agencies prohibit the outsourcing of administrative functions offshore and 11 Medicaid agencies allow it. The 11 Medicaid agencies that allow offshore outsourcing of administrative functions each maintain BAAs with contractors, which is a requirement under HIPAA. Among other things, BAAs are intended to safeguard PHI. These 11 Medicaid agencies do not have additional State requirements that specifically address safeguarding PHI. Seven of the eleven Medicaid agencies reported outsourcing offshore through subcontractors, but none reported sending PHI offshore. If Medicaid agencies engage in offshore outsourcing of administrative functions that involve PHI, it could present potential vulnerabilities. For example, Medicaid agencies or domestic contractors that send PHI offshore may have limited means of enforcing provisions of BAAs that are intended to safeguard PHI. Although some countries may have privacy protections greater than those in the United States, other countries may have limited or no privacy protections.

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Recent Declines in Adolescent Inhalant Use

April 18, 2014 Comments off

Recent Declines in Adolescent Inhalant Use (PDF)
Source: Substance Abuse and Mental Health Services Administration

+ In 2012, almost 650,000 adolescents aged 12 to 17 used inhalants in the past year.

+ Past year inhalant use among adolescents generally has been declining since about 2006; most recently, rates decreased from 3.3 percent in 2011 to 2.6 percent in 2012.

+ Rates of past year inhalant use among adolescents decreased between 2011 and 2012 for several demographic groups, including males, whites, those living in the Northeast and West, and those living in metropolitan areas.

FDA discourages use of laparoscopic power morcellation for removal of uterus or uterine fibroids

April 18, 2014 Comments off

FDA discourages use of laparoscopic power morcellation for removal of uterus or uterine fibroids
Source: U.S. Food and Drug Administration

In a safety communication notice issued today, the U.S. Food and Drug Administration discouraged the use of laparoscopic power morcellation for the removal of the uterus (hysterectomy) or uterine fibroids (myomectomy) in women because, based on an analysis of currently available data, it poses a risk of spreading unsuspected cancerous tissue, notably uterine sarcomas, beyond the uterus.

Laparoscopic power morcellation is one of several available treatments for fibroids. It is a procedure that uses a medical device to divide the uterine tissue into smaller pieces or fragments so it can be removed through a small incision in the abdomen, such as during laparoscopy.

Uterine fibroids are non-cancerous growths that originate from the smooth muscle tissue in the wall of the uterus. According to the National Institutes of Health, most women will develop uterine fibroids at some point in their lives. While most uterine fibroids do not cause problems, they can cause symptoms, such as heavy or prolonged menstrual bleeding, pelvic pressure or pain, and frequent urination, sometimes requiring medical or surgical therapy.

Based on an analysis of currently available data, the FDA has determined that approximately 1 in 350 women who are undergoing hysterectomy or myomectomy for fibroids have an unsuspected type of uterine cancer called uterine sarcoma. If laparoscopic power morcellation is performed in these women, there is a risk that the procedure will spread the cancerous tissue within the abdomen and pelvis, significantly worsening the patient’s likelihood of long-term survival.

The Five Most Costly Children’s Conditions, 2011: Estimates for U.S. Civilian Noninstitutionalized Children, Ages 0-17

April 17, 2014 Comments off

The Five Most Costly Children’s Conditions, 2011: Estimates for U.S. Civilian Noninstitutionalized Children, Ages 0-17
Source: Agency for Healthcare Research and Quality

This Statistical Brief presents data from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) regarding medical expenditures associated with the top five most costly conditions for children in 2011. These top five conditions–mental disorders; asthma/chronic obstructive pulmonary disease (COPD); trauma-related disorders; acute bronchitis and upper respiratory infections (URI); and otitis media (ear infections)–were determined by totaling and ranking the expenses for all medical care delivered in 2011.

Gender Differences in Primary Substance of Abuse across Age Groups

April 16, 2014 Comments off

Gender Differences in Primary Substance of Abuse across Age Groups
Source: Substance Abuse and Mental Health Services Administration

+ In 2011, about 609,000 of the 1.84 million admissions to substance abuse treatment were female (33.1 percent), and 1.23 million were male (66.9 percent)
+ Compared with their male counterparts, a larger proportion of female admissions aged 12 to 17 reported alcohol as their primary substance of abuse (21.7 vs. 10.5 percent)
+ Marijuana as the primary substance of abuse was less common among female than male admissions aged 12 to 17 (60.8 vs. 80.7 percent) and 18 to 24 (22.1 vs. 33.4 percent)
+ Within the 65 or older age group, the proportion of female admissions reporting primary abuse of prescription pain relievers (e.g., oxycodone) was nearly 3 times that of their male counterparts (7.2 vs. 2.8 percent)

Acupuncture Research – Areas of High and Low Programmatic Priorities

April 15, 2014 Comments off

Acupuncture Research – Areas of High and Low Programmatic Priorities
Source: National Center for Complementary and Alternative Medicine

On this page:

  • Published Research
  • Areas of High Programmatic Priority
  • Areas of Low Programmatic Priority
  • NCCAM Contact Information
  • Selected References

HHS OIG — Limited Compliance With Medicare’s Home Health Face to Face Documentation Requirements

April 15, 2014 Comments off

Limited Compliance With Medicare’s Home Health Face to Face Documentation Requirements
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
The Patient Protection and Affordable Care Act (ACA) requires that physicians (or certain practitioners working with them) who certify beneficiaries as eligible for Medicare home health services document-as a condition of payment for home health services-that face-to-face encounters with those beneficiaries occurred. This study (1) determined the extent to which physicians who certified home health care documented the face-to-face encounters, (2) described the nature of face-to-face documentation, and (3) assessed CMS’s oversight of the face-to-face requirement.

HOW WE DID THIS STUDY
We reviewed 644 face-to-face encounter documents to analyze the extent to which the documents confirmed encounters and contained the required elements. We interviewed the four Home Health and Hospice Medicare Administrative Contractors (HH MACs) to describe how they ensure that home health agencies met the face-to-face encounter requirements. We also reviewed guidance documents and policies from CMS or the HH MACs about monitoring the face-to-face requirement.

WHAT WE FOUND
For 32 percent of home health claims that required face-to-face encounters, the documentation did not meet Medicare requirements, resulting in $2 billion in payments that should not have been made. Furthermore, physicians inconsistently completed the narrative portion of the face to face documentation. Some face-to-face documents provide information that, although not required by Medicare, could be useful, such as a printed name for the physician and a list of the home health services needed. CMS oversight of the face-to-face requirement is minimal.

WHAT WE RECOMMEND
We recommend that CMS (1) consider requiring a standardized form to ensure that physicians include all elements required for the face-to-face documentation, (2) develop a specific strategy to communicate directly with physicians about the face-to-face requirement, and (3) develop other oversight mechanisms for the face-to-face requirement. CMS concurred with all of our recommendations.

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The Children’s Bureau Training & Technical Assistance Network 2014 Directory

April 11, 2014 Comments off

The Children’s Bureau Training & Technical Assistance Network 2014 Directory (PDF)
Source: U.S. Department of Health and Human Services, Administration for Children and Families

This booklet summarizes information on the Children’s Bureau Training and Technical Assistance (T&TA) Network, within the Administration for Children and Families (ACF), U.S. Department of Health and Human Services. This directory offers information on the specific focus of each of the 23 T&TA Network members.

The mission of the T&TA Network is to provide a seamless array of services that build the capacity of States, Tribes, territories, and courts to achieve sustainable, systemic changes that will result in improved outcomes for children, youth, and families. To do so, the Network members provide training, TA, research, information and referral, and consultation on the full array of Federal requirements administered by the Children’s Bureau.

T&TA Network members also assist State, local, Tribal, and other publicly administered or publicly supported child welfare agencies and family and juvenile courts to achieve conformity with the outcomes and systemic factors defined in the monitoring reviews conducted by the Children’s Bureau.

The T&TA Network provides both on-site and off-site T&TA. On-site assistance might cover several weeks or months and comprise multiple visits; off-site assistance might consist, for example, of conducting a policy review or responding to a request for materials in a specific practice area. The Network has an open-door policy for making T&TA requests.

Vital Signs: Births to Teens Aged 15–17 Years — United States, 1991–2012

April 8, 2014 Comments off

Vital Signs: Births to Teens Aged 15–17 Years — United States, 1991–2012
Source: Morbidity and Mortality Weekly Report (CDC)

Background:
Teens who give birth at age 15–17 years are at increased risk for adverse medical and social outcomes of teen pregnancy.

Methods:
To examine trends in the rate and proportion of births to teens aged 15–19 years that were to teens aged 15–17 years, CDC analyzed 1991–2012 National Vital Statistics System data. National Survey of Family Growth (NSFG) data from 2006–2010 were used to examine sexual experience, contraceptive use, and receipt of prevention opportunities among female teens aged 15–17 years.

Results:
During 1991–2012, the rate of births per 1,000 teens declined from 17.9 to 5.4 for teens aged 15 years, 36.9 to 12.9 for those aged 16 years, and 60.6 to 23.7 for those aged 17 years. In 2012, the birth rate per 1,000 teens aged 15–17 years was higher for Hispanics (25.5), non-Hispanic blacks (21.9), and American Indians/Alaska Natives (17.0) compared with non-Hispanic whites (8.4) and Asians/Pacific Islanders (4.1). The rate also varied by state, ranging from 6.2 per 1,000 teens aged 15–17 years in New Hampshire to 29.0 in the District of Columbia. In 2012, there were 86,423 births to teens aged 15–17 years, accounting for 28% of all births to teens aged 15–19 years. This percentage declined from 36% in 1991 to 28% in 2012 (p <0.001). NSFG data for 2006–2010 indicate that although 91% of female teens aged 15–17 years received formal sex education on birth control or how to say no to sex, 24% had not spoken with parents about either topic; among sexually experienced female teens, 83% reported no formal sex education before first sex. Among currently sexually active female teens (those who had sex within 3 months of the survey) aged 15–17 years, 58% used clinical birth control services in the past 12 months, and 92% used contraception at last sex; however, only 1% used the most effective reversible contraceptive methods.

Conclusions:
Births to teens aged 15–17 years have declined but still account for approximately one quarter of births to teens aged 15–19 years.

Implications for public health practice:
These data highlight opportunities to increase younger teens exposure to interventions that delay initiation of sex and provide contraceptive services for those who are sexually active; these strategies include support for evidence-based programs that reach youths before they initiate sex, resources for parents in talking to teens about sex and contraception, and access to reproductive health-care services.

HHS OIG — Questionable Billing for Medicare Electrodiagnostic Tests

April 8, 2014 Comments off

Questionable Billing for Medicare Electrodiagnostic Tests
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
In 2011, Medicare paid approximately $486 million to 21,700 physicians who billed for electrodiagnostic tests for 877,000 beneficiaries. Electrodiagnostic tests are used to evaluate patients who may have nerve damage. Recent investigations have found that electrodiagnostic testing is an area vulnerable to fraud, waste, and abuse. For example, in 2011, following work by the Medicare Fraud Strike Force, a group of physicians was charged with fraudulently billing Medicare $113 million for false claims, including claims for electrodiagnostic tests. CMS issues comparative billing reports to providers for a variety of services, including electrodiagnostic testing. Such reports are intended to proactively educate providers and to help them identify and correct errors in their billing.

HOW WE DID THIS STUDY
We developed seven measures of questionable billing on the basis of past OIG work and input from CMS staff. We analyzed Medicare 2011 electrodiagnostic test claims to identify physicians who had unusually high billing for at least one of these measures. We also determined whether physicians with questionable billing for electrodiagnostic tests received comparative billing reports in 2011 for such tests. Finally, we identified the geographical areas with the highest amounts of questionable billing.

WHAT WE FOUND
In 2011, 4,901 physicians had questionable billing for Medicare electrodiagnostic tests totaling $139 million. Additionally, we found that approximately 20 percent of these physicians received comparative billing reports in 2011 on the basis of their 2010 billing for electrodiagnostic tests. Finally, physicians in the New York, Los Angeles, and Houston areas had the highest total questionable billing for Medicare electrodiagnostic tests in 2011.

WHAT WE RECOMMEND
We recommend that CMS (1) increase its monitoring of billing for electrodiagnostic tests, (2) provide additional guidance and education to physicians regarding electrodiagnostic tests, and (3) take appropriate action regarding physicians whom we identified as having inappropriate or questionable billing. CMS partially concurred with two of our recommendations and concurred with the third recommendation.

CDC Grand Rounds: Global Tobacco Control

April 8, 2014 Comments off

CDC Grand Rounds: Global Tobacco Control
Source: Morbidity and Mortality Weekly Report (CDC)

During the 20th century, use of tobacco products contributed to the deaths of 100 million persons worldwide (1). In 2011, approximately 6 million additional deaths were linked to tobacco use, the world’s leading underlying cause of death, responsible for more deaths each year than human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis, and malaria combined (1). One third to one half of lifetime users die from tobacco products, and smokers die an average of 14 years earlier than nonsmokers (2,3). Manufactured cigarettes account for 96% of all tobacco sales worldwide. From 1880 to 2009, annual global consumption of cigarettes increased from an estimated 10 billion cigarettes to approximately 5.9 trillion cigarettes (Figure 1), with five countries accounting for 58% of the total consumption: China (38%), Russia (7%), the United States (5%), Indonesia (4%), and Japan (4%). Among the estimated 1 billion smokers worldwide, men outnumber women by four to one. In 14 countries, at least 50% of men smoke, whereas in more than half of these same countries, fewer than 10% of women smoke (4). If current trends persist, an estimated 500 million persons alive today will die from use of tobacco products. By 2030, tobacco use will result in the deaths of approximately 8 million persons worldwide each year (4). Yet, every death from tobacco products is preventable.

CRS — Regulation of Clinical Tests: In Vitro Diagnostic (IVD) Devices, Laboratory Developed Tests (LDTs), and Genetic Tests

April 7, 2014 Comments off

Regulation of Clinical Tests: In Vitro Diagnostic (IVD) Devices, Laboratory Developed Tests (LDTs), and Genetic Tests (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

In vitro diagnostic (IVD) devices are used in the analysis of human samples, such as blood or tissue, to provide information in making health care decisions. Examples of IVDs include (1) pregnancy test kits or blood glucose tests for home use; (2) laboratory tests for infectious disease, such as HIV or hepatitis and routine office blood tests such as for cholesterol and anemia; and (3) tests for various genetic diseases or conditions. More recently, a specific diagnostic test—called a companion diagnostic—may be used to select the best therapy, at the right dose, at the correct time for a particular patient; this is often referred to as personalized medicine.

Federal agencies involved in the regulation of IVDs include the Food and Drug Administration (FDA) and the Centers for Medicare & Medicaid Services (CMS). FDA derives its authority to regulate the sale and distribution of medical devices, such as IVDs, from the Federal Food, Drug, and Cosmetics Act and the Public Health Service Act. CMS’s authority to regulate IVDs is through the Clinical Laboratory Improvement Amendments of 1988. FDA regulates the safety and effectiveness of the diagnostic test as well as the quality of the design and manufacture of the diagnostic test, and CMS regulates the quality of clinical laboratories and the clinical testing process.

Traditionally, most genetic tests have not been subject to premarket review by the FDA. This is because in the past, genetic tests were developed by laboratories primarily for their in-house use—referred to as laboratory-developed tests (LDTs)—to diagnose rare diseases and were highly dependent on expert interpretation. However, more recently LDTs have been developed to assess relatively common diseases and conditions, thus affecting more people, and direct-to-consumer (DTC) genetic testing has become widely available over the Internet. In June 2010 FDA announced its decision to exercise its authority over all LDTs. FDA has provided a number of reasons for the decision to assert its enforcement authority over LDTs, including that the public needs assurances that LDTs are sound and reliable. FDA has not yet finalized guidance with respect to all LDTs. A provision in the Food and Drug Administration Safety and Innovation Act stipulates that the agency “may not issue any draft or final guidance on the regulation” of LDTs without “at least 60 days prior to such issuance,” first notifying Congress “of the anticipated details of such action.”

NCCAM Clinical Digest: Chronic Low-Back Pain and Complementary Health Approaches

April 4, 2014 Comments off

NCCAM Clinical Digest: Chronic Low-Back Pain and Complementary Health Approaches
Source: National Center for Complementary and Alternative Medicine

This issue of the digest summarizes current scientific evidence about spinal manipulation, acupuncture, massage, and yoga, the complementary approaches most often used by people for chronic low back pain.

Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014

April 4, 2014 Comments off

Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014
Source: Morbidity and Mortality Weekly Report (CDC)

Electronic nicotine delivery devices such as electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine, flavorings (e.g., fruit, mint, and chocolate), and other chemicals via an inhaled aerosol. E-cigarettes that are marketed without a therapeutic claim by the product manufacturer are currently not regulated by the Food and Drug Administration (FDA) (1).* In many states, there are no restrictions on the sale of e-cigarettes to minors. Although e-cigarette use is increasing among U.S. adolescents and adults (2,3), its overall impact on public health remains unclear. One area of concern is the potential of e-cigarettes to cause acute nicotine toxicity (4). To assess the frequency of exposures to e-cigarettes and characterize the reported adverse health effects associated with e-cigarettes, CDC analyzed data on calls to U.S. poison centers (PCs) about human exposures to e-cigarettes (exposure calls) for the period September 2010 (when new, unique codes were added specifically for capturing e-cigarette calls) through February 2014. To provide a comparison to a conventional product with known toxicity, the number and characteristics of e-cigarette exposure calls were compared with those of conventional tobacco cigarette exposure calls.

An e-cigarette exposure call was defined as a call regarding an exposure to the e-cigarette device itself or to the nicotine liquid, which typically is contained in a cartridge that the user inserts into the e-cigarette. A cigarette exposure call was defined as a call regarding an exposure to tobacco cigarettes, but not cigarette butts. Calls involving multiple substance exposures (e.g., cigarettes and ethanol) were excluded. E-cigarette exposure calls were compared with cigarette exposure calls by proportion of calls from health-care facilities (versus residential and other non–health-care facilities), demographic characteristics, exposure routes, and report of adverse health effect. Statistical significance of differences (p<0.05) was assessed using chi-square tests.

During the study period, PCs reported 2,405 e-cigarette and 16,248 cigarette exposure calls from across the United States, the District of Columbia, and U.S. territories. E-cigarette exposure calls per month increased from one in September 2010 to 215 in February 2014 (Figure). Cigarette exposure calls ranged from 301 to 512 calls per month and were more frequent in summer months, a pattern also observed with total call volume to PCs involving all exposures (5).

E-cigarettes accounted for an increasing proportion of combined monthly e-cigarette and cigarette exposure calls, increasing from 0.3% in September 2010 to 41.7% in February 2014. A greater proportion of e-cigarette exposure calls came from health-care facilities than cigarette exposure calls (12.8% versus 5.9%) (p20 years (42.0%). E-cigarette exposures were more likely to be reported as inhalations (16.8% versus 2.0%), eye exposures (8.5% versus 0.1%), and skin exposures (5.9% versus 0.1%), and less likely to be reported as ingestions (68.9% versus 97.8%) compared with cigarette exposures (p<0.001).

FDA approves new hand-held auto-injector to reverse opioid overdose

April 4, 2014 Comments off

FDA approves new hand-held auto-injector to reverse opioid overdose
Source: U.S Food and Drug Administration

The U.S. Food and Drug Administration today approved a prescription treatment that can be used by family members or caregivers to treat a person known or suspected to have had an opioid overdose. Evzio (naloxone hydrochloride injection) rapidly delivers a single dose of the drug naloxone via a hand-held auto-injector that can be carried in a pocket or stored in a medicine cabinet.

It is intended for the emergency treatment of known or suspected opioid overdose, characterized by decreased breathing or heart rates, or loss of consciousness.

Drug overdose deaths, driven largely by prescription drug overdose deaths, are now the leading cause of injury death in the United States – surpassing motor vehicle crashes. In 2013, the Centers for Disease Control and Prevention reported the number of drug overdose deaths had steadily increased for more than a decade.

Naloxone is a medication that rapidly reverses the effects of opioid overdose and is the standard treatment for overdose. However, existing naloxone drugs require administration via syringe and are most commonly used by trained medical personnel in emergency departments and ambulances.

Invasive Cancer Incidence — United States, 2010

March 31, 2014 Comments off

Invasive Cancer Incidence — United States, 2010
Source: Morbidity and Mortality Weekly Report

Cancer has many causes, some of which can, at least in part, be avoided through interventions known to reduce cancer risk (1). Healthy People 2020 objectives call for reducing colorectal cancer incidence to 38.6 per 100,000 persons, reducing late-stage breast cancer incidence to 41.0 per 100,000 women, and reducing cervical cancer incidence to 7.1 per 100,000 women (2). To assess progress toward reaching these Healthy People 2020 targets, CDC analyzed data from U.S. Cancer Statistics (USCS) for 2010. USCS includes incidence data from CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program and mortality data from the National Vital Statistics System (3). In 2010, a total of 1,456,496 invasive cancers were reported to cancer registries in the United States (excluding Arkansas and Minnesota), an annual incidence rate of 446 cases per 100,000 persons, compared with 459 in 2009 (4). Cancer incidence rates were higher among men (503) than women (405), highest among blacks (455), and ranged by state from 380 to 511 per 100,000 persons. Many factors, including tobacco use, obesity, insufficient physical activity, and human papilloma virus (HPV) infection, contribute to the risk for developing cancer, and differences in cancer incidence indicate differences in the prevalence of these risk factors. These differences can be reduced through policy approaches such as the Affordable Care Act,* which could increase access for millions of persons to appropriate and timely cancer preventive services, including help with smoking cessation, cancer screening, and vaccination against HPV (5).

Invasive cancers include all cancers except in situ cancers (other than in the urinary bladder) and basal and squamous cell skin cancers.

Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010

March 31, 2014 Comments off

Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010
Source: Morbidity and Mortality Weekly Report (CDC)

For 2010, the overall prevalence of ASD among the ADDM sites was 14.7 per 1,000 (one in 68) children aged 8 years. Overall ASD prevalence estimates varied among sites from 5.7 to 21.9 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and racial/ethnic group. Approximately one in 42 boys and one in 189 girls living in the ADDM Network communities were identified as having ASD. Non-Hispanic white children were approximately 30% more likely to be identified with ASD than non-Hispanic black children and were almost 50% more likely to be identified with ASD than Hispanic children. Among the seven sites with sufficient data on intellectual ability, 31% of children with ASD were classified as having IQ scores in the range of intellectual disability (IQ ≤70), 23% in the borderline range (IQ = 71–85), and 46% in the average or above average range of intellectual ability (IQ >85). The proportion of children classified in the range of intellectual disability differed by race/ethnicity. Approximately 48% of non-Hispanic black children with ASD were classified in the range of intellectual disability compared with 38% of Hispanic children and 25% of non-Hispanic white children. The median age of earliest known ASD diagnosis was 53 months and did not differ significantly by sex or race/ethnicity.

State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage — United States, 2008–2014

March 30, 2014 Comments off

State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage — United States, 2008–2014
Source: Morbidity and Mortality Weekly Report (CDC)

Medicaid enrollees have a higher smoking prevalence than the general population (30.1% of adult Medicaid enrollees aged <65 years smoke, compared with 18.1% of U.S. adults of all ages), and smoking-related disease is a major contributor to increasing Medicaid costs (1,2). Evidence-based cessation treatments exist, including individual, group, and telephone counseling and seven Food and Drug Administration (FDA)–approved medications (3). A Healthy People 2020 objective (TU-8) calls for all state Medicaid programs to adopt comprehensive coverage of these treatments.* However, most states do not provide such coverage (4). To monitor trends in state Medicaid cessation coverage, the American Lung Association† collected data on coverage of all evidence-based cessation treatments except telephone counseling§ by state Medicaid programs (for a total of nine treatments), as well as data on barriers to accessing these treatments (such as charging copayments or limiting the number of covered quit attempts) from December 31, 2008, to January 31, 2014. As of 2014, all 50 states and the District of Columbia cover some cessation treatments for at least some Medicaid enrollees, but only seven states cover all nine treatments for all enrollees. Common barriers in 2014 include duration limits (40 states for at least some populations or plans), annual limits (37 states), prior authorization requirements (36 states), and copayments (35 states). Comparing 2008 with 2014, 33 states added treatments to coverage, and 22 states removed treatments from coverage; 26 states removed barriers to accessing treatments, and 29 states added new barriers.¶ The evidence from previous analyses suggests that states could reduce smoking-related morbidity and health-care costs among Medicaid enrollees by providing Medicaid coverage for all evidence-based cessation treatments, removing all barriers to accessing these treatments, promoting the coverage, and monitoring its use (3,5–8).

CMS System for Sharing Information About Terminated Providers Needs Improvement

March 28, 2014 Comments off

CMS System for Sharing Information About Terminated Providers Needs Improvement
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
The Patient Protection and Affordable Care Act (ACA) requires the Centers for Medicare & Medicaid Services (CMS) to establish a process for sharing information about terminated providers. To meet this requirement, CMS established a Web-based portal, the Medicaid and Children’s Health Insurance Program State Information Sharing System (MCSIS). Sharing terminated provider data among States prevents terminated providers in one State from enrolling in another State. CMS and State agencies can submit information about providers that meet CMS’s criteria for having been terminated “for cause” from Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). State Medicaid agencies can use these data to identify these providers and subsequently terminate them from their Medicaid programs as required under another section of the ACA. In November 2013, subsequent to the timeframe we examined for this study, CMS revised its process for sharing information about terminated providers. The findings and recommendations in this report remain relevant to the new process.

HOW WE DID THIS STUDY
We examined all provider records contained in MCSIS as of June 1, 2013. We (1) determined the extent to which MCSIS contained records submitted by CMS and State Medicaid agencies; (2) identified records that did not meet CMS criteria for reporting providers terminated “for cause” from Medicare, Medicaid, or CHIP; and (3) assessed whether records had complete identifying information about providers, including National Provider Identifiers (NPIs), provider types, and provider addresses.

WHAT WE FOUND
As of June 1, 2013, MCSIS contained records on terminated providers submitted by CMS and 33 State Medicaid agencies and did not contain records from the remaining State Medicaid agencies. Contrary to CMS guidance, about one-third of the 6,439 records in MCSIS did not relate to providers terminated “for cause.” Over half of MCSIS records did not contain NPIs, a critical data element for accurately identifying providers. Additionally, one-third of MCSIS records did not identify the provider types and one quarter had no provider addresses.

WHAT WE RECOMMEND
Our findings suggest that CMS’s process for sharing information on terminated providers needs improvement to make it more useful to State Medicaid agencies in identifying providers that must be terminated pursuant to Federal law because they were terminated “for cause” by Medicare, Medicaid, or CHIP. Therefore, we recommend that CMS (1) require each State Medicaid agency to report all terminated providers, (2) ensure that the shared information contains only records that meet CMS’s criteria for inclusion, and (3) take action to improve the completeness of records shared through the process. CMS concurred with all recommendations.

FDA – Proposed Rule: Focused Mitigation Strategies to Protect Food Against Intentional Adulteration

March 28, 2014 Comments off

Proposed Rule: Focused Mitigation Strategies to Protect Food Against Intentional Adulteration
Source: U.S. Food and Drug Administration (via Regulations.gov)

The Food and Drug Administration (FDA or we) is proposing to require domestic and foreign food facilities that are required to register under the Federal Food, Drug, and Cosmetic Act (the FD&C Act) to address hazards that may be intentionally introduced by acts of terrorism. These food facilities would be required to identify and implement focused mitigation strategies to significantly minimize or prevent significant vulnerabilities identified at actionable process steps in a food operation. FDA is proposing these requirements as part of our implementation of the FDA Food Safety Modernization Act (FSMA). Further, as part of the proposal, FDA discusses an approach to addressing economically motivated intentional adulteration. We expect the proposed rule, if finalized as proposed, would help to protect food from intentional adulteration caused by acts of terrorism.

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