Yesterday, the Department of Health and Human Services' (HHS) Center for Consumer Information and Insurance Oversight released the final Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges. Most qualified health plans offered in these exchanges must offer plans that included the 10 mandatory categories of essential health benefits as mandated by the Affordable Care Act, which include rehabilitative and habilitative services.

The guidance sets out timelines and requirements for state exchange documents (ie, "blueprints") each state must file with HHS. The document explains what type of exchange the state will run and how it will comply with the requirements.

A complete blueprint and declaration letter (specifying the chosen exchange model) must be submitted no later than November 16 for states seeking to operate a state-based or state partnership exchange for plan year 2016. Those states that submit letters more than 20 business days before the submission of their blueprints may request additional consultation and support from the Centers for Medicare and Medicaid Services to assist in blueprint preparation.

States that intend to operate in a federally-facilitated exchange but retain control of their own reinsurance programs also must submit a declaration letter by November 16.

HHS will begin plans to implement a fully federally-facilitated exchange in states that do not submit a blueprint and declaration letter before or by November 16.

The final guidance was released in conjunction with the first of 4 regional implementation forums that HHS is holding this month in the District of Columbia, Atlanta, Chicago, and Denver.

In 2011, rates of adult obesity remained high, with state estimates ranging from 20.7% in Colorado to 34.9% in Mississippi, according to new data from the Centers for Disease Control and Prevention (CDC). Twelve 12 states reported a prevalence of 30% or more. The South had the highest prevalence of adult obesity (29.5%), followed by the Midwest (29%), the Northeast (25.3%), and the West (24.3%).

In 2011, CDC made several changes to its Behavioral Risk Factor Surveillance System (BRFSS) that affect estimates of state-level adult obesity prevalence. First, there was an overall change in the BRFSS methodology, including the incorporation of cell phone-only households and a new weighting process. These changes in methodology were made to ensure that the sample better represents the population in each state. Second, to generate more accurate estimates of obesity prevalence, small changes were made to the criteria used to determine which respondents are included in the data analysis.

Because of these changes in methodology, estimates of obesity prevalence from 2011 forward cannot be compared to estimates from previous years. Data collected in 2011 will provide a new baseline for obesity prevalence data collected in subsequent years.

Based on stakeholder feedback obtained over the last year, the Centers for Medicare and Medicaid Services (CMS) has made improvements to the Provider Enrollment, Chain, and Ownership System (PECOS), which allows most providers and suppliers to enroll in the Medicare program or make changes to their Medicare enrollment information via the Internet rather than through the paper form. The following upgrades aim to make PECOS more user-friendly:

• Providers/suppliers now can submit their entire enrollment application including supporting documentation electronically with the new digital document feature. Hard copies of supporting documentation to the Medicare Administrative Contractors are no longer required. 
• Individual providers who reassign benefits to individuals/organizations with multiple practice locations will be able to designate a primary and secondary practice location where services are rendered. Selecting a primary and secondary practice location does not restrict the provider from providing services at other practice locations associated with the individual/organization to which they are reassigning benefits. It is recommended that a primary and secondary practice location be specified, but it is not required.  
• Providers/suppliers now can enter multiple contact persons in the contact information section and will have the ability to identify the contact's relationship to the provider/supplier. While Internet-based PECOS requires at least 1 contact person to be entered in this section, additional contacts and the relationship to the provider field are optional.
• At least 1 managing employee now will be required when submitting a CMS 855A, CMS 855B, and CMS 855S enrollment application. Applications that do not include at least 1 managing employee will receive an error message in Internet-based PECOS under the error/warning check tab and will not be able to proceed with submitting the enrollment application. Internet-based PECOS also will recommend that at least 1 owner is entered for a CMS 855A, CMS 855B, and CMS 855S application. Applications that do not include at least 1 owner will receive a warning message under the error/warning check tab in Internet-based PECOS. This warning message will not prevent the user from submitting the enrollment application.
• Providers/suppliers now will have the option to select "county" in the "geographic location" topic when identifying the geographic location where services are rendered for CMS 855A and CMS 855B enrollment applications. Prior to this feature the only available options were state, city, or zip code. When selected, Internet-based PECOS will populate the county field with all counties that exist within the enrollment state identified for the application.   
• CMS has redesigned the CMS 855O paper application, which is used to enroll in Medicare solely to order and refer services, and those changes are reflected in Internet-based PECOS. Providers who are currently enrolled in Medicare and are of a specialty that is eligible to order and refer already have the ability to order and refer services. Therefore, they are not required to submit a separate CMS 855O enrollment application solely to order and refer services. 

APTA members can find more information about the program on the association's PECOS webpage. 

Functional-based exercise, such as such as ironing while standing on 1 leg, should be a focus for interventions to protect older, high-risk people from falling and to improve and maintain functional capacity, say authors of an article published August 7 in BMJ.  

Researchers in Australia conducted a 3-arm randomized trial in which 317 residents of Sydney older than 70 years who had 2 or more falls or 1 injurious fall within the previous year were recruited and randomly assigned to 1 of the following interventions—a novel activity-integrated exercise program called Lifestyle integrated Functional Exercise (LiFE), a structured exercise program, or a gentle exercise control program.

"In the LiFE approach, movements specifically prescribed to improve balance or increase strength are embedded within everyday activities, so that the movements can be done multiple times during the day… whenever the opportunity arises," write the authors. For example, a prescribed activity incorporating the balance strategy of "reducing base of support" might involve a tandem stand while working at a countertop, and over time could be upgraded to working while standing on 1 leg. A prescribed activity incorporating the strategy to increase strength by bending knees might involve squatting instead of bending at the waist to close a drawer, and could be upgraded to picking things up from the floor.

The researchers performed follow-up at 6 months and 12 months after study participants started their programs. After 12 months of follow-up, the authors recorded 172 falls in the LiFE group, 193 in the structured exercise group, and 224 falls in the control group. The LiFE, structure exercise, and control groups had 21, 24, and 26 people who fell once, and 39, 41, and 45 who fell at least twice, respectively.

"The LiFE program provides an alternative to traditional exercise to consider for fall prevention," say the authors. 

Don't forget to sign up for the National Council on Aging's (NOCA) free webinar on August 28 and learn how you can participate in Falls Prevention Awareness Day, recognized September 22. Find patient care, consumer education, and NOCA resources, in addition to continuing education courses on balance and falls at www.apta.org/BalanceFalls/. 

More than 2,000 hospitals, including some nationally recognized ones, will be penalized starting in October under the Affordable Care Act's Hospital Readmissions Reduction Program, says a Kaiser Health News  article. Together, these hospitals will forfeit about $280 million in Medicare payments over the next year for excess readmissions for heart attack, heart failure, and pneumonia.

The penalties will be the most severe in hospitals in New Jersey, New York, the District of Columbia, Arkansas, Kentucky, Mississippi, Illinois, and Massachusetts. Hospitals that treat the most low-income patients will be hit particularly hard.

A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law—1% of their base Medicare payments. Several of those are top-ranked institutions, including Hackensack University Medical Center in New Jersey; North Shore University Hospital in Manhasset, New York; and Beth Israel Deaconess Medical Center in Boston, the article says.

The total number of hospitals receiving penalties is 2,211. According to Medicare records, 1,933 hospitals will receive penalties less than 1% percent. Massachusetts General Hospital in Boston, which has been rated as the best hospital in the country, will lose 0.5% of its Medicare payments because of its readmission rates.  

Nearly 1 in 5 Medicare beneficiaries are readmitted within 30 days of discharge each year, costing Medicare 17.4 billion in additional hospital bills, according to a 2009 study on Medicare claims data from 2003-2004. The national average readmission rate has remained steady at slightly above 19%, even as many hospitals have worked to lower theirs, says Kaiser Health News. 

Physical therapists can help serve an important role in patient care transitions and care coordination and can help reduce readmissions by providing recommendations for the most appropriate level of care to the health care team prior to and during care transitions. For more information and to find clinical practice and patient education resources to reduce readmissions, visit APTA's Hospital Readmissions webpage.