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  • Washington Highlights

    HHS OIG Releases Updated Work Plan

    Mary Mullaney, Director, Hospital Payment Policies

    The Department of Health and Human Services (HHS) Office of Inspector General (OIG) June 15 released its updated work plan, which sets forth several different projects – including OIG audits and evaluations that are underway or planned – to be addressed during the fiscal year and beyond by OIG’s Office of Audit Services and Office of Evaluation and Inspections. The work plan was last published November 2016.

    Some recently added items to the work plan include:

    • Review of Quality Measures Data Reported by Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP): OIG will review MSSP ACOs that received earned shared savings payments to determine whether they reported quality measures data in accordance with Federal requirements. The review is part of several OIG reviews that will examine various aspects of the ACOs under the MSSP.

    • Including Non-Covered Versions When Setting Payment Amounts for Medicare Part B Drugs: OIG will examine how the Centers for Medicare and Medicaid Services (CMS) determines which versions of drugs are included in Part B payment amount calculations, and the cost to Medicare and its beneficiaries of including non-covered, self-administered versions when calculating Part B payment amounts.

    • Follow-up: CMS’s Management of the Quality Payment Program (QPP): OIG will assess CMS's progress in addressing key challenges to implementing the QPP, a new initiative intended to shift Medicare from a volume-based payment system to one that rewards value. OIG will review CMS’s clinician outreach and training efforts and determine the status of IT system development, including the extent to which CMS has conducted security and functionality testing.

    • Reasonable Assumptions in Manufacturer Average Manufacturer Price (AMP) Reporting: OIG will examine CMS’s oversight of the reasonable-assumptions process under the Medicaid Drug Rebate Program and explore whether manufacturers believe that CMS’s recent final rule clarified issues for which manufacturers previously made assumptions.