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Health Care Reform Implementation Update - June 18, 2013

Posted on June 18, 2013 by Mark Alderman

Last week the House Committee on Ways & Means Health Subcommittee held a hearing on Medicare overhaul proposals affecting post-acute care; the Congressional Budget Office (CBO) wrote to House Budget Committee Chairman Paul Ryan announcing that it will not update its 10-year budget baseline in August, which extends the low cost estimate of the Medicare Sustainable Growth Rate from February; the Medicare Payment Advisory Commission (MedPAC) released its annual Report to the Congress on Medicare and the Health Care Delivery System; proposed rules from the Centers for Medicare & Medicaid Services on exchange, SHOP, premium stabilization programs and market standards were filed; the Arizona legislature passed Medicaid expansion; and the Obama administration decided to stop its attempts to block over-the-counter access to the morning-after contraceptive pill.

ON THE HILL

On June 13, Sen. Ron Wyden (D-Ore.), who could take over the Senate Finance Committee in 2015, announced that he is planning to tackle Medicare reform by focusing on chronic disease. He suggested that ACOs should be encouraged to specialize in particular chronic conditions.

On June 14, the House Committee on Ways & Means Subcommittee on Health held a hearing focused on reforming payment for care delivered after a hospitalization in the Medicare program.

On June 12, Sens. Marco Rubio (R-Fla.) and Orrin Hatch (R-Utah) offered several immigration amendments, one of which would limit immigrants’ access to health subsidies under the Affordable Care Act. Immigrants who came to the United States illegally and go through the legalization process would be prevented from getting these subsidies for five years after they receive green card status.

The Federal Bureau of Investigation (FBI) is beginning to pay attention to congressional staffers in its pursuit of tracking down the connection between the Medicare Advantage rate announcement and Wall Street's early knowledge of it.

AT THE AGENCIES

On June 13, the Congressional Budget Office wrote to Chairman of the Committee on the Budget Paul Ryan saying that it will not update its 10-year budget baseline in August. This is a positive development for providers because it means the lower price of replacing the Medicare SGR unveiled in February will run through November.

The Centers for Medicare and Medicaid Services (CMS) will be publishing a proposed rule on Exchange, Shop, Premium Stabilization Programs, and Market Standards on June 19. The proposed rule provides financial integrity and oversight standards with respect to Affordable Insurance Exchanges; Qualified Health Plan issuers in federally facilitated exchanges; and states with regard to the operation of risk adjustment and reinsurance programs. It also proposes additional standards with respect to agents and brokers.

Surgeon General Regina Benjamin announced that she plans to leave the position she has held since 2009. The Deputy Surgeon General, Boris Lushniak, will be the acting surgeon general while a replacement is sought.

On June 10, the IRS issued final regulations to implement the ACA's tax on indoor tanning beds. The Affordable Care Act includes a 10 percent tax on the use of tanning beds.

According to data released by CMS, since March 2011, CMS has expelled 14,633 providers from participating in Medicare due to fraud control efforts. The ACA established new screening and review requirements for Medicare participation.

A new report by the Department of Health and Human Services’ Office of Inspector General shows that if the U.S. Medicare program had paid the lowest rates negotiated by private insurers for lab tests instead of Medicare rates, $1 billion would have been saved in 2011.

On June 13, the Medicare Payment Advisory Commission issued its Report to Congress: Medicare and the Health Care Delivery System is available here.

IN THE STATES

On June 13, the Arizona legislature approved Medicaid expansion legislation. On June 17, Gov. Jan Brewer signed the legislation into law.

Democrats in the Pennsylvania legislature are doing everything they can to force a vote on Medicaid expansion. On June 10, Democrats tried to offer a Medicaid amendment to the state budget to this effect, however the House declined to allow a vote on the proposal. Meanwhile, Governor Corbett continues to negotiate with the Obama administration. On June 12, a coalition of 120 groups brought a delegation of medically vulnerable uninsured Pennsylvanians to Harrisburg to tell their personal stories and urge the legislature and Governor Corbett to expand the state’s Medicaid program.

On June 10, Colorado, which is one of only 16 states setting up its own health insurance marketplace, named 58 organizations to make up the state’s “assistance network” for health marketplace enrollment.

The Ohio Department of Insurance announced that it predicts health insurance premiums in 2014 to rise by 88 percent. The department estimated that the average individual premium will increase from $223 per month to $420 per month under the ACA. A study from Milliman last week suggested a similar outlook, arguing that individual premiums will increase between 25 and 40 percent under the ACA. The announcement was made shortly before President Obama announced the lower-than-expected premium rates in California.

On June 7, Alabama Gov. Robert Bentley signed an executive order to create a commission to review the Medicaid pharmacy program and make recommendations on how to contain the costs in the $600 million program. The commission is to report back to Gov. Bentley by December 1. The governor remains opposed to Medicaid expansion in his state.

Mississippi’s current Medicaid program is set to expire on July 1. Partisan disagreement over Medicaid expansion is keeping the state from moving forward on any Medicaid legislation, putting Mississippi’s current Medicaid population at risk. Democrats in the state want a vote on expansion. Republicans, on the other hand, want to reach a deal with Democrats on Medicaid reauthorization without voting on extension before the vote.

According to Gov. Neil Abercrombie’s office, HHS and CMS have approved Hawaii’s health insurance marketplace plans. Hawaii’s online marketplace is called the Hawaii Health Connector.

On June 12, the Maine House passed a Medicaid expansion plan that would allow the state to expand Medicaid for three years, while the federal government covers the full cost. At that point, legislators would have to vote to renew it. Gov. Paul LePage has said he will veto this legislation. The plan passed the House 97-51 – had there been two more votes in its favor, it would have had enough support to override the governor’s veto.

Oregon Gov. John Kitzhaber signed legislation designed to address regulatory issues related to biological medicine interchangeability. While the U.S. Food and Drug Administration (FDA) oversees approval of biologic medicines, policies governing whether one product may be substituted in place of a doctor’s prescription and whether a pharmacist must notify a consumer are covered by state law.

California Insurance Commissioner Dave Jones is seeking to prohibit Anthem Blue Cross from operating on the state’s health exchange for small businesses because of its excessive, repeated rate hikes.

IN THE WHITE HOUSE

On June 7, President Obama made a speech in California touting the benefits of the ACA and encouraging the uninsured to enroll. California is a crucial state for enrollment with its nearly six million uninsured individuals. It is also the largest insurance marketplace in the United States.

IN THE COURTS

On June 11, the Obama administration decided to stop its attempts to block over-the-counter access to the morning-after contraceptive pill. The Justice Department will now begin putting into effect a judge’s order to have the FDA certify the drug for nonprescription use, rather than appealing the judge’s ruling.

IN THIRD PARTIES

Enrollment in Medicare Advantage plans increased by close to 10 percent in 2013 compared with 2012, according to a Kaiser Family Foundation/Mathematica Policy Research study released June 10.

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., ACA, Articles, CMS, Health Care Reform Implementation Updates, MedPAC, Medicaid, Medicaid expansion, Medicare, Medicare Advantage, SGR, SHOP, doc fix

Health Care Reform Implementation Update - June 12, 2013

Posted on June 12, 2013 by Mark Alderman

Discussions around reforming Medicare’s sustainable growth rate (SGR) continued this week as the Committee on Energy & Commerce held a hearing to solicit input on a draft bill for replacing the current SGR formula; the Ways and Means Committee noticed a hearing on post-acute care reform for Friday 6/15; the House of Representatives approved track and trace legislation; Dr. Gilfillan’s departure from the Centers for Medicare & Medicaid Innovation (CMMI) became public; CMS released average estimated submitted charges for 30 hospital outpatient procedures; Michigan Gov. Snyder pushed state legislators to approve Medicaid expansion in the state and the Maine state House voted for expansion.

ON THE HILL

On June 5, the House Energy & Commerce Committee held a hearing to solicit input on a draft bill for replacing the current Sustainable Growth Rate (SGR) formula. The draft bill suggests pay stability until quality measures are developed for an outcomes-based pay system.

On June 3, the House of Representatives approved a track and trace bill, which legislates how the federal government will track prescription drugs moving through the distribution chain, aiming to prevent counterfeit drugs from reaching consumers.

Republicans in the House are planning to try to pass a revamped bill on the ACA’s high-risk pool later this month. House Majority Leader Eric Cantor (R-Va.) sent a memo to his Republican colleagues saying that the House would try to pass a bill in June that would kill the Prevention and Public Health Fund. The Helping Sick Americans Now Act has been reworked from earlier this spring so that it will repeal the Prevention and Public Health fund without boosting funding for the Pre-existing Conditions Insurance Plan, and it will transfer funding only to state-based pools.

Senators Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) say that despite a recent federal ruling affirming that Medicare data should be available to the public and federal efforts to make some data publicly available, much more still needs to be done to make Medicare claims data fully transparent. The two plan to reintroduce the Medicare Data Access for Transparency and Accountability Act (Medicare DATA Act), which would require the Secretary of HHS to issue regulations to make available a searchable Medicare payment database that the public can access at no cost.

On June 5, House Democrats met with the White House’s communications adviser for health care, Tara McGuinness, about enrollment in the law's marketplaces.

On June 5, Rep. Raul Labrador (R-Idaho), who is a member of the "Gang of Eight" working on immigration reform, informed his colleagues that he would not be able to sign on to the legislation the group plans to introduce soon. He will be leaving the group because he is concerned that the bill will not protect taxpayers from having to cover the costs of undocumented immigrants’ health care.

On June 4, Sen. Marco Rubio proposed The Right to Refuse Amendment, a constitutional amendment that would undo the individual mandate requirement of the Affordable Care Act. The proposed amendment would declare that "Congress shall make no law that imposes a tax on a failure to purchase goods or services." It is not expected that this symbolic proposal will get much traction.

AT THE AGENCIES

On June 3, it became public news that Dr. Richard Gilfillan, who has led the Center for Medicare and Medicaid Innovation since its creation in 2010, will leave his position as director at the end of June. Patrick Conway, who is CMS’ CMO and director of the Center for Clinical Standards and Quality, will serve as acting director of CMMI in addition to his other roles.

On June 3, CMS released average estimated submitted charges for 30 hospital outpatient procedures, revealing big differences among hospitals in how much they bill patients for the same service. This data follows CMS’ recent disclosure of pricing for 100 common hospital inpatient procedures.

On June 4, at a hearing before the House Education and the Workforce Committee, Health and Human Services (HHS) Secretary Sebelius said that she spoke with companies her department is responsible for regulating about supporting, but not funding, enrollment organizations linked to the Affordable Care Act.

Two IRS officials – Fred Schindler and Donald Toda – responsible for implementing the Affordable Care Act have been placed on administrative leave due to their acceptance of free food and gifts.

Several publications flagged the discovery this week that Secretary Sebelius, as well as other officials at the Department of Health and Human Services and the Department of Labor, use secret email addresses not usually disclosed to the public. The Associated Press published one of Sec. Sebelius’ email addresses despite a request from her aides not to make it public.

Two HHS agencies – the Office of the National Coordinator for Health Information Technology and the Office of the Assistant Secretary for Planning and Evaluation – announced they are partnering together to develop a data-sharing plan for outcomes research. The Affordable Care Act made close to $200 million available for building this infrastructure.

IN THE WHITE HOUSE

On June 3, the Obama administration unveiled new initiatives aimed at reducing the stigma of mental illnesses. President Obama discussed bringing mental illness "out of the shadows" at a White House conference on psychological health included in a wider campaign to reduce gun violence. Also during the conference, Secretary Sebelius said that HHS officials want to finish clarifying the parity act, which would cover mental health services on a par with physical health care, by the end of the year.

IN THE STATES

Gov. Rick Snyder is prodding Michigan state lawmakers to approve Medicaid expansion in the state before the legislature’s recess begins on June 27. Snyder invited Sec. Sebelius to meet with Republican lawmakers to consider a House GOP proposal that would put a four-year lifetime cap on able-bodied adults to be on Medicaid.

On June 4, the D.C. Council voted unanimously for temporary legislation that mandates small-business owners to purchase employee health insurance through a government-run exchange. This mandate will not take effect until 2015. The temporary legislation, however, will expire in October 2014, so we expect the debate over a small-business owner mandate to reemerge then.

Pennsylvania Governor Tom Corbett wrote to Sec. Sebelius requesting an exemption to prevent close to 70,000 Pennsylvania children in the Children's Health Insurance Program (CHIP), a state-subsidized health insurance program, from having to switch to Medicaid. Community Legal Services of Philadelphia, a public interest law center, is disputing Corbett's claims.

On June 4, the Maine House approved a bill to expand the state’s Medicaid program. The amended version says the state can opt out of the Medicaid expansion if the federal government fails to live up to its promises to cover most of the cost of the added Medicaid spending.

This week, five health insurance firms announced they plan to sell insurance in Arkansas’ health insurance marketplace – Arkansas Blue Cross Blue Shield of Little Rock, National Blue Cross Blue Shield Multi-state Plan, QCA Health Plan of Little Rock (does business as QualChoice of Arkansas), Celtic Insurance Co. of Chicago (through its subsidiary NovaSys Health), and United Security Life & Health Insurance of Bedford, Ill.

IN THE COURTS

At least three circuit courts of appeal have heard oral arguments on the ACA’s contraceptive coverage requirement in the past few weeks. The cases arose when businesses challenged the requirement that they provide contraceptives to employees in their health plans. We expect that any party that loses one of these cases will appeal the ruling to the Supreme Court. The Supreme Court is more likely to consider the issue if there are split decisions in the circuit courts. Another, and possibly riskier threat to the ACA, is the set of cases that argue the Internal Revenue Service is unlawfully implementing some subsidies to help individuals buy insurance since the law as written only authorizes the agency to provide subsidies to those in exchanges “established by the state.”

IN THIRD PARTIES

Because 14 states have decided not to expand Medicaid, a study in Health Affairs, which ultimately argues that states should expand their Medicaid program, estimates that 3.6 million fewer people will get insurance, with a total of 27.9 million people uninsured, and federal payments to the state could decrease by $8.4 billion.

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., ACA, Articles, CHIP, CMMI, CMS, Health Care Reform Implementation Updates, Medicaid expansion, Medicare, PCIP, SGR, doc fix

Health Care Reform Implementation Update - June 4, 2013

Posted on June 4, 2013 by Mark Alderman

Medicare Trustees released their annual report finding that the Medicare trust fund will be exhausted in 2026, two years later than was predicted last year; over the past two weeks, as Washington has investigated the Internal Revenue Service’s (IRS) use of targeting, lawmakers have been working to ensure similar targeting cannot occur at the agencies implementing the Affordable Care Act (ACA); with bipartisan support Marilyn Tavenner became the first confirmed Centers for Medicare and Medicaid Services (CMS) Administrator in almost seven years; the House of Representatives voted to repeal the ACA for the 37th time; 17 of the 27 states running their own Preexisting Condition Insurance Plans (PCIPs) decided to let the federal government take control and responsibility; and the Center for Medicare & Medicaid Innovation (CMMI) is starting to accept letters of intent from parties interested in its second round of innovation grants.

ON THE HILL

After a Treasury Department audit found that the IRS had singled out conservative groups for special scrutiny, some lawmakers have been tying the targeting to Affordable Care Act implementation. The House GOP campaign committee launched ads in some districts where Democrats are vulnerable in midterm elections claiming Democrats are planning to “Put the IRS in charge of your healthcare.” The IRS is, in fact, responsible for implementing major pieces of health reform – at least 40 provisions in the ACA add or amend provisions of the tax code. The IRS’s tasks include collecting information on who has insurance from employers and insurers, determining who qualifies for subsidies or Medicaid, and figuring out who must pay a penalty. Notwithstanding the large role the IRS will play in implementing the ACA, the Department of Health and Human Services (HHS) responded to these suggestions saying that “The Affordable Care Act maintains strict privacy controls to safeguard personal information. The IRS will not have access to personal health information.”

Sen. John Thune (R-S.D.) sent a letter to Attorney General Eric Holder and Treasury Secretary Jack Lew requesting they disclose whether Sarah Hall Ingram, the former commissioner of the office responsible for tax-exempt organizations between 2009 and 2013 had “inexplicably been promoted to oversee the IRS’ Affordable Care Act office.” Thune goes on to request that the IRS stop enforcing regulations drafted under Ingram’s supervision and that the IRS cease working on health care law regulations until the Department of Justice confirms that Ingram is not being investigated.

House Ways and Means Oversight Subcommittee Chairman Charles Boustany (R-La.), Rep. Diane Black (R-Tenn.), Rep. Ralph Hall (R-Texas) and Rep. Mike Kelly (R-Pa.) introduced the Stopping Government Abuse of Taxpayer Information Act “to protect Americans from political targeting at all government agencies charged with the implementation and enforcement of the Patient Protection and Affordable Care Act.”

On May 14, the Congressional Budget Office (CBO) released the news that the cost of repealing the sustainable growth rate (SGR) would not be as high as once expected, indicating to many that the momentum behind achieving repeal is likely to continue this year. The Medicare Payment Advisory Committee’s (MedPAC’s) Executive Director said to the Senate Finance Committee that CBO’s reduced cost estimate of repealing the SGR may alter recommendations it has previously made to Congress for transitioning the Medicare payment system. At the time MedPAC made its initial recommendations the estimated cost was $300 billion over 100 years, but the CBO has revised this estimate to $138 billion over 10 years.

The House Ways and Means Subcommittee on Health held a hearing on May 21, in which there was discussion of three ways to utilize beneficiary cost sharing in Medicare in anticipation of a deficit reduction package. The three areas identified as targets for cost sharing were increasing income related premiums for Medicare Parts B and D, increasing the annual Medicare Part B deductible, and establishing a home health copay.

The House of Representatives voted 229 to 195, largely along partisan lines, to repeal the Affordable Care Act for the 37th time. The vote gave some freshmen congressmen their first opportunity to vote for repeal, which will give them the ability to campaign on these grounds as midterm elections near.

Ways and Means Health Subcommittee Chair Kevin Brady (R-Texas) and Ways and Means Oversight Subcommittee Chair Charles Boustany (R-La.) wrote a letter to HHS Sec. Sebelius expressing concern over the potential for privacy violations by health insurance exchange navigators and non-navigator assisters. In the letter, they request further detail on what information these entities will be able to access.

At a House Oversight hearing on May 21, Center for Consumer Information and Insurance Oversight (CCIIO) Director Gary Cohen said he was confident that HHS has authority, despite lack of explicit statutory instructions, to set up navigator and assister programs to help with enrollment in state-based exchanges.

AT THE AGENCIES

On May 31, the Medicare Trustees released their 2013 report, projecting that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2026, which is two years beyond what was projected in last year’s report. The improved outlook can be attributed to lower-than-expected Part A spending in 2012 and lower projected Medicare Advantage program costs. At this juncture it does not appear that action will be triggered from the Independent Payment Advisory Board (IPAB). This report is likely to influence upcoming congressional debates over the debt ceiling, proposals to reduce the deficit and the future of entitlement programs.

On May 31, CMS released a final rule on Small Business Health Options Program (SHOP) exchanges along with an application that provides small employers with easy-to-understand access to health insurance options for their employees.

HHS announced a second round of Center for Medicare & Medicaid Innovation (CMMI) innovation awards, through which up to $1 billion are now available for payment and delivery system models that improve care and lower costs. Specifically, CMMI is seeking proposals in the following categories: Models that are designed to rapidly reduce Medicare, Medicaid and/or CHIP costs in outpatient and/or post-acute settings; models that improve care for populations with specialized needs; and models that improve the health of specific populations through activities focused on engaging beneficiaries, such as prevention, wellness, and comprehensive care that extend beyond the clinical service delivery setting.

On May 15, the Senate approved President Obama’s nominee to run CMS, Marilyn Tavenner. Tavenner is the first confirmed CMS administrator since 2006.

On May 29, implementing a component of the ACA, HHS finalized rules for wellness programs offered through employer health care plans. The final rule closely mirrored the proposed rule. Under the rules, employer health plans may offer rewards to workers who satisfy certain fitness goals. The rule increases the maximum possible reward for successful completion of a health-contingent wellness program from 20 percent to 30 percent of an employee’s premiums.

The Office of Management and Budget (OMB) has begun reviewing final rules on Medicaid, Exchanges, and Children’s Health Insurance Programs; Conditions of Participation for Community Mental Health Centers; Exchange Functions: Eligibility for Exemptions and Miscellaneous Minimum Essential Coverage Provisions; Inpatient Psychiatric Facility Prospective System; and Home Health Prospective Payment System Rate.

The Medicare Fraud Strike Force has found $223 million of alleged Medicare fraud, charging 89 individuals in eight cities , according to the Department of Health and Human Services.

IN THE STATES

The ACA established the Preexisting Condition Insurance Plan (PCIP) to provide health insurance coverage for Americans whose preexisting conditions made them uninsurable in the private market until 2014, when insurance that does not underwrite based on health status will become available. In February of 2013, due to the quick consumption of the program budget, HHS increased cost sharing under the program and suspended new enrollments in the federal program. Last week, HHS informed states that they would have to renegotiate their PCIP contracts and accept limited funding to continue their programs. Concerned that they would get stuck with the tab if they operated these plans themselves, 17 states opted to discontinue their programs and turn their enrollees over to the federal program, while 10 will continue to administer the PCIP in their states.

Two states that had planned to run their own state health exchanges have appealed to the federal government for help. The health insurance board chairmen in Idaho and New Mexico said they could not prepare the computer systems by October 1, 2013 and would need help from the federal government. Thirty-six states’ exchanges will now be run in full or in part by the federal government. New Mexico will run its exchange in partnership with the federal government. Though Idaho will receive assistance from the federal government, Idaho Gov. Butch Otter said it will still be a “state-run exchange.”

Pennsylvania Governor Tom Corbett pushed back last week against the Pennsylvania’s Independent Fiscal Office’s (IFO) report, which claimed Medicaid expansion would provide the state as much as $515 million in savings, revenue or underestimated costs to the state. Bev Mackereth, the Acting Secretary of the Department of Public Welfare, sent a letter to the Independent Fiscal Office explaining that the Department had “serious concerns” about some of the assumptions contained in the IFO report. One of Gov. Corbett’s top aides said that if Pennsylvania is to expand Medicaid, it likely will not happen until January 2015. Mackereth said that the administration would need that much time to negotiate with the federal government and create the program.

Four insurers – Aetna, CareFirst Blue Cross Blueshield, Kaiser Permanente and United Healthcare – are planning to offer almost 300 different health insurance policies through the D.C. Health Benefit Exchange.

On May 23, Maine’s Democratic-controlled legislature passed a bill to expand the state’s Medicaid program. Maine Governor Paul LePage (R) immediately began veto procedures.

IN THE COURTS

On May 16, Liberty University argued before the 4th U.S. Circuit Court of Appeals panel that it would face millions of dollars in penalties if it were to refuse to provide employee health insurance. Providing the required insurance, however, would violate the university’s religious beliefs because it is required to cover contraceptives and other drugs the university argues cause abortions.

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., ACA, Articles, CCIIO, CHIP, CMMI, CMS, HHS, Health Care Reform Implementation Updates, IPAB, IRS, Medicaid, Medicaid expansion, Medicare, PCIP, SGR, SHOP, doc fix

Health Care Reform Implementation Update - May 15, 2013

Posted on May 15, 2013 by Mark Alderman

Last week the Senate agreed to vote on Marilyn Tavenner’s nomination to lead the Centers for Medicare and Medicaid Services (CMS); the Department of Health and Human Services (HHS) announced an initiative that will give consumers information on what hospitals charge and posted an initial set of data on CMS’ website; two major Medicare authorizing committees launched significant sustainable growth rate (SGR) reform initiatives; HHS opened the door to a bifurcated exchange approach by allowing Utah to operate its small business exchange itself with the federal government operating the individual exchange; Kentucky Gov. Steve Beshear and West Virginia Gov. Earl Ray Tomblin announced that their states would expand Medicaid; and the Florida legislature closed its session without passing a bill to expand Medicaid.

ON THE HILL

On May 10, the bipartisan leadership of the Senate Finance Committee announced a hearing on May 14 to address ways to reform the SGR, including witness testimony from the Medicare Payment Advisory Commission’s (MedPAC’s) Executive Director Mark Miller, health care consultant and former Government Accountability Office (GAO) analyst Bruce Steinwald, and the Brookings Institution’s Kavita Patel. It also solicited feedback in an open letter to stakeholders, which asks for specific solutions to improving the Medicare Physician Fee Schedule. Submissions are due by May 31 to the dedicated mailbox at sgrcomments@finance.senate.gov.

After repeated rejections from Congress for additional funds to set up the Affordable Care Act (ACA), HHS Secretary Sebelius has been reaching out over the past few months to ask health industry executives, community organizations and church groups to make donations to groups like Enroll America that are working to enroll those without insurance and increase awareness of the law. On May 11, the ranking Republican on the Senate Committee on Health, Education, Labor and Pensions, Sen. Alexander (R-Tenn.), said that Sec. Sebelius’s “fundraising and coordinating with private entities to implement the new health care law may be illegal.”

On May 8, the House Ways and Means Subcommittee on Health discussed ideas for reforming Medicare’s SGR with a group of influential medical practitioners and experts. Subcommittee Chairman Kevin Brady (R-Texas) said the system "fails to take into account the quality of the care provided or how efficiently that care was furnished." The committee’s ranking member, Rep. Jim McDermott (D-Wash.) said "we need a policy that rewards quality, not just quantity. We need a policy that incentivizes team-based, coordinated care, with a strong primary care component."

On May 7, Sen. Tom Harkin (D-Iowa) said he would allow Marilyn Tavenner’s nomination to head CMS to go forward. He had previously put a hold on Marilyn Tavenner’s nomination because he was upset about cuts the administration had made to the ACA’s prevention and public health fund. The Senate agreed to vote on Tavenner after an hour of debate, although a specific date for the vote has not been set.

Health care also has taken a place in the immigration debate in which Senators have been engaged. Part of the debate focuses on the economic impact of allowing undocumented illegal immigrants to become legal immigrants – many lawmakers have expressed concern over the cost of providing Medicare, Medicaid or subsidies for the new health marketplaces to a large group of newly legalized immigrants. Sen. Orrin Hatch (R-Utah) filed an amendment that would bar the group from receiving ACA subsidies for five years after becoming legal. Sen. Jeff Flake (R-Ariz.) filed an amendment that would require HHS to ensure those with registered provisional immigration status are not receiving means-tested public benefits and would revoke the registered provisional immigrant status of anyone in that status convicted of fraudulently claiming or receiving federal means-tested benefits. Other lawmakers are concerned that if this group is denied these subsidies, some of them may get health care in emergency rooms, which could be more costly.

In response to instances of counterfeit drugs and stolen – and then spoiled – drugs being sold in pharmacies, Congress is working on “track and trace” legislation to help ensure the authenticity and safety of prescription drugs. Committees in the House and Senate have released draft versions of bills that would require manufacturers to place bar codes on packages of drugs they ship. The bar codes would be scanned by wholesalers and other middlemen on their way to the pharmacy, at which point the pharmacy would track the drug by its barcode to ensure its authenticity and safety.

On May 7, Rep. Bill Cassidy (R-La.) filed legislation to attempt to create more financial and efficiency accountability for Medicaid funding. The first version of Rep. Cassidy’s Medical Accountability and Care Act died in Congress last year.

House Majority Leader Eric Cantor (R-Va.) said that the House will vote again to repeal the Affordable Care Act. The House has already voted more than 30 times to repeal the law, but freshmen congressmen have not yet had an opportunity to vote on the issue.

Conservative House Republicans are exploring options for delaying the Affordable Care Act as part of the debt ceiling fight. Members of the Republican Study Committee met with the Congressional Budget Office (CBO) to inquire how much savings could be generated from delaying exchange and Medicaid expansion.

IN THE WHITE HOUSE

On May 10 in a Mother's Day-themed event at the White House, President Obama targeted women and young people to promote the benefits of the Affordable Care Act for women – free cancer screenings and contraceptives, among the major perks. President Obama urged mothers to encourage their adult children to sign up for the health insurance exchanges that open this fall.

On May 9, the Obama administration pledged $150 million for community health centers to provide in-person enrollment assistance to uninsured patients.

AT THE AGENCIES

On May 8, as part of the agency’s efforts to make health care more affordable and accountable, HHS Secretary Sebelius announced a three-part initiative that will, for the first time, give consumers information on what hospitals charge. New data was released and posted on the CMS website for the 100 most common Medicare inpatient stays, that shows significant variation across the country and within communities in what hospitals charge for common inpatient services.

HHS also announced that it has made about $87 million available to states to enhance their rate review programs and further health care pricing transparency. The Robert Wood Johnson Foundation, a nonprofit focused on public health issues, is planning a data visualization challenge that would further the dissemination of the data to a larger audience.

IN THE STATES

Notwithstanding the Missouri Governor’s support of Medicaid expansion, the Missouri legislature did not include expansion measures in its 2014 budget. Neither the state House or Senate included expansion in their blueprints. They have opted instead to create committees to study the issue for the remainder of the year and report on the impact of expansion in early 2014, which delays any decision on the matter to after the January 1 start date.

On May 9, the Idaho health insurance exchange board met. The board is working to determine how it can set up a state exchange even with very little done so far. It has been discussing possibly partnering with the federal government in some ways, while still remaining a “state-based exchange and remaining in control.”

On May 9, Kentucky Governor Steve Beshear announced that his state will expand the Medicaid program to adults earning up to 133 percent of the federal poverty level, covering an additional 300,000 people.

On May 9, West Virginia Governor Earl Ray Tomblin announced that West Virginia would expand its Medicaid program, making him the 26^th governor to back the expansion. Governor Tomblin’s office expects the expansion to cover more than 91,000 people in the state.

After months of discussions with state leaders in Utah, HHS agreed on May 10 to let the state run its own small business health exchange but for the federal government to run the individual exchange, as the state requested, potentially opening the door to a bifurcated exchange approach for other states as well.

California has delayed its plan to launch a program to test new ways to coordinate care for dual eligbiles.

IN THE COURTS

On May 7, Dr. Steven Hotze of Houston sued the United States over the Affordable Care Act. Dr. Hotze argues that the law violates the U.S. Constitution’s origination and takings clause, which were not part of the arguments before the Supreme Court in June. He also argues that the ACA violates the constitutional requirement that revenue bills originate in the House.

IN THIRD PARTIES

The Urban Institute is out with a new proposal to curb deficit spending. The report says that capping the tax exclusion for employer-sponsored health coverage could save hundreds of millions of dollars annually. The proposal is controversial, with some arguing that this would change the health insurance market.

An article from May’s issue of Health Affairs by David Cutler and Nikhil Sahni argued that if the slowed rate of health care spending growth persists, public-sector health spending will be as much as $770 billion less than predicted.

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To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., ACA, Articles, CMS, HHS, Health Care Reform Implementation Updates, MedPAC, Medicaid expansion, Medical Accountability and Care Act, Medicare Physician Fee Schedule, SGR, doc fix

Health Care Reform Implementation Update - May 6, 2013

Posted on May 6, 2013 by Mark Alderman

Last week the Centers for Medicare & Medicaid Services (CMS) issued new proposed regulations on FY 2014 payment updates and regulatory policy changes for inpatient and long term care hospitals, skilled nursing facilitates, hospices and inpatient rehabilitation facilities; the Internal Revenue Service (IRS) released a proposed rule on the minimum value of coverage employers must provide to their employees; the Center for Consumer Information and Insurance Oversight (CCIIO) issued guidance explaining the role agents and brokers will play in health insurance marketplaces; Hill leadership, while technically out of session, was busy debating how federal employees will interact personally with insurance marketplaces; and the Department of Health and Human Services (HHS) shortened the application for health coverage in response to concerns that initial enrollment forms were too long.

ON THE HILL

A provision of the Affordable Care Act (ACA) requires lawmakers and their staff to participate in the health-insurance marketplaces. At the end of last week, questions were raised about whether, under the ACA, congressional employees will be able to continue having their health insurance premiums subsidized by the government, or whether they will have to pay 100 percent of their premiums in 2014. Congressional leaders are discussing possible exemptions for Capitol Hill staffers but are sensitive to the potential for political backlash from a decision to exempt them.

On May 1, House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) and Senate Finance Committee Ranking Member Orrin Hatch (R-Utah) released Making Medicaid Work, a blueprint to modernize the Medicaid program.

IN THE WHITE HOUSE

Speaking at a news conference at the White House on April 30, President Obama said the Affordable Care Act is already benefitting most Americans, even if they do not know it. Major provisions of the Affordable Care Act, however, do not take effect until 2014.

AT THE AGENCIES

CMS announced that the application for health coverage has been simplified and significantly shortened. The application for individuals without health insurance has been reduced from 21 to three pages, and the application for families was reduced by two-thirds. Also, CMS announced that for the first time consumers will be able to fill out one simple application to see their entire range of health insurance options, including plans in the Health Insurance Marketplace, Medicaid, the Children’s Health Insurance Program (CHIP) and tax credits that will help pay for premiums.

This week, CMS, as is usual, issued proposed rules for FY 2014 for inpatient and long term care hospitals, skilled nursing facilitates, hospices and in-patient rehabilitation facilities. In general, the rules propose modest positive updates and appear to be in line with initial expectations, notwithstanding some novel policy proposals. As always, the rules are proposed and will not be finalized until later this summer. Cozen O’Connor Public Strategies has evaluated the inpatient and long term care hospital rule, and a summary is available here. We will be writing similar summaries of the other rules in the days ahead. Please be advised that there is ample opportunity to comment on these proposals before they go into effect on October 1.

On April 30, the IRS released a proposed rule on the health insurance premium tax credit enacted by the Affordable Care Act. Under the Affordable Care Act, some employees will be eligible for premium tax credits if the coverage provided by the employer does not provide “minimum value.” The rule spells out how to determine the value of coverage an employer must provide in order not to trigger the employer mandate penalty by proposing inputs that will be used to determine whether minimum value has been met.

The Center for Consumer Information and Insurance Oversight (CCIIO) issued a document explaining the role agents and brokers will play in the health insurance marketplaces. The guidance suggests that agents and brokers, including web brokers, will be a major source of marketplace assistance for individual consumers using the marketplaces.

On April 30, the Food and Drug Administration (FDA) eased requirements for purchase of Plan B emergency contraception. Those who are 15 years and older will not need a prescription to get this emergency contraception, which lowers the current age restriction by two years.

IN THE STATES

House Bill 818 passed through the Pennsylvania House by a vote of 144-53. The bill is designed to prevent health plans on Pennsylvania’s insurance exchange, when the law kicks in, from including abortion services. The bill reads, “No qualified health plan offered in this Commonwealth through the health insurance exchange shall include coverage for the performance of any abortion.” The Pennsylvania Senate will consider the bill soon.

On April 24, a Louisiana house health panel voted along party lines to defeat a measure that would expand the state’s Medicaid program. A parallel discussion took place in the state Senate Health and Welfare Committee. The senators moved to delay a vote on the bill because they would like to have a representative from the Department of Health and Hospitals answer questions first.

Legislation that would let optometrists, pharmacists and nurse practitioners perform medical tasks currently reserved for doctors passed through the California Senate Business, Professions and Economic Development Committee on April 29.

The dominant insurer in Maryland, CareFirst BlueCross BlueShield, says proposed premiums for new policies for individuals are going to rise by 25 percent on average next year.

IN THE COURTS

On May 2, a group of small business owners and self-employed individuals from six states filed a lawsuit against the federal government arguing that the IRS did not have the authority to impose an employer coverage requirement or the associated penalties in those states with a federally facilitated exchange. The lawsuit was filed in D.C. District Court.

IN THIRD PARTIES

A new study from the Brookings Institution, Bending the Curve, outlines reforms designed to reduce health care spending by improving care and promoting value-based payments.

Forty-two percent of those surveyed in a new Kaiser Family Foundation poll did not know that the Affordable Care Act continues to be the law. Some responded that it had been repealed by Congress; others said it was overturned by the Supreme Court.

A new study from The New England Journal of Medicine, The Oregon Experiment – Effects of Medicaid on Clinical Outcomes, received a lot of press attention this week. The study compares thousands of low-income people in Oregon receiving Medicaid with an identical population that did not. The study shows that those with Medicaid coverage spent more on health care, but were not, however, healthier. A 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided a unique opportunity for this randomized-controlled trial.

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To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., ACA, Articles, CCIIO, CHIP, CMS, HHS, Health Care Reform Implementation Updates, IRS, Medicaid

Health Care Reform Implementation Update - April 26, 2013

Posted on April 26, 2013 by Mark Alderman

Marilyn Tavenner received bipartisan support from members of the Senate Committee on Finance in her confirmation hearing to lead the Centers for Medicare and Medicaid Services (CMS) though a full Senate vote is being held up, the president released his FY 2014 budget proposal with health care reform and specified reimbursement reductions to providers and manufacturers totaling $400 billion over 10 years sprinkled throughout it, and Department of Health and Human Services (HHS) Secretary Sebelius received a warm welcome from the Senate Committee on Health, Education, Labor & Pensions but faced tough questions from members of the House Committee on Ways and Means and Senate Finance Committee Chair Max Baucus, who announced his retirement this week but called the secretary’s health reform implementation efforts a “train wreck.”

IN THE WHITE HOUSE
On April 10, the president released his FY 2014 budget proposal. As is always the case, the president’s budget is a non-binding proposal meant to serve as a guide for Congress to the president’s priorities. The budget would give HHS about $1.5 million for setting up marketplaces and helping consumers navigate them. It also would reduce growth in Medicare spending by $371 billion over the next decade. Changes to Medicare include requiring higher cost sharing for new Medicare beneficiaries, making wealthier seniors pay more of their Part B and D premiums, closing the doughnut hole by 2015 instead of 2020 as in the Affordable Care Act, and cutting payments to hospitals and other providers for bad debt and graduate medical education over the next 10 years. The budget also suggests delaying the planned reduction to hospitals in disproportionate share payments to offset the charity care they provide. The proposal would eliminate the Center for Disease Control and Prevention’s Preventive Health and Health Services Block Grant Program, and expand and simplify the tax credits provided to small businesses for their non-elective contributions to employee health insurance. The budget requests $305 million for the IRS to pay for IT to implement the health law – in total, the plan calls for about $440 million and nearly 2,000 more workers to implement the law.

AT THE AGENCIES
On April 9, the Senate Finance Committee held a confirmation hearing for President Obama’s nominee to lead CMS, Marilyn Tavenner. Tavenner has been the CMS acting administrator on an interim basis for over a year. It has been about six years since the Finance Committee last held a confirmation hearing for a CMS administrator. Tavenner is expected to be confirmed. Sen. Orrin Hatch, the ranking Republican on the Senate Finance Committee, said he supports Tavenner’s nomination. House Majority Leader Eric Cantor introduced Tavenner and expressed strong support in his introduction. Tavenner said she would run the agency as a business. On April 23, the Senate Finance Committee voted to approve Tavenner’s nomination. Then on April 24, Sen. Harkin delayed Tavenner’s full vote in response to CMS’s use of the public health and prevention money for ACA implementation. We do not expect this to be a permanent problem for Tavenner and expect her to be confirmed in the near future.

On April 8, CMS issued a pair of proposed rules that would extend the safe harbor exception for donated electronic health records systems from December 31, 2013 to December 31, 2016, when the Medicare meaningful use incentive program also ends.

ON THE HILL
On April 24, bipartisan members of the Senate Committee on Finance released an analysis outlining a comprehensive overview of the policy and legislative recommendations received from 146 stakeholders in the health care community on ways to improve federal efforts to combat waste, fraud, and abuse in the Medicare and Medicaid programs.

On April 12, Sec. Sebelius testified at a hearing before the House Ways and Means Committee on the president’s budget. She told the committee that the federally run insurance exchange would be up and running by October 1. Sec. Sebelius explained that the exchange data hub was “basically built and paid for” but also that implementation funding was still a challenge. Though many expect House Republicans will be unwilling to provide additional funding for reform implementation, members of the committee did not explicitly say so at the hearing.

On April 17, Secretary Sebelius testified before the Senate Committee on Finance. Chairman Max Baucus questioned the law’s implementation and said he “see[s] a huge train wreck coming down.” Sen. Baucus was a key architect of the Affordable Care Act. Then on April 23, Sen. Baucus announced that he would not seek reelection in 2014.

House Republicans were pushing H.R. 1549, The Helping Sick Americans Now Act, which would divert money from the ACA's Prevention and Public Health Fund to fund the Pre-Existing Condition Insurance Plan through the remainder of the year. In February, HHS had announced it was suspending enrollment because its $5 billion appropriations were depleted. The House canceled a vote on the bill on April 24, when it became clear there were not enough votes.

On April 24, CMS Center for Consumer Information and Insurance Oversight (CCIIO) Director Gary Cohen testified before the House Energy and Commerce oversight subcommittee. House Republicans expressed deep concern to Cohen that the health insurance exchanges would not be ready in time for open enrollment, and Cohen assured them that HHS was on schedule.

IN THE STATES
Five states were awarded $275.6 million from the Obama administration to continue building health insurance exchanges. Hawaii received $128.1 million, Illinois received 115.8 million, Arkansas received $16.5 million, New Hampshire received $5.4 million and Rhode Island received $9.8 million.

On April 18, the Ohio House of Representatives passed its budget in House Bill 59 without Governor Kasich's proposed Medicaid expansion. The House is calling for a separate debate on this issue and the budget includes an amendment that will make it possible to revisit the issue.

On April 16, the Arkansas House voted 77-23 to approve an appropriation bill that plans on Medicaid expansion in the state, and on April 17 the Arkansas Senate approved a "private option" Medicaid expansion as well, 28-7. Unlike traditional Medicaid or the expanded Medicaid originally envisioned by the ACA's drafters, the Medicaid expansion proposed in Arkansas would use federal Medicaid dollars to buy private coverage in insurance exchanges. On April 23, Arkansas Gov. Mike Beebe signed the plan into law. The Obama administration has agreed to the plan in principle but has not yet given final approval. Arkansas officials will travel to Washington soon to present the plan.

On April 16, North Dakota Governor Jack Dalrymple(R) signed legislation to expand Medicaid in the state. The expansion is expected to grow the program from covering about 65,000 a month to 85,000 a month.

On April 16, the Iowa Senate Ways and Means Committee advanced a bill that would extend a state tax break to small businesses that cover their employee's health care costs.

IN THIRD PARTIES
A new study by the Kaiser Family Foundation predicts that by 2019, annual health care cost growth will be over 7 percent, compared to the 3.9 percent between 2009 and 2011. The study attributes most of this disparity to the poor economy, but suggested that structural changes in the health care system may be playing a role as well.

A new study from Families USA says that almost 26 million individuals will be eligible for tax credits through the ACA to help them purchase health insurance in marketplaces.

On Friday (4/19), Alan Simpson and Erskine Bowles, who lead President Obama's 2010 National Commission on Fiscal Responsibility and Reform, released a new deficit reduction proposal. The plan aims to cut the deficit by a total of $5.2 trillion over 10 years. The proposal is similar to the original Simpson-Bowles plan but more modest. It would cut deficits by $2.5 trillion.

The Bipartisan Policy Center issued a report on health care cost containment with recommendations for the next phase of health reform. The plan suggests over 50 recommendations, which would cut the federal deficit by about $560 billion over the next 10 years.

Tags: Washington, D.C., ACA, Articles, Budget, CMS, HHS, Health Care Reform Implementation Updates, Medicaid expansion, Medicare, Medicare Advantage

Health Care Reform Implementation Update - April 12, 2013

Posted on April 12, 2013 by Mark Alderman

While Congress was in recess, the Centers for Medicare and Medicaid Services (CMS) surprised many when it changed course on Medicare Advantage payment rates – switching from a 2.3 percent reduction to a 3.3 percent increase, the Department of Health and Human Services (HHS) announced a one-year delay for the small business health options program exchange to offer multiple health plans, and HHS released a final rule detailing the expanded Medicaid program and confirming that the federal government would cover 100 percent of the expenses for newly eligible Medicaid beneficiaries.

AT THE AGENCIES

On Monday (4/1), CMS surprised many when it announced that it would change the 2.3 percent cut to Medicare Advantage rates to a 3.3 percent increase. Prior to the news, health insurers were predicting painful changes for Medicare Advantage customers. The initial rates included in the proposed regulation assumed that there would be significant cuts in physician payments, and in turn lower Medicare costs, because of the Sustainable Growth Rate. The switch follows a report from the Congressional Research Service, which said CMS could assume that Congress would avoid major cuts to Medicare physician reimbursements at the end of the year, and letters from Senate Finance Committee Chairman Max Baucus, Ranking Member Orrin Hatch and 98 House members to CMS expressing concern about the proposed rates.

On Wednesday (4/3), CMS released a proposed rule that outlines standards for navigators in federally facilitated and state partnership markets. Navigators will help educate consumers on available health coverage options and will assist them in shopping for health insurance.

On Tuesday (4/2), CMS published an update to the clinical quality measures for hospitals participating in the meaningful use program for electronic health records (EHRs). Prior to the update, hospitals were required to use EHR systems that met the clinical quality measure specifications of the December 2012 interim final rule. Now, however, CMS is encouraging the use of updated clinical quality measures.

HHS announced a one-year delay to a requirement of the small business health options program (SHOP) exchange this week. Though small businesses were supposed to be able to choose from multiple health plans through insurance exchanges beginning in 2014, HHS granted an extra year for the requirement to offer multiple plans on SHOP exchanges.

On Friday (3/29), HHS released a final rule describing the methodology states will use for claiming a higher match rate for newly eligible Medicaid beneficiaries. The regulation implements the ACA provision that authorizes states to expand Medicaid to adults under 65 with incomes up to 135 percent of the federal poverty level. The federal government will cover the full cost of newly eligible beneficiaries for the next three years, and afterward the federal contribution will gradually be phased down to 90 percent by 2020.

The National Association of Insurance Commissioners had its annual spring meeting on Friday (4/5). At the meeting, a draft paper titled "Rate Increase Mitigation Strategies" was presented. The paper addresses the "rate shock" that may be caused by the ACA.

ON THE HILL

On Thursday (4/4), Sen. Chuck Grassley (R-Iowa) sent a letter pressing CMS for information about how a Wall Street analyst was able to learn about the Medicare Advantage rates in advance of CMS’s official announcement.

On Friday (4/5), Reps. Joe Pitts (R-Pa.) and Michael Burgess (R-Texas) of the House Ways and Means Subcommittee on Health released a press release offering suggestions for making health reform more affordable. Suggestions offered in the release include creating a premium increase safety valve, allowing state coverage compacts, giving Americans coverage options like those of members of Congress, ensuring consumers who like their insurance can keep it, prioritizing coverage for Americans with pre-existing conditions over wasteful spending, and replacing price controls with market-based solutions and incentives.

IN THE STATES

Vermont posted its partnership plan proposals this week, listing the prices residents can expect for health insurance coverage in 2014. The Vermont Department of Financial Regulation posted a summary sheet that compares what Blue Cross Blue Shield Vermont and MVP Health Care – two carriers that have filed proposed rates with the department – might charge for coverage for singles, couples, single parents with children, and couples with children.

An amendment to a bill that lays out health care exchanges passed the Virginia House and Senate. The amendment bars health insurance plans sold through a federal exchange from covering most abortions.

Pennsylvania Gov. Tom Corbett met with Sec. Sebelius on Tuesday (4/2) to discuss Medicaid expansion. Neither HHS nor Gov. Corbett publicly reported any developments after the meeting. Gov. Corbett said the meeting was “meaningful,” that he asked the secretary for answers to key questions and that he is still considering the options for Pennsylvania.

On Friday (4/5), Center for Consumer Information & Insurance Oversight (CCIIO) Director Gary Cohen sent Massachusetts a letter granting it permission to phase in certain rules Massachusetts business leaders had argued would have led to rate shock in 2014. Massachusetts will be permitted to phase out certain rating standards such as age, smoking status and wellness.

IN THE COURTS

On Thursday (4/4), the Department of Justice filed a brief in the 4^th Circuit Court of Appeals arguing that the Anti-Injunction Act prevents the court from hearing the case of Liberty University, which continues to challenge the ACA’s employer mandate and argues that the reform law provided federal funding for abortions.

Federal Judge Edward Korman ruled on Friday (4/5) that the most common morning after pill be made available over the counter for all ages, rather than requiring a prescription for girls 16 and younger. The Food and Drug Administration has recommended this type of unrestricted access for years, however both President Obama and Sec. Sebelius have supported restricting over the counter access to morning after pills for those younger than 17.

Tags: Washington, D.C., ACA, Articles, CMS, HHS, Health Care Reform Implementation Updates, Medicaid, Medicaid expansion, Medicare Advantage

Health Care Reform Implementation Update - March 26, 2013

Posted on March 26, 2013 by Mark Alderman

Last week, as the Affordable Care Act turned three, the drumbeat of concern over Medicare Advantage cuts grew louder when Senate Finance Committee Chairman Max Baucus and Ranking Member Orrin Hatch – as well as 98 house members – wrote to the Centers for Medicare and Medicaid Services (CMS) expressing concern about rates for Medicare Advantage plans, MedPAC released its March report to Congress, the House and Senate passed a continuing resolution to fund the government through September 2013 at current law levels including sequestration, and the House and Senate each passed a 2014 budget.

ON THE HILL

Rep. Paul Ryan's (R-Wis.) budget passed the House of Representatives on Thursday (3/21). No Democrats voted for the plan. The bill would balance the budget in 10 years by cutting domestic spending and reforming Medicare. The budget would reform Medicare starting in 2024 by giving seniors a choice between traditional Medicare coverage or a private plan with similar benefits. The House budget would also convert Medicaid into a block grant program such that states would receive a lump sum for their programs instead of the open-ended federal medical assistance percentages they now receive. Though the budget does not eliminate the entire Affordable Care Act, it does assume that Congress would eliminate the parts of the Affordable Care Act that subsidize insurance coverage for the uninsured.

On Saturday (3/23) just before 5:00 a.m., the Senate passed its first budget in four years, with no Republicans voting for it and four Democrats voting against it. The four Democrats, all of whom are up for re-election in 2014, were Mark Pryor (Ark.), Kay Hagan (N.C.), Mark Begich (Alaska) and Max Baucus (Mont.). The Senate budget would boost infrastructure spending by $100 billion to bolster the economy and raise taxes to bring $975 billion over 10 years into the government. The budget trims spending modestly and includes an expedited track for passing tax increases. The Senate budget includes health care cuts as well – accelerating payment reforms that tie provider reimbursement to patient outcomes, reducing waste and fraud, and encouraging greater provider engagement.

The drumbeat of concern over Medicare Advantage cuts grew louder on (3/15) when Senate Finance Committee Chairman Max Baucus and Ranking Member Orrin Hatch sent a letter to CMS Acting Administrator Tavenner raising concerns about the proposed Medicare Advantage cuts and 98 bipartisan House members sent a separate letter to Tavenner, also requesting changes to the Medicare Advantage rates. These rates are expected to be finalized by April 1, 2013.

The Director of CMS’s Center for Medicare and Medicaid Innovation (CMMI), Dr. Richard Gilfillan, testified before the Senate Finance Committee on Wednesday (3/20). At the hearing, Dr. Gilfillan said the results of the Pioneer Accountable Care Organization demonstration will be available this summer. Dr. Gilfillan also said that CMMI was currently analyzing data from the multi-payer advanced primary care practice and federally qualified health center advanced primary care practice demonstrations.

Last week, the House and Senate approved a continuing resolution to prevent a government shutdown and keep agencies funded through the end of the fiscal year and sent it to the White House to be signed into law.

AT THE AGENCIES

Health and Human Services (HHS) Sec. Sebelius announced that the third anniversary of the Affordable Care Act saw more than 6.3 million Medicare beneficiaries save over 6.1 billion on prescription drugs, and 71 million Americans in private health insurance plans receive coverage for at least one free preventive health care service.

On Monday (3/18), the Departments of Health and Human Services, Labor and Treasury issued a proposed rule under the Affordable Care Act that prohibits health plans from imposing waiting periods over 90 days on enrollees before coverage begins.

On Friday (3/15), the Medicare Payment Advisory Commission (MedPAC) released its March report to Congress. In the past, the commission’s recommendations have formed the basis for payment changes later in the year.

IN THE STATES

The Colorado state exchange board approved a 1.4 percent fee on all health policies sold through the state’s health exchange. The revenue would be used to fund the exchange after federal backing runs out. The board expects the exchange to cost between $22 and $24 million per year to run.

On Saturday (3/23), the Maryland House of Delegates gave initial approval to a measure that would expand Medicaid eligibility to 133 percent of the federal poverty line and create a funding mechanism for the state's health marketplace. The funds will come from an existing state-regulated 2 percent tax on insurance plans.

On Thursday (3/21), the Michigan State Senate Health Policy Committee approved a bill that would allow health care providers and institutions to refuse to provide service on moral, religious or conscientious grounds. This bill already passed the state Senate in December.

IN THE COURTS

Tom Monaghan and his company, Domino's Farm Corp., sued the federal government in December 2012, arguing that complying with the Affordable Care Act’s mandate requiring employee insurance plans to provide coverage for contraception violated his legal rights. On March 15, U.S. District Judge Lawrence P. Zatkoff found that the company and Monaghan could be irreparably harmed if the mandate was enforced while the lawsuit is pending and issued a preliminary injunction.

IN THIRD PARTIES

This month's tracking poll from the Kaiser Family Foundation shows that the public is more confused about the Affordable Care Act than ever, in particular about items that are or are not part of reform.

The Health Care Incentive Improvement Institute issued a report card evaluating states on the requirements state laws put on hospitals and providers for transparency in health care costs. The report gave 29 states failing marks and seven a D. Two states, Massachusetts and New Hampshire, received an A.

Tags: Washington, D.C., ACA, Affordable Care Act, Articles, CMMI, CMS, HHS, Health Care Reform Implementation Updates, MedPAC, Medicare Advantage

Health Care Reform Implementation Update - March 14, 2013

Posted on March 14, 2013 by Mark Alderman

Last week, the Department of Health and Human Services (HHS) conditionally approved state partnership marketplaces in Iowa, Michigan, New Hampshire and West Virginia; Accountable Care Organizations wrote to the Centers for Medicare & Medicaid Services (CMS) arguing that the quality targets set by the Center for Medicare & Medicaid Innovation (CMMI) were arbitrary; and legislation implementing Medicaid expansion in Florida struggled to get through the state legislature.

ON THE HILL

On Wednesday (3/6), the Republican controlled House of Representatives passed a continuing resolution that would fund the government through the end of the fiscal year. The measure allows the Food and Drug Administration (FDA) to fully collect medical device and generic drug user fees. Senator Ted Cruz (R-Texas) is planning to offer an amendment to the legislation that would delay funding of the ACA.

Senators Alexander and Corker are pushing S.11, the Fiscal Sustainability Act, which would save an estimated $689 billion in health savings over 10 years and reform Medicaid and means-test Medicare.

AT THE AGENCIES

In response to CMMI’s quality metrics for ACOs, which are the targets pioneer Accountable Care Organizations (ACOs) have to meet in order to receive bonus payments in 2013, many of the ACOs wrote to CMS arguing that at least 19 of the targets were arbitrary or unreasonable due to a lack of data to support them. The Pioneer ACOs received payments in 2012 for reporting on the 33 metrics. In 2013 though, the ACOs will be paid for performance, not just reporting.

IN THE STATES

HHS conditionally approved state partnership marketplaces in Iowa, Michigan, New Hampshire and West Virginia. The partnership marketplaces (formerly exchanges) will allow these states to control various marketplace components, while the federal government runs others. Seven states have now been approved for partnership marketplaces.

On Thursday (3/7), the Minnesota Senate approved a bill implementing the state health insurance marketplace. A companion bill passed in the House on Monday (3/4). Unlike the House bill, which would fund the exchanges’ operating costs with a tax on exchange premiums up to 3.5 percent, the Senate bill would fund it by diverting money from an existing 75-cent state fee on a pack of cigarettes.

On Monday (3/4), the Florida House of Representatives signaled it does not plan to go along with Gov. Rick Scott's turnaround on Medicaid. On Monday, the House Select Committee on the Patient Protection and Affordable Care Act expressed substantial doubts that the federal promises for Medicaid funding assistance could be relied on long term.

On Tuesday (3/5), hundreds of protesters marched in Austin to protest Texas Governor Rick Perry's decision not to support Medicaid expansion in his state.

IN THIRD PARTIES

In health care industry heavy Massachusetts, the Retail Association of Massachusetts and the South Shore Chamber of Commerce are urging the White House to reconsider its proposed rule on rate review, which prevents health plans from denying coverage or setting rates based on certain factors. The Massachusetts groups argue that holding small businesses to the same rating standards as large businesses is discriminatory. Specifically, the group’s request that nothing in the rule should be construed to preclude a state from allowing health insurance carriers to offer additional discounts and incentives if approved by the state insurance regulator.

The Urban Institute argues in a new paper that the government could save close to $90 billion over 10 years if it allowed 65 and 66-year olds to buy into Medicare if they choose to, but asking middle and high income earners to share more of the cost.

Tags: Washington, D.C., ACA, ACO, Articles, CMMI, CMS, FDA, HHS, Health Care Reform Implementation Updates, Medicaid, Medicaid expansion, Medicare

Health Care Reform Implementation Update - February 27, 2013

Posted on February 27, 2013 by Mark Alderman

As Washington and the rest of the country brace for cuts from the sequester to kick in on March 1, Florida Gov. Rick Scott surprised many and confirmed others' predictions by announcing his state will expand its Medical program, and the Department of Health and Human Services (HHS) issued long-awaited final rules on essential health benefits, as well as pre-existing conditions and premium rate bands.

AT THE AGENCIES
On Friday (2/22), HHS released final rules implementing the provisions of the Affordable Care Act (ACA) that require insurers to cover those with pre-existing conditions without charging higher prices.

Friday’s final rules also crystalize regulations on how insurers may set their premiums. Under the ACA, only certain, very limited criteria may be used to set premiums. With respect to age, the law says plans can only charge older patients three times more than younger ones, even though older patients are notoriously much more expensive to treat than younger ones. Though many interest groups fought this provision when it was included in the proposed rule, it nonetheless remains in the final rule. America’s Health Insurance Plans (AHIP) says this outcome will cause insurance for young people to spike “overnight.” The rules do ensure young adults will have access to a catastrophic coverage plan, which will offer lower premiums and less generous coverage for those who do not seek much health care outside of an emergency situation.

On Wednesday (2/20), HHS issued a long-awaited final rule on essential health benefits (EHB). The final rule outlines the standards for essential health benefits that insurers must cover in and out of health insurance marketplaces beginning in 2014. Insurers must cover 10 broad care categories, which include emergency services, maternity care, mental health and substance abuse services, and preventive and wellness services. As in the proposed rule, individual and small group plans for 2014 and 2015 must cover at least one drug in every therapeutic category and class or the same number of prescription drugs in each category and class as the state's EHB benchmark plan, whichever is greater. Many states require at least two drugs per class.

The final regulation does not differ much from the proposed regulation. One change uncovered by the American Cancer Society Cancer Action Network concerns colonoscopies. Under both the proposed and final regulations, colonoscopies are deemed a preventive service that insurers have to cover without copayment. What was previously unsettled, however, was whether if a doctor discovered a polyp and removed it during the procedure, whether this too would be included. The final regulation says insurance companies cannot charge patients for the removal of a polyp during a recommended colonoscopy.

The Medicaid and CHIP Payment and Access Commission (MACPAC) named Anne L. Schwartz, PH.D., as its new executive director. Schwartz has been the acting executive director for the past four months.

On Thursday (2/21), the Center for Medicare and Medicaid Innovation announced that it is awarding $300 million to 25 states through the State Innovation Models Initiative, which supports the development and testing of state-based models for multipayer payment and health care delivery system transformation to improve health system performance. Six states will receive awards for Model Testing, three for Model Pre-Testing, and 16 for Model Design. Of the $300 million, more than $250 million will go to Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont.

IN THE STATES
Friday (2/15) was officially the last day for states to report to the federal government that they wanted to participate in running health insurance marketplaces in their states in partnership with the federal government. The federal government will be running more than half – 26 – of the state’s health insurance marketplaces.

Florida Gov. Rick Scott, a Republican and leading critic of the Affordable Care Act, announced on Wednesday (2/20) that his state would expand Medicaid coverage. A day after Gov. Scott’s announcement, Sec. Sebelius said that states are opting to expand Medicaid because the offer is “simply too good to pass up.”

On Tuesday (2/19), Oklahoma State Representative Mike Ritze (R) introduced legislation that would declare the Affordable Care Act unconstitutional and void in the state. Ritze's motivation is the law’s mandate that requires employers to provide birth control coverage in health insurance plans. The legislation was approved 7-3 by the House Public Health Committee.

ON THE HILL
Still no deal on the Hill to prevent the sequester, set to begin March 1. Medicaid is protected from the cuts, but Medicare spending will be cut by 2 percent through reductions in payments to hospitals, physicians and other care providers. Additionally, according to the Congressional Budget Office (CBO), other health-related programs like medical research, mental health treatment and approvals for new drugs are subject to 5 percent or more in cuts.

IN THIRD PARTIES
On Thursday (2/21), 17 major medical specialty groups recommended that doctors reduce their use of 90 widely used unnecessary tests and treatments. The list includes recommendations not to induce labor or perform a Cesarean section before a woman’s 39th week of pregnancy unless it is medically necessary, not to automatically use CT scans to examine children’s minor head injuries, and to avoid routine preoperative testing for low-risk surgeries without a clinical indication.

On Thursday (2/21), Time Magazine ran the longest article by one writer the magazine has ever published, "Bitter Pill: Why Medical Bills are Killing Us." The cover story provides in-depth discussion of the country’s high medical costs and the major problems hospitals, insurance companies and the pharmaceutical industry are facing.

Tags: Washington, D.C., ACA, Affordable Care Act, Articles, HHS, Health Care Reform Implementation Updates, Medicaid, Medicaid expansion, Medicare, sequestration

Health Care Reform Implementation Update - February 19, 2013

Posted on February 19, 2013 by Mark Alderman

Last week another marketplace deadline came and went, Illinois became the 21st state approved to operate a health insurance marketplace, and U.S. senators pressed the HHS official responsible for the bulk of exchange implementation for information.

AT THE AGENCIES

On Friday (2/15), the Obama administration said the state-based high-risk pools from the ACA will close to new applicants in the next few days or weeks as funding is beginning to run low. The 100,000 or so people who are already enrolled in these pools will not, however, be affected.

On Friday (2/15), CMS issued its annual projection of Medicare Advantage and Part D premiums and rates for calendar year 2014. CMS said that for the first time since the Part D program began, the standard Part D deductible will go down from $325 in 2013 to $310 in 2014, and cost- sharing amounts will also be lower. Comments are due on March 1.

CMS also issued a proposed rule that would implement medical loss ratio requirements for the Medicare Advantage Program and Medicare Prescription Drug Benefit Program under the ACA.

On Friday (2/8), the Obama administration released details on some of the nonmilitary cuts that will take effect due to sequestration from the Budget Control Act of 2011. Among other things, the cuts would result in the loss of 12,000 research positions funded by National Institutes of Health grants and the end of treatment for 373,000 individuals with mental illness.

IN THE STATES

Technically, the deadline to apply for a state-federal partnership exchange/marketplace was Friday 2/15. HHS has shown, however, that it is willing to be flexible on deadlines in return for state participation in implementing health reform.

Long-awaited decisions on three state exchanges came on Friday (2/15). Govs. Chris Christie of New Jersey, Rick Scott of Florida, and Bill Haslam of Tennessee said they would not embrace partnership models for their exchanges. Because the states also are not choosing to run their own exchanges, they will default to federally run exchanges.

On Wednesday (2/13), New Hampshire Governor Maggie Hassan officially applied for a partnership exchange in a letter to HHS Sec. Sebelius.

On Wednesday (2/13), Wisconsin Gov. Scott Walker announced he will not propose expanding Medicaid in his state, and instead proposed tightening income eligibility for Medicaid, lifting a cap on a program that covers childless adults, and forcing more people to buy insurance through a government-run marketplace in order to cover the state’s low-income uninsured population. The plan outlined by Walker would cover non-disabled adults up to 100 percent of the federal poverty level, down from its current 200 percent federal poverty level limit for state assistance, and allow those above 100 percent to purchase coverage through the exchanges.

On Wednesday (2/13), Illinois became the 21st state (including the District of Columbia) to be approved to operate a health insurance exchange, with enrollment to begin in October 2013. Illinois’ exchange will be a partnership marketplace.

On Wednesday (2/13), the Georgia House passed House Bill 198 that would require health insurance navigators to be licensed in order to help uninsured Georgians and businesses use the health insurance exchange.

North Carolina Gov. Pat McCrory said on Tuesday (2/12) that the Medicaid program in his state is too troubled to expand, and he does not want to play a part in implementation of an insurance exchange in his state. On Wednesday (2/13), the state House gave tentative approval to legislation blocking the expansion of Medicaid and the development of a health insurance exchange.

ON THE HILL

On Thursday (2/14), Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services, testified before the Senate Finance Committee. Cohen said HHS is making great progress and will be ready for people across the country to obtain high-quality affordable health care coverage beginning on October 1. Sen. Orin Hatch (R-Utah) argued that the health insurance exchanges required by the ACA are going to increase health care costs. Sen. Bill Nelson (D-Fla.) pushed Cohen for information about why funding for co-ops under the ACA was eliminated in the tax compromise. Sen. Maria Cantwell (D-Wash.) questioned Cohen on the delay to implementation of the Basic Health Program, which would have enabled states to offer government insurance to people who did not qualify for Medicaid but who would still have had a difficult time affording premiums and cost sharing in the exchange. Sen. Ron Wyden (D-Ore.) expressed disappointment that the administration had not extended the law’s definition of “affordable” coverage to family plans.

In an effort to shelter health care programs, Food and Drug Administration (FDA) funding, and several other items from the sequester, set to kick in on March 1, Senate Democrats crafted a proposal, the American Family Economic Protection Act, which includes a combination of revenue increases and equally split cuts to defense and non-defense discretionary spending. Republicans criticized the proposal, especially for the increases in taxes it requires.

On Friday (2/15), Reps. Charles Boustany (R-La.) and Jim Matheson (D-Utah) reintroduced a bill to repeal the health insurance tax in the Affordable Care Act. The Congressional Budget Office (CBO) valued the tax at $100 billion over 10 years. Boustany also sponsored the bill in the last Congress and gathered 226 cosponsors. The bill, however, never came up for a vote.

IN THIRD PARTIES

About 50 leading conservative voices signed on to a memo calling for Congress to defund the Affordable Care Act in the next continuing resolution.

Tags: Washington, D.C., ACA, Articles, CMS, Health Care Reform Implementation Updates, Medicaid, Medicaid expansion, exchange, sequestration

Health Care Reform Implementation Update - January 23, 2013

Posted on January 23, 2013 by Mark Alderman

In the past week, the health insurance exchanges were rebranded as “health insurance marketplaces;” HHS extended the deadline for states to opt into administering their own marketplaces and announced $1.5 billion in new grants to states for building them; and CMS released a proposed rule that details eligibility standards for marketplaces, Medicaid and CHIP.

AT THE AGENCIES

On Monday (1/14), Sec. Sebelius announced that the deadline for states to opt into administering marketplaces (exchanges) under the Affordable Care Act would be waived or extended. The administration said it is trying to encourage states to share the responsibilities of running the marketplaces, supervising health plans and assisting consumers.

CMS released a proposed rule on Monday (1/14) that provides further detail on state marketplaces, Medicaid and the Children's Health Insurance Programs (CHIP). Sec. Sebelius said the rule is intended to “give states more flexibility to implement the law in a way that works for them.” The rule details options for coordinating Medicaid, CHIP and marketplace communications regarding eligibility to consumers.

On Thursday (1/17), HHS announced $1.5 billion in new grants to states building insurance exchange marketplaces under the Affordable Care Act. The states that received funding are California, Delaware, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon and Vermont.

CMS announced that physicians who were excluded from the meaningful use program because of the way they process Medicare claims (assigning reimbursement and billing to critical access hospitals) are now eligible to participate in the electronic health record meaningful use program.

On Thursday (1/17), the HIPAA omnibus rule was posted on the Federal Register public inspection desk. The package substantially modifies HIPAA privacy, security and enforcement rules and increases penalties for noncompliance. The final rule will be effective in March 2013.

On Wednesday (1/16), HHS kicked off an effort to raise awareness of the individual mandate with a website relaunch and a switch in the name of health insurance exchanges to health insurance marketplaces.

IN THIRD PARTIES

A coalition of 21 hospital associations sent a letter to the White House asking it to help fight a provision of the Affordable Care Act. The provision at issue allows hospitals in Massachusetts to dramatically boost their Medicare payments at the expense of other states. In their letter, the hospital associations argue that “scarce Medicare funding should reward value and efficiency in healthcare, not be diverted based on manipulation of obscure payment formulas.”

On Tuesday (1/15), the new nonprofit coalition, Enroll America, launched and announced its campaign to ensure that those who are eligible sign up for new insurance under the Affordable Care Act. Enroll America is an outgrowth of various Affordable Care Act support groups, especially Families USA.

IN THE COURTS

On Tuesday (1/15), HHS and other named agencies appealed the preliminary injunction that was granted by U.S. District Judge Reggie Walton, to Tyndale House Publishers, a Christian publishing company, in November. Tyndale does not want to provide its employees with contraceptives as required by the Affordable Care Act.

Tags: Washington, D.C., ACA, Affordable Care Act, Articles, CHIP, CMS, Children's Health Insurance Programs, HHS, HIPAA, Health Care Reform Implementation Updates, Medicaid, health insurance marketplaces

Health Care Reform Implementation Update - January 14, 2013

Posted on January 14, 2013 by Mark Alderman

The Obama administration gave eight more states conditional approval to operate health insurance exchanges, bringing the total number of fully or partially approved exchanges to 20; HHS approved 106 new accountable care organizations; and Congress reached a deal on the fiscal cliff that includes a “doc fix,” cuts the Community Living Assistance Services and Supports Program (CLASS), and slashes funds for the Consumer Operated and Oriented Plan program (CO-OP).

IN THE STATES

On Monday (1/7), Florida Gov. Rick Scott met with HHS Sec. Sebelius to discuss whether Florida will assist with the implementation of the state exchange and expand its Medicaid program in accordance with the Affordable Care Act. Gov. Scott is concerned about expanding the state’s Medicaid program, which already consumes close to 30 percent of the state’s budget, because he knows the expansion would be difficult or impossible to reverse and fears that the state portion of spending will grow over time. Scott said, "Growing government is never free." Prior to Scott’s meeting with Sec. Sebelius, however, Scott projected health reform could cost state taxpayers $26 billion, and after the meeting his administration released new cost estimates of $3 billion.

On Friday (1/4), Montana Governor-elect Steve Bullock unveiled state budget changes. Bullock intends to keep the proposed expansion of Medicaid under the ACA intact.

In response to Utah’s request from mid-December that the federal government allow Utah to run its own exchange by utilizing its already-existing exchange, the Obama administration gave conditional approval but said it would have to go beyond the services already offered.

On Thursday (1/3), Gov. John Hickenlooper announced a plan that would expand Medicaid in Colorado in accordance with the Affordable Care Act. The governor said that expansion would cost Colorado about $128 million over 10 years, however, his administration has identified more than $280 million in cuts and savings to the Medicare program to cover the change.

New Mexico Gov. Susan Martinez, who is a Republican, said the state will act in accordance with the Affordable Care Act and expand its Medicaid program.

According to the state budget California Gov. Jerry Brown released Thursday (1/10), it would cost California $350 million to participate in Medicaid expansion under the Affordable Care Act. These projected costs result largely from “the woodwork effect,” the increase in program participation from those individuals who were already eligible.

Former CMS Administrator Don Berwick said Tuesday (1/8) he is considering running for governor of Massachusetts in 2014.

ON THE HILL

On Tuesday (1/1), the House of Representatives approved the Senate’s last-minute fiscal cliff package. The deal includes a one-year doc fix, which prevents the 27 percent cut to physician Medicare payments. Such “doc-fixes” have been made every year since 2003. Physicians are happy the cuts will not go into effect this year but are disappointed the fix did not go beyond the usual one-year patch. Hospitals are less happy – the doc fix was paid for, in part, by cutting $15 billion in Medicare and Medicaid payments to hospitals over the next 10 years.

Additionally, the CLASS Act, which was intended to provide long-term care insurance, was eliminated. The executive branch had already said it would not proceed in implementing the CLASS Act because it was financially unsustainable.

Another loser in the fiscal cliff deal was the Affordable Care Act’s Consumer Operated and Oriented Plans (CO-OPs). Though the federal government has already awarded more than $2 billion in CO-OP loans, no state-level CO-OP is fully funded or operational yet.

On Thursday (1/10), President Obama signed the Strengthening Medicare and Repaying Taxpayers (SMART) Act into law, which changes the way Medicare collects money from those whose negligence caused a patient to incur medical bills.

AT THE AGENCIES

HHS issued a split decision on Governor Paul LePage's request for the state of Maine to eliminate health insurance for about 37,000 Medicaid recipients to account for the $20 million budget gap the state faces. The Obama administration partially approved Maine's request and allowed it to eliminate coverage for 12,592 working parents with earnings between 133 and 200 percent of the federal poverty level.

On Thursday (1/3), HHS gave eight more states conditional approval to operate the health care exchanges they laid out in blueprints to the federal government. The approved exchanges include the state-based exchanges of California, Hawaii, Idaho, Nevada, New Mexico, Vermont and Utah, and the partnership exchange of Arkansas. This brings the total number of states approved to fully or partially operate their exchanges to 20, 18 state-based and two partnership exchanges.

HHS approved 106 new accountable care organizations under the Affordable Care Act. According to an HHS press release, the new ACOs will benefit 4 million Medicare beneficiaries.

On Thursday (1/10), HHS issued a new report showing that Medicare’s costs are rising at an historically low rate while seniors receive more benefits.

On Wednesday (1/9), a White House official said that Kathleen Sebelius will remain the Secretary of HHS.

Tags: Washington, D.C., ACA, ACO, Articles, HHS, Health Care Reform Implementation Updates, Medicaid, Medicaid expansion, doc fix

Health Care Reform Implementation Update - December 27, 2012

Posted on December 27, 2012 by Mark Alderman

The extended deadline for states to submit plans to run their own insurance exchanges is now behind us. A total of 18 states submitted blueprints to run their own exchanges. The 32 remaining states have until February 15, 2013 to indicate they want to set up a partnership exchange. The states that do not submit partnership applications will have federal exchanges. HHS has now conditionally approved 11 states and the District of Columbia to run their own exchanges. Meanwhile, health care providers wait at the edge of their seats to see if the fiscal cliff talks will include a “doc-fix” to avoid the 26.5 percent cut to Medicare claims starting January 1, 2013.

IN THE STATES

The deadline for states planning to run their own health insurance marketplaces come 2014 was Friday December 14, 2012. A total of 18 states said they will plan their own exchanges. The states that submitted new blueprint applications the week of the extended deadline are California, Hawaii, Idaho, Minnesota, Mississippi, Nevada, New Mexico, Rhode Island, Vermont and Utah. Some states submitted prior to the Friday deadline, and on Friday, the government conditionally approved those of the District of Columbia, Kentucky and New York. Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington had already been approved. The 32 remaining states have until February 15, 2013 to indicate they want to set up a partnership exchange.

On Friday (12/14), Iowa Governor Branstad announced Iowa would enter into a partnership with the federal government on its health care exchange.

On Wednesday (12/12), Ohio announced it secured federal approval to participate in CMS’ State Demonstrations to Integrate Care for Dual Eligible Individuals. Ohio is the third state to be approved by CMS for the demonstration project, following Massachusetts and Washington.

On Tuesday (12/11), Utah Gov. Gary Herbert sent a letter asking the Obama administration to approve the health insurance exchange already in place in Utah.

ON THE HILL

As part of the fiscal cliff negotiations, the White House has called for a permanent fix to the sustainable growth rate as well as $400 billion in health care cuts. Rep. Phil Gingrey (R-Ga.), who serves as co-chairman of the GOP Doctors Caucus said he believes there will be some physician payment fix in fiscal cliff negotiations, likely a one-year fix.

On Thursday (12/13), House Minority Leader Nancy Pelosi (D-Calif.) held a press conference during which she said raising the Medicare age was not on the table in the fiscal cliff negotiations. She further argued that Medicare and Social Security reform do not belong in the negotiations at all.

On Wednesday (12/19), the American Medical Association sent a letter to Senate Majority Leader Harry Reid urging Congress to act immediately to avert the Medicare payment cut to physicians. A cut of 26.5 percent on Medicare claims is scheduled to go into effect starting January 1.

AT THE AGENCIES

Early in December, 11 governors asked for a meeting with President Obama to negotiate for greater control over their Medicaid programs. The governors were interested in having the flexibility to expand Medicaid more modestly than the Affordable Care Act envisions. A few days later, Acting CMS Administrator Marilyn Tavenner and other CMS officials announced that if states do not expand their Medicaid systems pursuant to ACA requirements, they would not qualify for the full 100 percent funding under ACA either.

The Patient-Centered Outcomes Research Institute announced it is awarding more than $40 million over the next three years to 25 comparative-effectiveness research projects.

A new report by the Government Accountability Office identifies three key examples of the overlap between the CMS Innovation Center and efforts from other CMS offices. To decrease the risk of CMS duplicating payments for services, the GAO recommended CMS Acting Administrator Marilyn Tavenner direct the Innovation Center to review and eliminate areas of duplication expeditiously.

Ten Republican senators wrote the Obama administration urging it to extend the 30-day comment period and allow more review time for three recently proposed regulations: the essential health benefits rule, the health insurance market rules, and the HHS notice of benefit and payment parameters for 2014 rule. The director of the Center for Consumer Information and Insurance Oversight at CMS said he would not consider extending the comment period because interested parties need clarity to be prepared for October.

A temporary (three-year) $63-per-person fee will hit health plans serving about 190 million Americans starting in 2014. The fee, buried in a new regulation, is intended to help pay for individuals with pre-existing conditions. This fee will have to be paid by individual beneficiaries or employers.

IN THIRD PARTIES

The Kaiser Family Foundation posted a new fact sheet that examines the similarities and differences between the Massachusetts and Washington five-year demonstrations to integrate care and align financing for dual eligible beneficiaries.

Findings from a new study by The Commonwealth Fund show the cost of family health coverage rose substantially faster than income between 2003 and 2011.

IN THE COURTS

On Friday (12/14), the founder of Domino's Pizza filed a lawsuit in federal court suing the federal government over the Affordable Care Act's mandatory contraception coverage. The founder currently offers health insurance to his employees that excludes contraception and abortion coverage.

Tags: ACA, Affordable Care Act, Articles, CMS, HHS, Health Care Reform Implementation Updates, Medicare, PPACA, exchange

Health Care Reform Implementation Update - December 12, 2012

Posted on December 12, 2012 by Mark Alderman

As the year’s end approaches, the Hill is a flurry of activity with representatives from various health groups trying to ensure that whatever solution Congress finds to the fiscal cliff problems does not negatively affect them and those they represent. More proposed rules were published this week – among them, one on reducing incentives for insurers to avoid enrolling unhealthy people and another on establishing a multistate insurance plan program for exchanges.

AT THE AGENCIES

The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordination for Health Information Technology (ONC) issued a proposed rule that tweaks the meaningful use criteria health care providers need to meet to qualify for payment under the federal Electronic Health Record (EHR) incentive program. It adds an alternative meaningful use criterion for the electronic transmission of structured lab results from hospitals to ambulatory care providers who ordered the lab test. Another change is to the ONC’s 2014 EHR certification criteria – the change calls for an update to the data element catalogue, which is what identifies which data is needed to calculate the clinical quality measures included in the EHR incentive payment program’s meaningful use requirements.

A CMS proposed rule, published on Friday (12/7), details a risk adjustment methodology to reduce incentives for health insurers to avoid enrolling people with pre-existing conditions.

A proposed rule, published on Wednesday (12/5), by the Office of Personnel Management provides guidance on establishing a multistate insurance exchange program. The proposed rule highlights five main objectives: ensuring a choice of a least two high-quality products to consumers, promoting competition in the health insurance market, offering plans from the same issuer to families or small businesses residing/operating in more than one state, providing effective contractual oversight of the multistate plans, and working cooperatively with states and HHS to ensure a “level-playing field” for qualified health plans and multistate plans.

The Internal Revenue Service released new proposed regulations and a set of frequently asked questions regarding some of the new taxes intended to help pay for the Affordable Care Act. The regulations address the Net Investment Income Tax, which applies at a rate of 3.8 percent to some net investment income for individuals, estates and trusts that are above certain statutory thresholds. The IRS also released proposed regulations on the additional Medicare tax, which also applies to individuals and couples that fall above certain thresholds.

ON THE HILL

Negotiations to avert the fiscal cliff continue on the Hill. Around Washington, people are expecting to see large cuts in spending on Medicare and Medicaid. Other items flagged as potential negotiating tools are the Medicaid provider tax and graduate medical education.

The House Small Business Committee will be releasing documents with guidance to small businesses to assist them in complying with the law. This past week, on Thursday (12/6), the committee released a list of provisions that will go into effect in the next two years.

Rep. Phil Roe (R-Tenn) and Rep. Phil Gingrey (R-Ga.) will serve as co-chairs of the House's GOP Doctors Caucus for the 113th Congress. The Caucus’ stated goal is “to play an effective role in protesting the largest overhaul of our nation’s health system in history.” Rep. Gingrey is currently a co-chair of the caucus, and Rep. Roe will be replacing current co-chair Rep. Murphy.

IN THE STATES

On Monday (12/3), 11 Republican governors sent a letter to President Obama requesting a meeting to discuss the impact of the Affordable Care Act. Among the signees of the letter were Florida Gov. Rick Scott, Louisiana Gov. Bobby Jindal, Ohio Gov. John Kasich, Virginia Gov. Bob McDonnell and Arizona Gov. Jan Brewer.

On Thursday (12/6), New Jersey Gov. Chris Christie vetoed state legislation to set up a health care exchange.

In an address to the South Dakota state legislature on Tuesday (12/4), Gov. Dennis Daugaard strongly expressed his opposition to expanding the state’s Medicaid program.

Ohio Gov. John Kasich notified HHS that Ohio would not run a health exchange. Though high level officials had already suggested this was the route Ohio would take, the state had not yet reported the decision to the federal department.

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., ACA, Affordable Care Act, Articles, CMS, Health Care Reform Implementation Updates, Health Reform, IRS, PPACA, exchange

Health Care Reform Implementation Update - December 4, 2012

Posted on December 4, 2012 by Mark Alderman

HHS is quickly moving to implement the Affordable Care Act. Rules are out in the past two weeks that charge insurance companies to participate in federal exchanges, prohibit discrimination based on pre-existing conditions, detail essential health benefit requirements, and expand employment-based wellness programs. In addition, in response to Liberty University’s request, the Supreme Court ordered the 4th Circuit to examine the constitutionality of ACA’s employer requirements.

AT THE AGENCIES

On Friday (11/30), HHS issued new rules that charge insurance companies monthly fees to sell plans through federally run insurance exchanges. These fees will be pegged to the number of customers each insurer has in the exchange.

On Tuesday (11/20), HHS released three proposed rules implementing the Affordable Care Act. Comments may be submitted during the 90-day comment period. One of the rules details ACA’s guaranteed issue and community rating requirements. The rule would prohibit health insurance companies from discriminating against individuals because of pre-existing or chronic conditions, gender or occupation starting in 2014. Under the rule, the only factors by which insurers can underwrite are family size, geography and whether or not the individual smokes. In addition, insurers may not charge seniors more than three times what they charge young people – currently, insurers in 42 states charge seniors five or more times what they charge young adults.

Another of the proposed rules outlines coverage of essential health benefits, which are the minimum package of benefits the Affordable Care Act says must be included in health insurance plans. The categories of benefits that must be included are inpatient and outpatient care, emergency services, maternity and childhood care, prescription drugs, preventive screenings and lab work, mental health and substance abuse treatment, rehabilitation for physical and cognitive disorders, and dental and vision care for children. Much of this information was already known. One surprise, however, is that health insurance plans will have to cover the same number of prescription drugs as the benchmark plan in their states, which means there will be a greater number of prescription drugs covered in each class of drugs.

Finally, HHS also released a proposed rule that implements and expands employment-based wellness programs to promote health and help control health care spending. Under the regulation, employers may reward employees for annual exams or regular workouts, but they may not punish people who do not engage in these activities.

IN THE STATES

According to a report released Monday (11/26) by the Kaiser Family Foundation, states that expand their Medicaid rolls would see only modest cost increases compared with the expense to the federal government. Part of the states' concern over costs, however, is that the federal government could increase the percentage of the bill states have to cover in later years in response to fiscal woes. The report also says that states would face increased Medicaid costs even if they do not expand their Medicaid programs.

On Friday (11/16), Georgia Gov. Nathan Deal said Georgia would not build a state exchange because it has "no interest in spending … tax dollars on an exchange that is state-based in name only."

Wisconsin Gov. Scott Walker, Texas Gov. Rick Perry, Maine Gov. Paul LePage and Arizona Gov. Jan Brewer also each sent letters to HHS Sec. Sebelius saying that their states would not set up state-based insurance exchanges. This means the federal government will set up the exchanges in these states. Gov. Perry also said he will not expand Medicaid.

On Friday (11/16), Michigan Gov. Rick Snyder announced he is planning to move forward with a partnership exchange, however, he has not foreclosed the option of a state-based exchange if the federal deadline is again moved or the state House votes for the bill.

Oklahoma Gov. Mary Fallin announced that Oklahoma would not pursue the creation of a state-based exchange or expand its Medicaid program.

On Monday (11/19), Pennsylvania Gov. Tom Corbett said that expanding Medicaid pursuant to the Affordable Care Act would cost the state millions of dollars that it does not have. The state has not officially made its decision yet, though. The state is particularly concerned about the “woodwork effect” – even though the federal government will cover the costs associated with newly eligible beneficiaries, many new beneficiaries will also “come out of the woodwork” who were previously eligible. These individuals would have to be paid for by Pennsylvania since the federal assistance is only for individuals who are newly eligible. This concern is by no means unique to Pennsylvania.

On Thursday (11/29), Missouri Gov. Jay Nixon said that he plans to expand Medicaid in the state.

IN THE COURTS

On Monday (11/26), the Supreme Court ordered the 4th Circuit Court of Appeals to examine the constitutionality of the Affordable Care Act’s employer requirements and mandatory coverage of contraceptives without a co-pay. This was in response to Liberty University’s request that the Supreme Court reopen arguments against the employer mandate and contraceptive coverage mandate.

On Monday (11/19), a federal judge ruled against Oklahoma City-based Hobby Lobby in its attempt to block enforcement of contraceptive health insurance provisions of the Affordable care Act. Hobby Lobby’s attorneys said they plan to appeal the ruling to a federal appeals court in Denver.

Tags: Washington, D.C., ACA, Articles, HHS, Health Care Reform Implementation Updates, PPACA, Supreme Court, exchange

Health Care Reform Implementation Update - August 1, 2012

Posted on August 1, 2012 by Mark Alderman

Over the past week, analysts at the Congressional Budget Office said they expect that the Supreme Court’s decision, which struck down the requirement that states expand their Medicaid programs, will result in 3 million more uninsured and reduce costs by $84 billion; and the House Appropriations Committee released its fiscal 2013 budget for HHS, allocating $68.3 billion to the agency and defunding the Affordable Care Act.

AT THE AGENCIES

On Tuesday (7/17), the House Appropriations Committee released a draft of its fiscal 2013 budget for HHS. The draft includes $68.3 billion for HHS, defunds the Affordable Care Act and ends HHS' Agency for Healthcare Research and Quality as of October 1.

On Thursday (7/26), HHS announced a new plan to crack down on health care fraud. The Department of Health Human Services and The Department of Justice will be partnering with over a dozen health insurers and industry groups to prevent fraudulent health care schemes.

On Thursday (7/19), HHS Secretary Sebelius announced an opportunity to help states design and test improvements to their health care systems. Through the initiative, states will work with a broad coalition of employers, insurers, community leaders, service organizations and health care providers to design or test multi-payer payment and delivery system improvements to health care systems for Medicare, Medicaid and CHIP beneficiaries.

ON THE HILL

On Tuesday (7/24), the Congressional Budget Office (CBO) said that 3 million fewer Americans will gain health insurance through the health reform law because the Supreme Court loosened the law's requirement that states expand Medicaid coverage, and the CBO’s revised budget reflecting the change includes an $84 billion reduction from its March 2012 estimate. The CBO also said that the proposed repeal of the Affordable Care Act would increase the deficit by $109 billion between the years of 2013 and 2022.

IN THE STATES

Virginia Attorney General Ken Cuccinelli is pointing to language in the Affordable Care Act that suggests if a state does not set up a state-based insurance exchange, its citizens will not be able to be fined for not participating. The fines in the law, Cuccinelli argues, apply only to failure to participate in a state-based exchange, but not a federally established one.

Alaska Governor Sean Parnell announced on Tuesday (7/17) that Alaska will not set up an insurance exchange program because it is too expensive.

On Wednesday (7/18), Arkansas Governor Mike Beebe said he is still inclined to move forward with an expansion of Medicaid under the Affordable Care Act, but the matter will be decided by a vote in the Legislature next year.

On Tuesday (7/17), Kentucky Governor Steve Beshear signed an executive order to create the Kentucky Health Benefit Exchange, effective January 1, 2014.

THIS WEEK

On Thursday (8/2) from 10:00 a.m. to 12:00 p.m. at 1333 H St. NW, the Center for American Progress will host a discussion titled, "Cutting Health Care Costs: Leading Experts to Propose Bold Solutions."

On Friday (8/3) from 12:15 to 2:00 p.m. in the Columbus Club at Union Station, the Alliance for Health Reform will hold a briefing titled, "Medicaid Managed Long-Term Services and Supports: Are More Caution and Oversight Needed?" RSVP by noon on August 2.

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., Alaska, Arkansas, Articles, HHS, Health Care Reform Implementation Updates, Health Reform, Kathleen Sebelius, Kentucky, Medicaid, PPACA, Supreme Court, Virginia

Health Care Reform Implementation Update July 18, 2012

Posted on July 18, 2012 by Mark Alderman

Last week the House of Representatives voted to repeal the Affordable Care Act, but several Republican governors expressed willingness to expand their states’ Medicaid programs in accordance with the Act if their states could be granted control over how the dollars would be spent, and Kentucky committed to joining 15 other states and the District of Columbia in establishing a health insurance exchange under the Act.

ON THE HILL

The House of Representatives voted to repeal the Patient Protection and Affordable Care Act. The bill passed 244 – 185, with five Democrats crossing over to support the symbolic repeal legislation. Eyes then turned to the Senate, where Republican Leader Mitch McConnell filed an amendment to force a similar repeal bill in the Senate, but Senate Majority Leader Harry Reid committed to blocking such efforts. As President Obama and others this week noted, this is the 33rd House vote to repeal the health care law.

House Republican Study Committee Chairman Jim Jordan and Congresswoman Michele Bachmann are asking their House colleagues to defund the Affordable Care Act now, not wait until next year and prospective future repeal votes. Jordan and Bachmann’s signature campaign has already put 80 congressmen on record as being willing to defund the law this year.

AT THE AGENCIES

As a result of the Affordable Care Act’s passage, 12.8 million Americans are now receiving a health insurance rebate, which was announced last month. The rebates average $151 per household and were triggered by the Act’s “medical loss ratio” provision, which caps insurance companies’ administrative costs at 20 percent of their premiums.

IN THE STATES

At the National Governors Association meeting over the weekend, five Republican governors expressed a willingness to expand their states’ Medicaid programs under the Affordable Care Act if the federal government would give their states the flexibility to use the funds as they see fit. The governors noted that their states – Virginia, Nebraska, Utah, Tennessee, and Wyoming – would prefer to receive Medicaid funds as block grants and disperse them as they believe best.

In Indiana, a new private health insurance exchange called JA Exchange launched last week. The exchange will offer private insurance alternatives to state-sponsored programs, but it will also incorporate provisions of the Affordable Care Act so consumers can receive a full menu of options as intended by the Act.

While Texas Governor Rick Perry has said his state will not now proceed with establishing a health insurance exchange, Texas Health and Human Services Commissioner Tom Suehs testified that implementing the Affordable Care Act would cost Texans less than he originally predicted. Suehs originally projected the creation of a federal health insurance overhaul would cost $27 billion over 10 years, but now he expects that figure to be more like $15.6 billion.

Kentucky Governor Steven Beshear formally told Health and Human Services Secretary Kathleen Sebelius on Tuesday that he would sign an executive order to create a health insurance exchange, which would meet the requirements of the Affordable Care Act. Kentucky will be the 16th state, plus the District of Columbia, to either have enacted legislation to create an insurance exchange or to have established one by executive order.

THIS WEEK:

Today (7/18) at 2:00 p.m. in 216 Hart, the U.S. Senate Special Committee on Aging will conduct a hearing titled "Examining Medicare and Medicaid Coordination for Dual-Eligibles.”

Tags: Articles, Health Care Reform Implementation Updates, Indiana, Kentucky, PPACA, Texas

Health Care Reform Implementation Update July 3, 2012

Posted on July 3, 2012 by Mark Alderman

The Supreme Court upheld the Patient Protection and Affordable Care Act in a landmark 5-4 decision, which prompted many in business, the administration and states around the country to proceed with the Act’s implementation, while others are preparing for a major political effort to repeal the law.

IN THE COURTS

In a landmark decision, the Supreme Court upheld much of the Patient Protection and Affordable Care Act on Thursday (6/28), including the federal mandate to purchase health insurance, but not the power of the federal government to withhold Medicaid funds from states that choose not to participate in the law’s Medicaid expansions.

AT THE AGENCIES

Medicaid expansions planned under the Affordable Care Act now hang in the balance as state officials decide whether to participate in or opt out of the law’s Medicaid provisions. The Supreme Court effectively said states may implement the new Medicaid expansions included within the law and receive the financial benefits that accompany those expansions, or they may maintain their existing Medicaid programs without having to face a withholding of funds for those programs.

IN THE STATES

Texas is weighing whether to participate in or opt out of the Affordable Care Act’s Medicaid provisions, which, if implemented, would extend coverage to 1.8 million Texans, but also cost the state an estimated $2.6 billion between 2014 and 2019.

Republican governors in numerous states that were party to the case before the Supreme Court vowed to ignore the Court’s ruling at least until after the election.

ON THE HILL

Republican lawmakers on Capitol Hill are already discussing ways to repeal the Affordable Care Act, including the use of unconventional means such as reconciliation, which might allow portions to be repealed with only 51 votes in the Senate. There will likely be a symbolic vote to repeal the Affordable Care Act on July 11, but a larger campaign to repeal the legislation would, at a minimum, require Republicans to win the White House, gain seats in the Senate, maintain control of the House, and then proceed in near perfect unity on repeal efforts, likely including little-known legislative procedural moves.

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., Affordable Care Act, Articles, Health Care Reform Implementation Updates, Health Reform, Medicaid, PPACA, Supreme Court, Texas

Health Care Reform Implementation Update June 22, 2012

Posted on June 26, 2012 by Mark Alderman

While business and government leaders awaited the Supreme Court’s decision on the Affordable Care Act, major Act implementation developments occurred around the country, including Rhode Island’s decision to proceed with health insurance standards, New Hampshire’s decision to block the implementation of a health insurance exchange, and CMS’s announcement that 14 million Americans have already been served by Affordable Care Act programs it manages, while the cost associated with those programs is likely to rise over the next decade.

AT THE AGENCIES

The Centers for Medicare and Medicaid Services report that 14.3 million seniors have already taken advantage of preventative health care benefits furnished through the Affordable Care Act, which means they have received at least one free preventative benefit over the past year.

Regardless of how the Supreme Court rules on the Affordable Care Act, the annual growth rate for U.S. health care spending will likely remain near historic lows for 2013, and then rise at a modest pace for about the next 10 years, CMS said last week. Between 2011and 2013, health care spending is projected to grow around 4 percent, which is just over the historically low rate of 3.8 percent, but the growth in spending is likely to rise to 7.4 percent as coverage expands under the Affordable Care Act.

CMS also announced that from August 1 through September 19, the center will accept applications related to the Advanced Payment Accountable Care Organization Model, driven by the Affordable Care Act. The advanced payment ACO model enables organizations that voluntarily come together to give coordinated, high quality care to their Medicare patients, to receive an advance on their expected shared savings.

ON THE HILL

The Affordable Care Act received support this week from a subcommittee of the Senate Appropriations Committee, which approved $1.5 billion of increased discretionary spending for HHS programs that will fall under the Affordable Care Act in 2013.

IN THE STATES

Rhode Island’s General Assembly approved legislation to establish health insurance standards consistent with those set forth in the Affordable Care. Gov. Lincoln Chafee requested enactment of the legislation.

Though he previously signaled support for creation of an exchange per the requirements of the Affordable Care Act, New Hampshire Gov. John Lynch signed Republican legislation to block the implementation of a health insurance exchange in New Hampshire.

THIRD PARTIES

The Catholic Health Association retreated from its initial position in support of the Affordable Care Act. The association, which is the largest group of nonprofit health care providers in the United States, said it is “imperative” that the Obama administration expand its exemption for Catholic hospitals, schools, and other ministries of the church.

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., Articles, Health Care Reform Implementation Updates

Health Care Reform Implementation Update June 7, 2012

Posted on June 8, 2012 by Mark Alderman

While the Supreme Court makes its decision on the Affordable Care Act, lawmakers in Washington, D.C., are driving forward repeal-oriented legislation and simultaneously talking about reinstating elements of the Act should the whole thing be struck down, while HHS, CMS, and the IRS all released new or proposed rules on how to implement elements of the Act, and states like California and Oregon moved closer to full implementation of the Affordable Care Act.

AT THE AGENCIES

The IRS issued guidance on employer implementation of the Affordable Care Act’s new $2,500 cap on employee contributions to flexible health savings accounts, and has requested comments on possible changes to the “use-or-lose” rules for health FSAs. The $2,500 limit will become effective with cafeteria plan years beginning after December 31, 2012 and will be indexed for inflation.

CMS released its 2011 data on the Primary Care Incentive Program which, established by the Affordable Care Act, requires Medicare to pay primary care providers whose primary care billings comprise at least 60 percent of their total Medicare allowed charges, a quarterly bonus of 10 percent from Jan. 2011 – Dec. 2015. The majority of funds (86 percent) went to physicians practicing in urban areas, and roughly 50 percent went to general internists while 38 percent went to family physicians.

ON THE HILL

Awaiting the Supreme Court’s decision on the Affordable Care Act, Senate Republicans now appear to be embracing a contingency plan rumored to be afoot among key House Republicans: Reinstate popular provisions of the Affordable Care Act if the Supreme Court overturns the law. Notable provisions under discussion include the ability of young adults to stay on their parents’ insurance through age 26, a guarantee of coverage for those with pre-existing conditions, and plans to close the Medicare prescription drug coverage gap known as the “doughnut hole.”

The House Ways and Means Committee marked up four bills and related measures on flexible savings accounts and health savings accounts, which easily passed committee with strong support from Democrats and Republicans.

The previously private details of a lengthy negotiation and deal between the Obama administration and the pharmaceutical industry on the Affordable Care Act were made public last week when the House Energy and Commerce Oversight and Investigations Subcommittee released a memo and associated documents as part of its ongoing investigation launched more than a year ago.

IN THE STATES

New Hampshire’s Granite State Network has teamed up with Cigna to launch a collaborative accountable care initiative that is focused on achieving many of the same goals as accountable care organizations.

Oregon’s Health Authority has provisionally certified 11 organizations to be the state’s first coordinated care organizations under an overhaul of the Oregon Health Plan, made possible by the Obama administration’s approval earlier last month of a $1.9 billion grant. The 11 organizations will be responsible for integrating health care for low-income patients on Medicaid, and more organizations are expected to apply for certifications soon and possibly come online this autumn.

California’s state senate approved a bill to make numerous protections of the Affordable Care Act – such as ensuring individuals do not lose or get denied coverage because of pre-existing conditions and requiring every health plan to include guaranteed availability and renewability of coverage – part of California law.

IN THIRD PARTIES

The nation’s largest umbrella group for U.S.-based Catholic nuns, which recently disagreed with the Catholic Bishops’ analysis of the health care law and supported President’s Obama plan, spoke out after the Vatican said the group had adopted “certain radical feminist themes incompatible with the Catholic faith.” The nuns said the Vatican’s assessment was unsubstantiated and result of a flawed process, and they will take their concerns to a meeting in Rome on June 12.

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., Articles, Health Care Reform Implementation Updates

Health Care Reform Implementation Update May 16, 2012

Posted on May 16, 2012 by Mark Alderman

Last week, HHS announced the first round of 26 Health Care Innovation Awards, CMS published the names of providers that have demonstrated meaningful use of electronic health records, and New Jersey Governor Chris Christie vetoed a bill to establish a health insurance exchange in his state.

AT THE AGENCIES

CMS published the names of Medicare providers that have demonstrated meaningful use of electronic health records and received incentive payments as of March 2012.

On Tuesday (5/8), HHS announced the first round of 26 Health Care Innovation Awards totaling $122.6 million. The next batch will be announced in early June. The awards support innovative projects throughout the country that are expected to save money, deliver high quality medical care and enhance the health care workforce.

CMS is encouraging states to control Medicaid costs by overhauling dual-eligible programs instead of cutting provider pay.

ON THE HILL

On Thursday (5/10), the Senate Finance Committee convened a group of former Medicare administrators to discuss the sustainable growth rate formula. The group talked about setting the sustainable growth rate close to the physicians’ own practices and moving away from a fee-for-service model.

IN THE STATES

On Thursday (5/10), New Jersey Gov. Chris Christie vetoed a bill from the majority Democratic state legislature that would have set up a health insurance exchange in the state. Gov. Christie said that if the Supreme Court upholds the Affordable Care Act, he would reconsider.

Illinois currently pays more than $800 million each year for retirees' health care, and 90 percent of those retirees pay nothing toward their health-insurance premiums. The Illinois Senate approved a measure that would end this taxpayer-subsidized benefit.

THIS WEEK

On Tuesday (5/15) at 10:00 a.m., in the Capitol Visitors Center Room SVC212-10, The National Coalition on Health Care held a forum on innovative private sector strategies to curb health costs.

On Wednesday (5/16) at 10:00 a.m., the Senate Health, Education, Labor and Pensions Committee will hold a hearing titled "Identifying Opportunities for Health Care Delivery System Reform: Lessons from the Front Line."

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., Articles, Health Care Reform Implementation Updates

Health Care Reform Implementation Update May 8, 2012

Posted on May 8, 2012 by Mark Alderman

Last week, the Obama administration announced that it would likely give Oregon $1.9 billion to get a new Medicaid initiative started and that it would provide $10.4 million to 70 grantees for rural health care and $728 million to more than 400 community health centers. Also last week, Massachusetts House leaders released their first version of legislation to reform the state's health care financing system by setting a target for the rate at which health spending should rise.

IN THE COURTS

On Friday (5/4), a federal appeals court ruled that Texas cannot ban Planned Parenthood from receiving state funds, at least until a lower court has a chance to hear formal arguments. As background, last year Texas legislators passed a law to effectively remove Planned Parenthood and other abortion providers from the Texas Medicaid Women's Health Program, and Planned Parenthood clinics sued the state to maintain funding.

AT THE AGENCIES

On Thursday (5/3), the Obama administration announced that it has tentatively agreed to chip in $1.9 billion over five years to help Oregon get a new health care initiative off the ground. Through the new program, the roughly 600,000 Oregon Medicaid enrollees will gain access to "coordinated care organizations," which are designed to help patients maintain their health and stay on top of treatments for chronic medical conditions.

On Wednesday (5/2), HHS Secretary Sebelius announced that rural health care providers across the country will receive over $10.4 million to provide direct health care services to their communities. Each of 70 grantees will receive approximately $450,000 over a 3-year period.

On Tuesday (5/1), HHS announced plans to provide more than $728 million in funding for more than 400 community health centers nationwide. Through the Patient Protection and Affordable Care Act, this funding will support 398 renovation and construction projects at community health centers.

On Wednesday (5/2), federal authorities charged 107 doctors, nurses and social workers with Medicare fraud as part of a nationwide crackdown on unrelated scams.

IN THE STATES

On Friday (5/4), Massachusetts House leaders released their first version of legislation to reform the state's health care financing system in order to bring health care costs under control. The bill proposes setting a target for the rate at which health spending should rise.

Kentucky Gov. Steve Beshear said that if the Supreme Court upholds the health care law, he plans to issue an executive order establishing a Kentucky health benefit exchange, which would allow individuals and small businesses to shop for health plans online and compare coverage, provider networks and costs.

In Oregon, enough health care providers have signed up for Gov. Kitzhaber's Coordinated Care Organization Medicaid plan that 90 percent of Medicaid recipients will be covered.

IN THIRD PARTIES

According to a new report from the Commonwealth Fund, the United States spends more than 12 other industrialized countries on health care, but does not provide superior care. The report's authors said that the cause of the higher costs is unnecessary and inefficient medical services.

THIS WEEK

On Monday (5/7) at 2:00 p.m. in 210 Cannon, the House Budget Committee was scheduled to mark up pending legislation on an alternative to the budget sequester.

On Wednesday (5/9) at 8:30 a.m. in the Falk Auditorium at 1175 Massachusetts Ave. NW, The Brookings Institution will host an event titled "Bringing Health Care into the 21st Century."

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., Articles, Health Care Reform Implementation Updates

Health Care Reform Implementation Update May 1, 2012

Posted on May 1, 2012 by Mark Alderman

Last week, the Medicare Board of Trustees released its annual report, the House of Representatives voted to take money from the healthcare overhaul to extend low interest rates for federal student loans, and the House Energy and Commerce Committee approved a proposal package that aims to save the federal government about $114 billion over 10 years by repealing several Affordable Care Act provisions.

AT THE AGENCIES

On Monday (4/23), the Medicare Board of Trustees released its annual report. The report shows that the hospital trust fund, or Medicare Part A, has an insolvency date of 2024. The trustees said that without the Affordable Care Act, the insolvency date would be 2016.

On Tuesday (4/24), CMS released a proposed rule that updates payments to acute-care and long-term-care hospitals for 2013 and includes several provisions that aim to improve quality. The American Hospital Association expressed disappointment that CMS used outdated data and a flawed methodology to implement coding cuts and also said CMS failed to account for the sequester, which is scheduled for January.

According to a final rule issued by CMS on Tuesday (4/24), all providers and suppliers who qualify for a National Provider Identifier (NPI) will be required to include the NPI on any enrollment applications to Medicare and Medicaid. An NPI is a 10-digit number that identifies a health care provider. CMS says that this requirement will save Medicare about $1.6 billion over 10 years. According to CMS, this rule will enable it and the states to link provider claims to the ordering or certifying physician or eligible professional and to check for suspicious ordering activity.

ON THE HILL

On Friday (4/27), the House of Representatives voted mostly along party lines to take money from the health care overhaul to extend low interest rates for federal student loans. The House sent the measure to the Senate, where Democrats are likely to reject it.

On Wednesday (4/25), the House Energy and Commerce Committee approved a proposal package that aims to save the federal government about $114 billion over 10 years by repealing several Patient Protection and Affordable Care Act provisions. Some of the proposals included in the package would repeal the law's Prevention and Public Health Fund, repeal HHS' unlimited direct appropriation to establish state health exchanges, cut funding for the Consumer Operated and Oriented Plan program, which would provide government loans to nonprofit health plans and repeal Medicaid maintenance-of-effort requirements.

On Thursday (4/26), Republicans on the House Energy and Commerce Committee released a report titled "Higher Costs, More Confusion, Less Coverage." The report says that some companies anticipate their health care costs will increase because of higher taxes, fees and administrative burdens under the reform law. House Democrats accused Republicans of creating a "fundamentally misleading" report.

On Monday (4/23), the GAO released a report saying that the Medicare Advantage demo is expensive, poorly run and should be canceled. CMS responded to the GAO report saying that the demo "will lead to faster and larger quality improvements" and that the project has helped the agency to improve its star-rating system so that it places "greater emphasis on clinical outcomes and beneficiary experience measures."

IN THE STATES

Colorado is beginning to expand its Medicaid roles. It is one of the few states that is expanding the program before 2014, when the Affordable Care Act requires it. Beginning in mid-May, Colorado will start offering Medicaid to those at 10 percent of the federal poverty level. It will not, however, be able to enroll everyone who meets this threshold in the program. Those who can become Medicaid beneficiaries will be chosen by a lottery in each county.

IN THIRD PARTIES

One of the first Affordable Care Act provisions to go into effect is the "medical loss ratio" provision, which requires that insurers spend at least 80 percent of every premium dollar on medical costs. U.S. health insurers will pay $1.3 billion in rebates to consumers and employers this year due to this provision. According to a new report from the Kaiser Family Foundation, almost a third of people who bought their own health insurance last year will get rebates averaging $127.

THIS WEEK

On Friday (5/4) at 1:00 p.m. in Brookings' Falk Auditorium, the Brookings Institute's Campaign 2012 project will hold a discussion on health care reform, the fifth in a series of forums to identify and address the 12 most critical issues facing the next president.

On Friday (5/4) at 12:15 p.m. in 902 Hart, the Alliance for Health Reform and the Centene Corporation will sponsor a luncheon briefing to address the question, "Behavioral Health: Can Primary Care Help Meet the Growing Need?"

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., Articles, Health Care Reform Implementation Updates

Health Care Reform Implementation Update April 24, 2012

Posted on April 25, 2012 by Mark Alderman

Last week, the House Ways and Means Committee marked up a proposal that calls for those who receive tax subsidy overpayments due to the Affordable Care Act to repay them, and a new study by The Commonwealth Fund shows that 26 percent of American adults were uninsured at some point in 2011.

IN THE COURTS

The Maine Equal Justice Partners and the American Civil Liberties Union of Maine Foundation brought a lawsuit in Maine on behalf of a man who lost his health care benefits while battling cancer and seeks class status for an estimated 500 others who lost coverage due to waiting periods for benefits.

ON THE HILL

On Wednesday (4/18), the House Ways and Means Committee marked up a proposal that could affect how the government implements the Affordable Care Act's health insurance purchase tax subsidy provision. If it is upheld in the Supreme Court, the law would create a new system of refundable income tax credits that people will be able to use to buy health insurance. Congressmen have noted that the mechanics of the law may end up giving some taxpayers bigger health insurance subsidies than they are entitled to receive. The new proposal calls for those who receive overpayments to repay them in full.

On Wednesday (4/18), the Judiciary Committee got close to adopting medical malpractice legislation capping non-economic damages at $250,000. The committee recessed before it took a final vote.

IN THIRD PARTIES

According to the latest Quinnipiac University poll, 49 percent want the court to strike down the Affordable Care Act, while 38 percent do not.

A new study by The Commonwealth Fund shows that 26 percent of American adults were uninsured at some point in 2011. The leading cause of lack of insurance was job loss or job switch. The report goes on to say that the Affordable Care Act will help close these gaps by making it easier for individuals to buy insurance when they do not have access to an employer-based policy.

IN THE STATES

On Friday (4/20), the Arkansas Legislative Council endorsed a plan for the state to use a $7.7 million federal grant to fund planning for the Affordable-Care-Act-required state insurance exchange.

THIS WEEK

On Tuesday (4/24) from 8:30 a.m. to 11:30 a.m., AEI hosted an event titled "The Future of Medicare: A Reality Check." The agenda can be found here http://www.aei.org/events/2012/04/24/the-future-of-medicare-a-reality-check/.

On Tuesday (4/24) at 10:00 a.m. in 215 Dirksen, the Senate Finance Committee held a hearing titled "Anatomy of a Fraud Bust: From Investigation to Conviction," focusing on a recent Justice Department sting operation that resulted in charges against 91 people accused of defrauding Medicare for nearly $300 million in false billings.

On Wednesday (4/25) at 10:00 a.m., the Senate Veterans' Affairs Committee will hold a hearing titled "VA Mental Health Care: Evaluating Access and Assessing Care."

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., Articles, Health Care Reform Implementation Updates

Health Care Reform Implementation Update March 14, 2012

Posted on March 14, 2012 by Mark Alderman

In the past week, HHS released the final rule for health insurance exchanges; the White House coordinated events to be held outside the Supreme Court during the March 26-28th arguments; and New York State warned health insurers that they would lose state contracts if women on Medicaid were denied their choice of higher-cost, brand-name contraceptives.

IN THE COURTS

On Wednesday (3/7), White House officials summoned leaders of nonprofit organizations that strongly back the Affordable Care Act to help coordinate plans for a prayer vigil, press conferences and other events outside the Supreme Court during the arguments, which begin in two weeks.

AT THE AGENCIES

On Monday, HHS released the final rule for health insurance exchanges. The long-awaited regulation stresses state and federal flexibility. The regulation lays out state functions: certifying "qualified health plans"; operating a website for comparing plans; running a toll-free hot line for consumer support; providing grants to "Navigators" for consumer assistance; determining eligibility of consumers for enrollment in qualified health plans; and helping with enrollment.

On Friday (3/9), Farzad Mostashari, the national coordinator for health information technology at the U.S. Department of Health and Human Services, said the government is proposing that medical providers have the capability to exchange patient data by 2014.

IN THE STATES

A report released on Monday (3/5) by nine state attorneys general says the Obama administration has broken the law and overstepped constitutional bounds 21 times.

On Tuesday (3/6), in a speech to the Greater Boston Chamber of Commerce, Massachusetts House Speaker Robert DeLeo offered business leaders a preview of state legislation aimed at reining in health care costs. Rep. DeLeo predicted the House proposal would make "aggressive" changes in disclosure requirements for the industry, give consumers and businesses more ability to make informed health care choices, and encourage employers to offer health and fitness incentives for workers.

On Thursday (3/8), Texas Gov. Rick Perry directed state officials to begin looking for money to fund the Medicaid Women’s Health Program in case the Obama administration revokes federal funding amid a fight over clinics affiliated with abortion providers.

According to a new report and accompanying white paper from the National Governors Association, Top IT Actions to Save States Money and Boost Efficiency, states could make better use of information technology to be more efficient and improve services.

On Monday (3/5), New York State warned health insurers that they would lose state contracts if women on Medicaid were denied their choice of higher-cost, brand name contraceptives unless cheaper, generic methods “fail first.”

THIRD PARTIES

A new study published Monday (3/5) in Health Affairs challenges the premise that electronic health records will reduce costs.

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., Articles, Health Care Reform Implementation Updates

Health Care Reform Implementation Update March 8, 2012

Posted on March 8, 2012 by Mark Alderman

In the past week, HHS reported that the Affordable Care Act has eliminated lifetime limits on coverage for more than 105 million Americans; a U.S. House subpanel approved a measure to repeal the Independent Payment Advisory Board (IPAB); and House Ways and Means Committee Chairman Rep. David Camp (R-Mich.) requested that the Obama administration explain the additional $111 billion it has requested to implement health reform.

IN THE COURTS

There are now only three weeks until the Supreme Court hears Florida v. Department of Health and Human Services.

AT THE AGENCIES

On Monday (3/5), HHS Sec. Sebelius released a report on how the health reform law has eliminated lifetime limits on coverage for more than 105 million Americans. Before ACA, many Americans with serious illnesses, such as cancer, risked hitting the lifetime limit on the dollar amount their insurance companies would cover.

The Centers for Medicare & Medicaid Services (CMS) is preparing to collect health insurance exchange construction progress reports from the states. Comments on the information collection activity will be due 60 days after the official Federal Register publication date.

Dr. Jacques Roy of Texas is charged with engaging in Medicare fraud that cost the system $375 million by recruiting homeless and fake patients to register for care that was not provided.

On Friday (3/2), federal officials announced that next month, New Hampshire will be the first state to receive ACA funds to keep seniors out of institutions and in their home communities.

ON THE HILL

On Wednesday (2/29), a House subpanel approved a measure to repeal the Independent Payment Advisory Board (IPAB). Two Democrats, including the panel's ranking member, joined Republicans in voting to get rid of the IPAB.

House Ways and Means Committee Chairman Dave Camp (R-Mich.) requested that the Obama administration explain why it needs an extra $111 billion to implement part of the health care reform law.

Sen. Roy Blunt (R-Mo.) proposed an add-on to the transportation bill that would require religiously affiliated hospitals and universities to provide birth control without co-pays to employees. HHS Secretary Kathleen Sebelius said this proposal is "dangerous and wrong" and that "...decisions about medical care should be made by a woman and her doctor, not a woman and her boss." On Thursday (3/1), the Senate rejected Sen. Blunt’s measure.

IN THE STATES

On Thursday (3/1), the Washington State Senate voted 27-22 to set new rules for the state's health care exchange.

On Tuesday (2/28), the Wyoming Senate voted to discontinue funding the Healthy Frontiers Medicaid expansion project.

Oregon Governor John Kitzhaber signed legislation that will allow the state to move forward with plans to overhaul its Medicaid Program. The new health law would allow officials to assign certain Medicaid patients to caseworkers who would manage all aspects of their care, with the goal of eliminating redundant tests and procedures and reducing expensive hospital stays.

Idaho House Republicans voted in favor of a panel to scrutinize how the Affordable Care Act is adopted in Idaho. The bill is now headed to the Senate.

On Monday (2/27), legislation was approved in New Jersey to create a state health insurance exchange.

THIRD PARTIES

On Monday (2/27), the American Medical Association (AMA) reiterated its support for Republican-led efforts to repeal the IPAB, created by the Affordable Care Act. The AMA said the IPAB is the wrong way to control health care costs.

Kaiser Health News reports that 63 percent of Americans said they support the Obama administration's requirement that health insurance plans supply free contraceptives as a preventive benefit for women.

A USA Today/Gallup Poll of the top dozen swing states found considerable opposition to the health reform law. The states surveyed were Colorado, Florida, Iowa, Michigan, Ohio, Pennsylvania, Nevada, New Hampshire, New Mexico, North Carolina, Virginia and Wisconsin.

THIS WEEK

On Tuesday (3/6) at 10:00 a.m. in 1100 Longworth, the House Ways and Means Subcommittee on Health held a hearing on the impact of the Independent Payment Advisory Board (IPAB) on medicine.

To view our compilation of recent health care reform implementation news, click here.

Tags: Washington, D.C., Affordable Care Act, Articles, Health Care Reform Implementation Updates, Health Reform

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