MHA Federalist

House rejects consideration of Senate compromise on H.R. 3630

The U.S. House of Representatives on Dec. 20 voted 229-193 to reject consideration of bipartisan Senate amendments to the Middle Class Tax Relief and Job Creation Act (H.R. 3630) and request a conference with the Senate on the legislation. In a statement, Senate Majority Leader Harry Reid said the chamber would not negotiate until the House passes the compromise measure.

Passed by the Senate on Dec. 18, the compromise bill would extend current Medicare physician payment rates for two months to prevent a 27.4% cut effective Jan. 1 without cutting hospital payments. It also includes several American Hospital Association-supported rural Medicare "extenders."

The House-passed bill, strongly opposed by the AHA, would offset the cost of a two-year physician pay fix by cutting hospital payments by nearly $20 billion.

Health Reform Hub moved to MHAConnect

The MHA Federalist blog will continue to track federal legislation of interest to our members, but the Health Reform Hub has moved to MHA Connect. The community setting allows members to share documents, post discussion items and read and share news and upcoming educational events.

If you are an MHA member and need your username and password to log in, contact Diane Clift at (601) 368-3217 or dclift@mhanet.org. This same username and password will also work to register for meetings at www.mhanet.org and access members-only information on MHA's new smartphone app.

 

The States' Medicaid 'Coercion' Claim: More Rhetoric Than Fact

Among the issues on which the United States Supreme Court has agreed to hear oral arguments in the Affordable Care Act cases is the question of whether its minimum Medicaid coverage requirements are constitutional. The states have based their appeal on a legal theory known as the “coercion doctrine.”

Citing a long history of precedents, the Court of Appeals for the Eleventh Circuit dismissed their arguments. Now the United States Supreme Court will decide.

Read more from the Health Affairs blog here.

Implementing Health Reform: CO-OPs, MEWAs, And Medicare Data

The week of December 5 was a particularly busy week in health care reform implementation. After a lull over the Thanksgiving holiday, new regulations, proposed regulations, guidance, and grant announcements have poured out of the agencies.

This Health Affairs blog post briefly summarizes three of these issuances: the final rule on the Establishment of Consumer Operated and Oriented (CO-OP) program; the final rule on the Availability of Medicare Data for Performance Measurement to qualified entities; and a series of proposed rules and forms issued by the Department of Labor to implement new provisions of the ACA intended to address Multiple Employer Welfare Association (MEWA) fraud and abusive practices. 

HHS issues final rule for ACA CO-OP program

The Department of Health and Human Services on Dec. 8 issued a final rule establishing the Consumer Operated and Oriented Plan program. Created by the Patient Protection and Affordable Care Act, the program will provide $3.8 billion in loans and grants to help organizations develop nonprofit health cooperatives, which will sell qualified health plans that promote care coordination to individuals and small businesses through state insurance exchanges.

According to the rule, which details eligibility and other standards for the program, organizations sponsored by existing health insurance issuers and their holding companies and foundations are not eligible for the loans. The program expects to award the first round of loans and grants next month.

[ via AHA News Now ]

CMS issues final rule for release/use of Medicare claims data under ACA

The Centers for Medicare & Medicaid Services on Dec. 5 issued a final rule for the release and use of Medicare claims data to qualified entities to measure the performance of Medicare providers under the Patient Protection and Affordable Care Act. Beginning in 2012, the ACA requires the Health and Human Services secretary to provide standardized extracts of Medicare Parts A, B and D claims data to qualified entities on request.

Among other changes to the proposed rule, CMS estimates the average cost for a qualified entity for the first year of the program is $40,000, down from $200,000 in the proposed rule. The estimate assumes 25 qualified entities will request data for an average 2.5 million beneficiaries.

The rule requires them to confidentially share measures, measurement methodologies and measure results with providers and suppliers at least 60 calendar days prior to making measurement results public, compared to 30 business days in the proposed rule. For more information, see the CMS Fact Sheet.

[ via AHA News Now ]

HHS issues final rule revising certain MLR requirements

The Centers for Medicare & Medicaid Services on Dec. 2 issued a final rule implementing changes to the Patient Protection and Affordable Care Act’s medical loss ratio requirements for health insurers effective Jan. 1. According to CMS, the changes from the interim final rule largely address technical issues involved in the way insurers calculate and report their MLR and the mechanism for distributing rebates to enrollees in group health plans.

For example, the rule requires insurers to provide notice of rebates to group policy holders and enrollees, and to provide the rebates through lower premiums or in other ways that are not taxable. Among other changes, the rule allows part of a health plan’s ICD-10 conversion costs to be considered as quality improvement activities, and addresses MLR adjustments for “mini-med” and expatriate policies.

CMS will accept comments through Jan. 6 regarding the rule’s treatment of ICD-10 conversion costs and the process for providing and reporting rebates to group enrollees. In a recent report, the Government Accountability Office said at least 64% of insurers in 2010 would have met or exceeded the 2011 ACA MLR standards.

Health-care case brings fight over which Supreme Court justices should decide it

Just a little more than an hour after some House Democrats recently demanded an inquiry into Supreme Court Justice Clarence Thomas’s ethics, Senate Republicans stepped up the pressure on Justice Elena Kagan to take herself out of the court’s decision on the health-care reform act.

The process repeated itself a few days later. House Judiciary Committee Chairman Lamar Smith (R-Tex.) called for the release of more documents about Kagan’s role as President Obama’s solicitor general; the liberal group People for the American Way came out with another broadside against Thomas.

Read the full story from Robert Barnes in the Washington Post here.

House approves change to ACA income definition

The U.S. House of Representatives on Nov. 16 passed legislation (H.R. 674) tightening the definition of modified adjusted gross income used to determine eligibility for subsidies, Medicaid and the Children's Health Insurance Program under the Patient Protection and Affordable Care Act. The bill adds the non-taxable portion of Social Security benefits to the current definition to prevent middle-income Americans from qualifying for the low-income program.

Other federal assistance programs also include the entire Social Security benefit as income. The president is expected to sign the bill, which passed the Senate last week.

It returned to the House for a final vote because the Senate added provisions to promote the hiring of veterans.

[ via AHA News Now ]

Senate holds hearing on health care delivery reform

The Senate Committee on Health, Education, Labor & Pensions on Nov. 10 held a hearing on the role of health care delivery reform in improving quality and lowering costs. Witnesses included Gary Kaplan, M.D., chairman and CEO of Virginia Mason Health System in Seattle, WA; and Greg Poulsen, senior vice president and chief strategy officer for Intermountain Healthcare in Salt Lake City.

Kaplan described his organization’s efforts to adapt the Toyota Production System to improve health care quality and lower costs, while Poulsen shared his organization’s recommendations for improving quality and avoiding waste. Other witnesses at the hearing included Centers for Medicare & Medicaid Services Deputy Administrator Jonathan Blum; Mark Fendrick, M.D., co-director of the Center for Value-Based Insurance Design; and Rhode Island Health Insurance Commissioner Chris Koller.