Diane Rowland, Chair of the Medicaid and CHIP Payment and Access Commission (MACPAC), announced that Lu Zawistowich was named the Commission’s Executive Director and that the first public MACPAC meeting will be convened in September. The Commission was authorized in the Children’s Health Insurance Program Reauthorization of 2009 (P.L. 111-3). Congress appropriated funding for MACPAC in the Affordable Care Act.  MACPAC will advise Congress on Medicaid, CHIP, and health insurance exchange policies. 

Dr. Zawistowich most recently served as the Acting Deputy Director of the Office of Consumer Information and Insurance Oversight at the Department of Health and Human Services. She previously worked at the Centers for Medicare and Medicaid Services as well as at the Maryland State Department of Health and Mental Hygiene. 

On July 21, Democratic Rep. Lynn Woolsey introduced H.R. 5808 to amend the Affordable Care Act (ACA) to include a public plan option. The Congressional Budget Office CBO issued a letter to House Ways and Means Health Subcommittee Chairman Pete Stark noting that the bill would reduce the budget deficit by $53 billion over 10 years. The letter also states that the cost of insurance under a public plan option would be 5-7 percent lower on average. 

Including a public plan option in health care reform legislation was a controversial issue that did not ultimately have traction in the Senate’s Patient Protection and Affordable Care Act. The House-passed health care reform bill included a public plan option.  The rates under the Affordable Health Care for America Act would be negotiated and could not be less than Medicare rates, but not higher than the average rates of other health benefit plans. Rep. Woolsey’s legislation would set reimbursement rates under the public plan option as equal to Medicare plus 5 percent. Although the legislation has 128 co-sponsors, the House is unlikely to move the bill during this session of Congress. 

The National Association of Insurance Commissioners convened last week to develop a recommendation to HHS regarding the definition of medical loss ratio, which would serve determine the types of insurance spending that should count as medical spending. NAIC was charged with this role in the Affordable Care Act, which requires large group health insurance plans to spend 85 percent of premium dollars on clinical services and activities related to quality of care. The NAIC hopes to present a recommendation to HHS by mid to late August; although, its work could continue into September. Secretary Kathleen Sebelius must certify the Commissioners work. NAIC has also been tasked with developing standard insurance benefits and enrollment forms and regulations for the state-based exchanges.

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Last week, the White House announced President Obama’s recess appointment of Donald Berwick as CMS Administrator. Dr. Berwick is a pediatrician and professor at Harvard University and the founder the Institute for Healthcare Improvement. He launched the“100,000 Lives” campaign to reduce the number of deaths attributable to medical errors in hospitals. He has previously served as Vice Chair of the U.S. Preventive Task Force, member of the Board of Trustees of the American Hospital Association, Chair of the National Advisory Council of AHRQ. Dr. Berwick was sworn in on July 12.   

The Constitution provides an exception to the Senate confirmation process for nominations. When the Senate is in recess, the President may make a temporary appointment known as a “recess appointment” without Senate approval. President Obama is making the appointment during a recess in the middle of a session, so Dr. Berwick’s appointment will expire at the end of the following session or at the end of the first session of the 112^th Congress. President Obama has made 15 recess appointments, not including Donald Berwick.

Senate Minority Leader Mitch McConnell, along with Republican Senators John Barrasso, Pat Roberts and Tom Coburn have objected to President Obama’s move noting that confirmation hearings had not been scheduled to allow for consideration of the nominee. Senate Finance Committee staff have responded to the announcement noting that Republicans have urged Leadership to expedite Dr. Berwick’s confirmation hearing and hold his hearing before Supreme Court Justice nominee Elena Kagan’s hearing.    

Republicans on the Senate Finance Committee sent a letter to Chairman Baucus requesting a hearing on the appointment of Dr. Berwick. The letter requests a chance for Dr. Berwick “to present his qualifications for the position in the usual process” so as not to create “a shadow over his legitimacy and authority to serve as Administrator during a critical time for CMS.”  Republican members of the House Ways and Means Committee also urged a hearing with Dr. Berwick.

The Office of Management and Director Peter Orszag has announced that his last day at his post will be July 30.  President Obama announced that he will appoint Jack Lew as the new OMB Director. Mr. Lew currently serves as an aide to Secretary of State Hillary Clinton and previously worked as the budget director for former President Bill Clinton. Given the current budget deficit, the new OMB Director will certainly continue the focus on reducing the deficit.         

The Chairmen of the National Commission on Fiscal Responsibility, former Republican Senator Alan Simpson of Wyoming and Erskin Bowles, former chief of staff to President Bill Clinton, spoke to the National Governor’s Association and relayed that Congress must examine any and all proposals to contain entitlement programs, particularly Medicare and Medicaid. The Commission is required to develop a plan by December 1 to reduce the deficit. 

Prior to the August recess, the Senate is expected to consider the “Small Business Lending Fund Act” (H.R. 5297), which was introduced by Rep. Barney Frank (D-MA) to address the impact of the financial crisis on small businesses. The Senate will also consider the House-amended war supplementing spending bill before it adjourns. The House amended the Senate-passed bill to include Senator Herb Kohl’s (D-WI) legislation, the “Preserve Access to Affordable Generics Act,” which would ban agreements between brand name and generic drug manufacturers. Senator Kohl has called such agreements “one of the most egregious tactics used to keep generic competitors off the market leaving consumers with unnecessarily high drug prices.” The Generic Pharmaceutical Association, however, expressed opposition to the amendment noting that such agreements have, at times, allowed generic drugs to come to market before the patents of the name brand drugs expire.

Last night, the White House announced that President Obama has decided to make a recess appointment for Dr. Donald Berwick to serve as CMS Administrator. 

Dr. Berwick is a pediatrician and professor at Harvard University and the founder of the Institute for Healthcare Improvement. He launched the “100,000 Lives” campaign to reduce the number of deaths attributable to medical errors in hospitals.  He has previously served as Vice Chair of the U.S. Preventive Services Task Force, a member of the Board of Trustees of the American Hospital Association, and Chair of the National Advisory Council of the Agency for Healthcare Research and Quality (AHRQ).

The Constitution provides an exception to the Senate confirmation process for nominations. When the Senate is in recess, the President may make a temporary appointment known as a “recess appointment” without Senate approval. President Obama is making the appointment during a recess in the middle of a session, so Dr. Berwick’s appointment will expire at the end of the following session or at the end of the first session of the 112^th Congress. 

President Obama has made 15 recess appointments, not including Dr. Berwick.

Senate Minority Leader Mitch McConnell (R-KY), along with Senators John Barrasso (R-WY), Pat Roberts (R-KS) and Tom Coburn (R-OK), objected to President Obama’s move and noted that confirmation hearings were not scheduled to allow for consideration of the nominee. Senate Finance Committee staff responded that Republicans have urged Leadership to expedite Dr. Berwick’s confirmation hearing and hold it before Supreme Court Justice nominee Elena Kagan’s hearing.

Last week, the House and Senate adjourned for the Fourth of July recess without extending the Medicaid FMAP funding increase or COBRA insurance despite the call of numerous Governors on Congress to extend the enhanced FMAP funding through June 2011. Republican Senators continue to object to extending these provisions unless they are fully offset. Republican Senator Scott Brown of Massachusetts introduced a bill to extend the FMAP funding. The bill would be paid for with unused stimulus funding. However, reapportioning stimulus funding stands little chance of being politically palatable to Democrats. Congressional staff have signaled determination in passing an FMAP extension, perhaps in a supplemental spending bill or Gulf relief legislation.

The House amended and passed a Senate-approved war supplementing spending bill before it adjourned. The House amended the bill to include Senator Herb Kohl’s legislation, the “Preserve Access to Affordable Generics Act,” which would ban agreements between brand name and generic drug manufacturers. Senator Kohl has called such agreements “one of the most egregious tactics used to keep generic competitors off the market leaving consumers with unnecessarily high drug prices.” The Generic Pharmaceutical Association, however, expressed opposition to the amendment noting that such agreements have, at times, allowed generic drugs to come to market before the patents of the name brand drugs expire.

Last week, the Centers for Medicare and Medicaid Services released the 2011 Physician Fee Schedule Proposed Rule. CMS estimated that without Congressional action, physician payments would be cut by 23 percent beginning on December 1 and reduced by an additional 6.1 percent beginning January 1, 2011. Congress is almost certain to have a lame duck session in which Members will pass another short-term SGR fix.

Capital Thinking Radio Show July 1, 2010

If you missed the Capital Thinking Radio Show with Kevin O’Neill last week, listen to the podcast on demand. 

Join us as we examine the hurdles of turning the new health care bill into a reality with advocacy leaders John Jonas and Julie Black.

Last night, the House passed the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010,” which will increase Medicare reimbursement to physicians by 2.2 percent through November 30, 2010. President Obama signed the legislation into law on June 25. 

Amy Hall, Director of the Office of Legislation at the Centers for Medicare and Medicaid Services (CMS) issued a notice to Hill staff explaining that Medicare physician “claims containing June 2010 dates of services which have been paid at the negative update rates will be reprocessed as soon as possible.” The notification indicated that contractors have been instructed to stop processing claims with the 21 percent cut and to hold claims for services provided in June until the 2.2 percent update is loaded into the claims processing systems.      

Congress is likely to reconvene after the November elections for a lame duck session. The short-term SGR fix along with a number of Medicare extenders that were included in the Affordable Care Act (ACA) will expire before the end of the year. In addition to addressing the Medicare physician reimbursement rate, Congress will likely extend:

• the floor on geographic adjustments to the work portion of the Medicare physician fee schedule;
• the process of allowing exceptions to limitations on medically necessary therapy;
• the policy that directly reimburses qualified rural hospitals for specified laboratory services;
• bonus Medicare payments to ambulance services provided in rural and other areas; and
• the physician fee schedule mental health add-on to increase the payment for psychiatric services.

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius spoke today at the National Partnership for Women and Families luncheon. The Secretary is only the fourth woman to lead the department.

She provided an update on the implementation of the Affordable Care Act (ACA), noting that it is the best woman’s health care bill since Medicare because it gives women more control over their health care. The Secretary stated that the law brings fairness into the marketplace because it prohibits insurance companies from charging women more for insurance than men. She applauded that being a woman is no longer a pre-existing condition. Secretary Sebelius highlighted that ACA limits co-payments for key preventive services. She explained the importance of this provision by noting that early detection of breast cancer yields a 98 percent survival rate.

The Secretary touted President Obama’s Patient Bill of Rights, which reiterates that beginning this fall, insurance companies cannot deny coverage for children who were born with or develop pre-existing conditions, prohibits recessions beginning in September, phases out the annual and lifetime limits, and protects patients’ choice of doctors.

Secretary Sebelius explained that ACA is important for older women, who live longer than men and tend to depend on Medicare in larger numbers. The law will reduce fraud and abuse and close the donut hole.

She stated that health information technology (HIT) is an underpinning of care coordination and management of chronic conditions. The Secretary applauded the President’s investment in HIT that was included in the American Recovery and Reinvestment Act (ARRA).

She concluded that the Affordable Care Act moves toward building a system where women receive the security, flexibility, and quality care that they deserve.

The Senate continues to focus its attention on consideration of legislation to extend unemployment benefits, COBRA insurance, and the increased FMAP rate.  This afternoon, Senate Finance Republicans circulated the most recent Senate amendment in the nature of a substitute for H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, compared to an earlier version along with a CBO score of the legislation.

On the Senate floor, Majority Leader Harry Reid (D-NV) indicated that Senate Finance Committee Chairman Max Baucus (D-MT) is working to revise the substitute amendment.  The Majority Leader signaled that he will determine how to proceed on the measure later tonight or tomorrow morning. 

UPDATE:  Sen. Baucus filed a revised subsitute amendment during the evening of June 23. A cloture vote on the measure is expected on Friday.

On June 17, 2010, the National Quality Forum (NQF) hosted a webinar focused on the intersection of health information technology (HIT) and quality improvement. 

Dr. Marc Overhage, MD, PhD, Director of Medical Informatics at Regenstrief Institute, reviewed the goal of the Health Information Technology for Economic and Clinical Health Act (HITECH) to improve care and the efficiency of care. He stated that the key to HITECH is the definition of “meaningful use.”  He reported that the Centers for Medicare and Medicaid Services (CMS) is close to issuing its final rule that will establish the definition of meaningful use. He speculated that the Agency will soften the definition of meaningful use in the final rule, but that the proposed and final rules will be very similar. He stated that the Agency’s goals in 2010 are data capture and sharing.  In 2013, the goal is increased data use to improve the quality of care and in 2015 CMS intends to focus on substantially improving outcomes for patients. 

Dr. Overhage described the incentives established in HITECH to encourage physicians to become meaningful users of EHRs.  He stated that the EHR adoption timeline is constructed in a graduated incentive model and that the Federal government hopes that many providers will adopt EHRs early.  He noted that if providers become meaningful user in 2011 and 2012, they will receive the full incentive payment. 

He highlighted the connection between the National Priorities Partnership priorities and the health outcomes policy priorities established in HITECH. He reported that patient and family engagement, population health, safety, and care coordination were common themes. The National Priorities Partnership also identified palliative and end-of-life care and overuse as additional priorities. 

Dr. Overhage shared that Regenstrief has established a Quality Health First® Program that uses HIT to drive performance measurement and quality improvement. The program has incorporated a Medicare demonstration program, which allows Medicare providers to participate along commercial providers and provide incentives.  He explained that providers receive incentive payments based upon their own quality improvement, even if they are the worst performing among providers. In 2009, a 5 percent improvement in quality was reported across the 1,000 primary care providers. 

He stated that NQF is convening the HIT and Quality Committees to: (1) help build the electronic infrastructure to help automate performance measurement; (2) encourage and harmonize information standards; (3) facilitate coordination between quality and HIT communities; and (4) establish quality measurement and clinical decision support to occur in simultaneous fashion.

NQF will host another webinar on July 16 at 12:00 pm Eastern Time focused on quality and leadership.

The Department of Health and Human Services released the Interim Final Rules for Relating to Status as a Grandfathered Health Plan under the Patient Protection and Affordable Care Act.