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Tag Archive | "ACA"

Medicare Trustees Release 2011 Report

On May 13, the Medicare Board of Trustees released its 2011 Report on the financial status of Medicare. The Board noted that the financial picture may be understated in the report because certain assumptions are not likely to be carried out. For example, the calculation of Medicare’s solvency is based on the assumption that Congress will not intercede to prevent the Medicare physician payment cuts scheduled to go into effect on January 1, 2012.

The Medicare Trustees issued their sixth “funding warning,” meaning that for Medicare is projected to draw more than 45 percent of its funding from general government revenue. Under the Medicare Modernization Act (MMA), as a result of the warning, the President is required to submit to Congress a legislative proposal to reduce Medicare. However, the White House has not historically issued such a proposal.

The report indicated that the reforms included in the Affordable Care Act (ACA) extend Medicare’s solvency by eight years. The Trustees project that the Medicare Trust Fund will be solvent until 2024.

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House Action on Health Care Reform Repeal

Last night, the House of Representatives voted 245-189 to pass the the “Repealing the Job-Killing Health Care Law Act” (H.R. 2).  At this time, the Senate has no plans to take up consideration of the bill, which would be unlikely to pass and would almost certainly face a Presidential veto if it were to.

The House will next take up consideration of H.Res. 9, instructing House Committees to recommend measures to replace the reform law. Specifically, the resolution directs Committees to “proposing changes to existing law” that address many of their chief concerns with the health law including: provisions that spur economic growth and create jobs; lower health premiums; preserve patients’ ability to keep their health plan; provide people with pre-existing conditions access to coverage; reform medical malpractice; increase the number of insured; protect the doctor-patient relationship; provide States with more Medicaid flexibility; expand personal responsibility; prohibit taxpayer funding of abortions; eliminate waste; and do not accelerate the insolvency of entitlement programs.

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Capital Thinking Podcast

As Congress returned from the August recess, lawmakers and stakeholders geared up for the first public meeting of the Budget Control Act’s Super Committee meeting on September 8.  In preparation for the Committee’s work, the House Ways and Means Committee Democrats released a list of potential health care specific cuts that the Super Committee could consider.  The compiled list was an accumulation of pay-fors that have been offered in various deficit reduction plans.  The list totals more than $500 billion over 10 years and staff confirmed the offsets have not been officially endorsed by Members.  The list included mostly Medicare focused cuts, such as accelerated home health rebasing ($3 billion) and a new home health copay ($40 billion), post acute provider market basket freeze ($14-28 billion), increased SNF cost-sharing ($21.3 billion), elimination of the rural health hospital add-on payment ($62 billion), GME cuts ($15 billion), new cost-sharing for clinical lab services ($24 billion), new Part D rebate for dual eligible and LIS beneficiaries ($120 billion), increased cost-sharing on beneficiaries with Medigap coverage ($12-53 billion), raise Medicare eligibility age to 67 ($124 billion), freeze income thresholds for high income beneficiaries and raise premiums ($13 billion) and chained CPI ($7 billion).   In a jobs-focused speech to a Joint Session of Congress, President Obama called on the Super Committee to come up with additional cuts to pay for his newly proposed American Jobs Act, such as through “modest adjustments” to Medicare and Medicaid.

As for committee action this past week, the Senate Appropriations Committee approved the Agriculture-FDA spending measure on Wednesday (HR 2112) and the Senate Health, Education, Labor and Pensions Committee advanced two health bills in a markup on Wednesday – reauthorization measures for graduate medical education at children’s hospitals (S 958) and autism research (S 1094).  Next week the Senate Committee on Health, Education, Labor and Pensions will hold a hearing on Wednesday, September 14 “Securing the Pharmaceutical Supply Chain” and the House Energy and Commerce Subcommittee on Health has scheduled a hearing on Thursday, September 15 titled, “Cutting the Red Tape: Saving Jobs from PPACA’s Harmful Regulations.”

The Obama Administration welcomed good news last week when a Virginia-based U.S. District Court of Appeals threw out two challenges to the health care reform law, the Affordable Care Act.  In a high profile case filed by the Commonwealth of Virginia by Attorney General Ken Cuccinelli, the court said that Virginia lacked standing to bring suit against the law.   The Attorney General filed the suit the day the Affordable Care Act was signed into law.  In the second case, filed by Liberty University of Lynchburg, Va., the appeals judges set aside a district court decision that the law is constitutional and ordered that the lawsuit be dismissed because the district court does not have jurisdiction to hear the challenge.  The Supreme Court is still likely to consider the constitutionality of the Affordable Care Act in the near future.

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Republican Governors Outline Policy Options for Medicaid Reform

The Republican Governors Public Policy Committee issued a report in response to a request from House Energy and Commerce Committee Chairman Fred Upton that includes the following policy options for Medicaid reform:

  • Repeal the Affordable Care Act and replace it with market-based reforms;
  • Allow states to define an outcome-based program operating agreement with CMS (program would include a limited number of measures and eliminate federal review process for Medicaid programs);
  • Enable states to measure accountability through measures of quality, cost, access and customer satisfaction;
  • Repeal maintenance of effort requirements; Entrust the state with responsibility for program integrity;
  • Require the federal government to assume the cost of uncompensated care for illegal aliens;
  • Allow states to pilot programs to reduce the occurrence of cost-shifting between the state and federal programs;
  • Permit a state (if it can demonstrate budget neutrality) to use state or local funds to pay for Medicaid services of system improvements that are not currently “matchable;”
  • Encourage states to develop innovative programs to reduce chronic illnesses, emergency room visits, and hospitalizations;
  • Provide states with the ability to implement bundling projects;
  • Allow states to use only one managed care organization (rather than at least two as currently required by CMS);
  • Amend ACA’s eligibility definition to reverse the use of MAGI;
  • Allow states to contract with private firms to streamline eligibility determination;
  • Provide states with flexibility to design benefit structures;
  • Eliminate benefit mandates that exceed private insurance market benchmark or benchmark equivalent;
  • Permit states to divide Medicaid into different parts; and
  • Engage in shared savings arrangements for dual eligible beneficiaries.

The report will serve as the basis for the Committee’s Health Care Summit in Washington in October.

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HHS and IRS Issue Exchange Regulations

On August 12, the Department of Health and Human Services (HHS) and the Department of the Treasury proposed regulations relating to the establishment of the State-based Affordable Insurance Exchanges mandated by the Affordable Care Act (ACA).

The Proposed Rule on Exchange Functions seeks to implement certain functions of the Exchanges established in the ACA.  The Affordable Care Act requires that health plans offered through the Exchange be certified as Qualified Health Plans (QHPs). HHS proposes that the Exchange perform eligibility determinations for enrollment in a Qualified Health Plan (QHP). HHS sets forth standards for eligibility, eligibility determination process, and applicant information verification process.  Additionally, the Department tasks the Exchange with determining eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) and subsequently notifying the State Medicaid or CHIP agency with the applicant’s information.

The Internal Revenue Service (IRS) of the United States Department of the Treasury released a Proposed Rule, entitled “Health Insurance Premium Tax Credit,” to implement Section 1402 of the ACA. Section 1402 the ACA amended the Internal Revenue Code to allow a refundable premium tax credit intended to help make health insurance coverage more affordable by reducing out-of-pocket premium costs. The IRS has scheduled a public hearing for November 17, 2011, which will be held at the Internal Revenue Building in Washington, D.C.

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Sen. Coburn Proposes Deficit Reduction Plan

Yesterday, Sen. Tom Coburn (R-OK) proposed a deficit reduction plan, “Back in Black,” which would achieve $106.7 billion/10 years in savings from the Department of Health and Human Services (HHS).  His proposal:

  • Reduces Medicare and Medicaid fraud, waste, and abuse
  • Repeals the Affordable Care Act
  • Repeals the Independent Payment Advisory Board (IPAB)
  • Repeals the Community Living Assistance Services and Supports program (CLASS)
  • Repeals policies that increase the cost of health care insurance for individuals – the medical device and pharmaceutical drugs fees and the health insurance excise tax
  • Repeals Medicaid expansion
  • Repeals individual mandate
  • Eliminates Children’s Hospital GME
  • Reduces improper payments, modernizes HHS’ systems, controls unnecessary costs, and improves management of resources
  • Cuts administrative budget
  • Allows American to purchase health insurance across state lines
  • Adopts medical malpractice reform

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HHS Releases Draft Regulations to Implement CO-OP Program

Today, the Department of Health and Human Services (HHS) issued draft regulations that would implement the Consumer Operated and Oriented Plan (CO-OP) program.  The program would provide loans to foster the creation of consumer-governed, private, nonprofit health insurance issuers to offer qualified health plans in the state health insurance exchanges. The purpose of this program is to create a new CO-OP in every state in order to expand the number of health plans available in the exchanges with a focus on integrated care and greater plan accountability.

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HHS Releases Draft Regulations on Exchanges

Today, the Department of Health and Human Services (HHS) released draft regulations on the health insurance exchanges authorized by the Affordable Care Act:

  • Requirements To Implement American Health Benefit Exchanges and Other Provisions of the Affordable Care Act (CMS-9989-P)
  • State Requirements for Exchange–Reinsurance and Risk Adjustments (CMS-9975-P)

Fact sheets are available online.

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CMS Announces New ACO Initiatives

Earlier this year, CMS release regulations on one of the signature health care reform proposals – the Accountable Care Organization. Perhaps to the Agency’s surprise, hospitals and physicians, who would be eligible to develop an ACO, have outlined numerous concerns with the proposal. Recognizing various concerns, on May 17, the CMS Center for Medicare and Medicaid Innovation announced three initiatives that would encourage doctors, hospitals, and other health care providers to become an Accountable Care Organization (ACO).

CMS is accepting applications for a Pioneer ACO Model, which is designed for organizations that already have an ACO or significant care coordination processes. The model is intended to work in conjunction with private payers to achieve cost savings and improve outcomes. Organizations interested in applying to the Pioneer ACO Model must submit a letter of intent on or before June 30, 2011. Applications must be received on or before August 19, 2011. In addition, the Agency requests comments on whether it should offer an Advanced Payment ACO Initiative that would allow certain ACOs participating in the Medicare Shared Savings Program access to a portion of their shared savings up front to help make the necessary investment critical to a successful ACO. Comments are due to CMS by June 17, 2011. Finally, CMS will host Accelerated Development Learning Sessions that will detail for providers the ways in which they can improve care delivery and develop an action plan for better coordinating care. The first of four learning sessions will be held in Minneapolis, Minnesota from June 20-22.

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Update on ACO Regulations

CMS officials continue to report that the ACO Proposed Rule will be released “very soon.”  CMS Deputy Administrator Marilyn Tavenner has signaled that CMS will issue the regulations by the end of March.

CMS officals of of late have alluded to regulations that provide the opportunity for lots of different providers to participate and signaled to stakeholders that they should expect to see cutting edge ideas for ACOs.   We understand that CMS intends to issue a solicitation for ”Pioneer Pilot Projects” shortly after the ACO Proposed Rule is released.

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