A judicial update. A legislative update. The big administrative story was of course the issuance of the ACO regulations, which we already shared with you separately, and more activity both pro and con in the states. Let's see what this week brings.
This week the Obama Administration formally responded to Judge Vinson’s ruling that the individual mandate of the Affordable Care Act exceeded Congress’s power to regulate interstate commerce. The Justice Department filed its appellate brief with the U.S. Court of Appeals for the 11th Circuit arguing, “The minimum coverage provision of the Affordable Care Act is a valid exercise of Congress’ commerce power.” On a related note, the Appeals Court scheduled oral arguments for June 8, 2011. The court denied the request for an en banc hearing sought by the 26 states that brought the original suit. The general understanding is that this case is ultimately headed to the Supreme Court.
On Thursday (3/31), the House Energy and Commerce Health Subcommittee approved five bills intended to limit the HHS secretary’s spending authority. The subcommittee voted that Congress must approve spending for 1) grants for states to establish health insurance exchanges; 2) the prevention and public health fund; 3) grants to support the construction of school-based health centers; 4) grants for personal responsibility education programs; and 5) development grants for teaching health centers. The subcommittee’s press release on the bills can be found here: http://energycommerce.house.gov/News/PRArticle.aspx?NewsID=8412.
The long-awaited Accountable Care Organization (ACO) regulations were released on Thursday, March 31. They can be found here: http://www.ofr.gov/OFRUpload/OFRData/2011-07880_PI.pdf. HHS will accept comments on the proposed rule for 60 days. In an article he wrote in the New England Journal of Medicine this week, CMS Administrator Don Berwick, MD, said he will listen carefully to concerns about the proposed rules. Also in Berwick’s article, he said the Center for Medicare and Medicaid Innovation will be used to begin testing “innovative models for a nationwide technical support platform for ACOs, to complement the numerous ongoing efforts in which the private sector is already engaged.” The ACO regulations enable physicians, hospitals and other health care professionals to form networks through which they can coordinate patient care and share in any savings they generate for the government by keeping Medicare patients healthy. Among the key effects CMS’s proposed ACO regulations would have are: 1) If you are a Medicare provider who participates in the Independence at Home Medical Practice Pilot Program or another Medicare program involving shared savings, then you cannot participate in the Shared Saving Program as an ACO participant. 2) An Accountable Care Organization may include ACO professionals, networks of individual practices of ACO professionals, partnership or joint venture arrangements between hospitals and ACO professionals, hospitals employing ACO professionals, and other Medicare providers and suppliers as determined by the HHS secretary. 3) ACOs will apply for three-year programs, which will begin on January 1st. For a more thorough list of provisions within the regulation, see http://www.beckershospitalreview.com/hospital-physician-relationships/10-key-points-in-newly-released-proposed-rules-on-acos.html.
This week CMS began implementing a provision of the Affordable Care Act that went into effect January 1, 2011. The provision requires physicians to meet face-to-face with individuals who want to be certified for Medicare home health and hospice services. CMS’s rule interpreting the home health services provision requires that: 1) the health care professionals who make certification decisions provide documentation of their in-person visit; and 2) the meeting occurs within the 90 days before the care begins or 30 days after care starts. In interpreting the hospice services provision, CMS said a hospice physician or nurse practitioner must have a face-to-face encounter with the hospice patient prior to the 180th day recertification and no more than 30 days prior to the patient’s third benefit period.
During the month of March, the Obama Administration granted 128 more waivers from the Affordable Care Act’s provision requiring at least $750,000 in annual benefits, bringing the new total number of waivers to 1,168.
In the states this week:
1) The Minnesota Senate approved a sweeping overhaul of the state’s government-funded health care system, which would force over 100,000 people below or near the poverty line into the private market for health insurance. It is expected that Democratic Gov. Mark Dayton will veto this plan.
2) The Missouri House gave initial approval to a measure that would enable Missouri to join a health care compact.
3) Legislation that would block “discretionary provisions” in the Affordable Care Act passed the Idaho House.
4) The Florida House approved a plan that basically shifts 2.9 million Medicaid beneficiaries into managed care in hopes of curbing the costs of a $20 million program. House Bills 7107 and 7109 split the state into eight regions, each of whose Medicaid recipients will be covered by unique managed-care plans.
5) Also in Florida, the House Health & Human Services Quality Subcommittee approved House Joint Resolution 1, a proposed constitutional amendment, which says, “A law or rule may not compel, directly or indirectly, any person or employer to purchase, obtain, or otherwise provide for health care coverage.”
As always, please feel free to contact us with any questions.
To view our compilation of this week's health care reform implementation news, click here.