The impact of the debt-ceiling deal on health care reform is yet to be determined. Medicare and Medicaid beneficiaries are off the table but providers are most certainly not safe. Also, some but not all of the Affordable Care Act's programs are in play. And that's IF the joint committee agrees on cuts. If it fails, then Medicare automatically drops 2 percent across the board. The bottom line is that in the next few months nearly every federal health care dollar is at risk.
CMS, also issued a number of rules and statements, one of which requires insurance companies to fully cover certain women’s health benefits, including “the morning-after pill” without requiring a co-pay. Also making headlines this week, Sec. Sebelius and CMS Administrator Don Berwick announced that premiums for the Medicare Part D prescription program will cost seniors slightly less in 2012.
ON THE HILL
This week, President Obama and Congress struck a deal to raise the nation's debt ceiling. The deal calls for the creation of a 12-member commission, comprising Democrats and Republicans selected from Congress, which will recommend a method of cutting $1.2 trillion in federal spending over the next two years. According to Kaiser Health News, though Medicare and Medicaid are protected from being cut in the first round of budget trimming, they are not protected in the next round of cuts. Additionally, if Congress cannot find a way to cut at least $1.2 trillion over the next 10 years, the debt-ceiling law will trigger automatic cuts, including a 2 percent reduction in Medicare payments to hospitals and other providers. According to CQ, hospital industry executives, doctors, and other health care providers are concerned about the implications of the deal, especially for Medicare beneficiaries.
On Monday (8/1), House Republicans requested details from HHS Sec. Sebelius about the rights of individuals and groups to challenge decisions by the IPAB. Energy and Commerce Chairman Fred Upton (R-Mich.) said the Affordable Care Act dictates that there be no administrative or judicial review of IPAB decisions.
On Thursday (8/3), Reps. Camp and Upton sent a letter to Sec. Sebelius in support of Michigan's request for a waiver from the medical-loss ratio provision of the Affordable Care Act.
IN THE COURTS
On Wednesday (8/3), the U.S. Court of Appeals in Philadelphia affirmed a lower court’s December decision that in the case of New Jersey Physicians Inc. v. President of the U.S., New Jersey Physicians Inc. failed to plead an “injury in fact.”
AT THE AGENCIES
The Affordable Care Act requires insurers to provide consumers with an opportunity to appeal if their requests for coverage are denied. HHS defers to state’s individual laws so long as they meet a set of minimum criteria. On Wednesday (8/3), HHS posted to its website a list of the states that do and do not satisfy the criteria. Laws in 23 states meet the insurance commissioners’ criteria, and 10 states have similar laws, which gives them until 2014 to amend them so that they meet standards. The remaining 17 states plus Washington D.C. do not fit into either of these categories and that could mean the federal government would have to administer rules in these states. States have until October 1st to protest this categorization.
CMS announced that payments to skilled nursing facilitates will be cut by $3.87 billion for FY 2012, an 11.1 percent drop from FY 2011 but still 3.4 percent higher than FY 2010 rates. The final rule is effective October 1.
The previous Friday (7/29), HHS awarded $71.3 million in grants to expand nursing education, training and diversity. This allocation is the result of the Affordable Care Act’s reauthorization of nursing workforce development grants, which are the primary means of federal funding for nursing education.
In a press release on Monday (8/1), CMS presented its final rule for the FY 2012 Inpatient Prospective Payment System. The rule establishes a documentation and coding adjustment of -2.0 percent instead of the proposed -3.15 percent.
On Thursday (8/4), HHS Sec. Sebelius and CMS Administrator Berwick announced that premiums for the Medicare Part D prescription program, which allows seniors and other Medicare beneficiaries to register for a privately administered, government-subsidized health plan to get prescriptions, will decrease slightly next year. Premiums in 2012 will average about $30, down from $30.76 in 2011. The officials reported that since the Affordable Care Act’s enactment, seniors have saved $460 million in prescription drugs.
Joel Ario, director of the state-based health insurance exchange office at HHS, is leaving his post in September. Insurance Oversight Director Steve Larsen and deputy director for HHS’ health reform office Tim Hill will take over planning the insurance exchanges. Some state officials have expressed concern about these changes at a time when the states most need guidance in implementation.
In new guidelines released Monday (8/1), HHS said that insurance companies must fully cover emergency contraception and HIV and HPV screening along with several other women’s health services without requiring co-pays. The administration will exempt some religious institutions opposed to birth control. These changes follow recommendations from the Institute of Medicine’s July 19th report.
According to a final rule issued Monday (8/1) by CMS, Medicare payment rates for inpatient services at acute-care hospitals will increase 1 percent in FY 2012, and payment rates for long-term acute-care hospitals will increase 1.8 percent.
On Sunday (7/31), CMS Administrator Berwick wrote an op-ed in Politico titled, “U.S. health care system fails to deliver,” in which he argues that the Affordable Care Act can fix these failures through initiatives like the Partnership for Patients, Accountable Care Organizations, and the creation of the Center for Medicare and Medicaid Innovation.
IN THE STATES
According to a Wednesday (8/3) announcement by HP Enterprise Services, which designed and built the Medicaid Management Information System (MMIS) in Massachusetts, CMS has approved MMIS.
On Monday (8/1), CMS announced it would extend New Jersey’s wage index floor policy for two years. This announcement was the product of an intense lobbying campaign organized by Sen. Robert Menendez and accounts for close to $90 million each year in Medicare payments to almost 40 New Jersey hospitals.
THIS WEEK
On Tuesday (8/9) beginning at 10 a.m. and Wednesday (8/10) beginning at 9 a.m. at the Westin Washington DC City Center, the National Advisory Council Subcommittee Identifying Quality Measures for Medicaid Eligible Adults held an advisory committee meeting.
On Thursday (8/11) at 12:15 p.m. in Hart Room 902, the Alliance for Health Reform hosted a briefing titled, "Improving Care and Managing Costs: Team- based Care of the Chronically Ill."
As always, please feel free to contact us with any questions.
To view our compilation of recent health care reform implementation news, click here.