The more things change . . .
This week's update brings the same ying-yang that has characterized 2011 so far. Ds implementing and Rs de-funding. No end in sight to this seesaw.
The following is the Health Care Reform Implementation Update for the week of February 21, 2011.
On Friday (2/18) the Republican-led House attached several measures to a spending bill, which would prevent enactment of the Affordable Care Act. The House passed: 1) a measure by Rep. Rehberg (R-Mont.) that would prohibit funds for implementing the new health care law; 2) two measures by Rep. King (R-Iowa) that would ban funds that would enable any provision of the law and bar salaries for government workers implementing the law; 3) a measure prohibiting funds to the IRS for enforcement of the law; 4) an amendment from Rep. Price (R-Ga.) that says no funds in the bill can be used to enforce the medical loss ratio requirement in the health care law; and 5) an amendment from Rep. Gardner (R-Colo.) that bars salaries to HHS employees developing regulations on insurance exchanges. The passing of the spending bill over united Democratic opposition sets the House on a collision course with Senate Democrats and the Obama administration. If the parties do not reach a spending agreement by March 4, funding will expire and the country may face a government shut down. The budget proposal President Obama introduced includes $465 million to implement provisions of the Patient Protection & Affordable Care Act — including more than $300 million for the Centers for Medicare and Medicaid Services.
Though House Republicans are working to prevent the federal health care law from taking effect and the country is still waiting for the Supreme Court to rule on the law’s constitutionality, the states, aided by millions of dollars from Washington, continue to implement its key provisions. On Wednesday (2/16), HHS announced the award of seven Early Innovator grants to Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin and a consortium of New England states, which together will receive about $241 million. Secretary Sebelius explained that the Early Innovator grants will enable these states to develop "a consumer-friendly marketplace where insurers must compete to deliver the best deal." The Early Innovator States have committed to assuring that the technology they develop is reusable and transferable so that the building blocks they develop for Exchange IT systems will provide models for how other Exchange IT systems can be created.
In Massachusetts on Thursday (2/17), Governor Deval Patrick proposed a Massachusetts health care overhaul that will shift 1.7 million state employees, Medicaid recipients, and other residents with state-subsidized health insurance to a new budget-minded payment system, in which hospitals and doctors are given a set fee for each patient’s care. Patrick’s plan would also establish standards for groups of hospitals and doctors called accountable care organizations. The bill would give the insurance commissioner the authority to regulate accountable care organizations and the attorney general the power to examine provider consolidation for potential antitrust problems.
Alaska Gov. Sean Parnell took a different stand on Thursday (2/17), declaring that he will refuse to implement a law he views as blatantly unconstitutional. Parnell says he considers the recent Florida ruling striking down the law as unconstitutional to be the law of the land. On Wednesday (2/16), the North Carolina Senate approved the Protect Health Care Freedom Act. The bill will now go back to the House, which passed similar legislation, for concurrence with changes the Senate made. On Saturday (2/19), Wyoming Governor Matt Mead signed a measure that puts a proposed state constitutional amendment, which asserts the right of Wyoming residents to make their own health care decisions, on next year’s ballot. On Wednesday (2/16), the North Dakota House endorsed a resolution asking Congress to repeal the health care overhaul and approved a separate state law that says North Dakotans cannot be required to buy health insurance except in limited circumstances. On Thursday (2/17), the Justice Department asked U.S. District Judge Roger Vinson to clarify the immediate impact of his ruling that declared the PPACA unconstitutional.
This week, HHS Secretary Sebelius said that Arizona could drop between 250,000 and 280,000 childless adults from the state's Medicaid program. Governors throughout the country are watching closely because many of their states, too, face massive budget deficits and are looking for ways to cut costs. In fact, in January, 33 Republican governors asked Sec. Sebelius for permission to do this as well. It is not clear whether other states will be able to take advantage of the permission granted to Arizona, however, because Arizona operates its Medicaid program under a temporary waiver that expires before 2014.
On Friday (2/18), CMS held a press conference to announce the posting of its 153-page advance notice and call letter for the 2012 Medicare Advantage and Medicare Part D prescription drug plan bidding process. Potential bidders and other stakeholders may comment on the notice and draft letter before March 4. According to the proposal, plans that have 4 or 5-star quality ratings (on a 5-star scale) will receive higher payments than other plans, and plans in some counties will receive higher payments than those in other counties. Additionally, CMS officials noted that they may eliminate some ordinary Medicare Advantage plans that have existed for 3 or more years and have fewer than 500 enrollees.
On Thursday (2/17), CMS published a proposed rule that would authorize states to identify "provider-preventable conditions" (PPCs), which will not be covered by Medicaid payments. Section 2072 of the Affordable Care Act requires the rule, which would go into effect July 1, 2011. Public comments will be accepted through March 18, 2011.
Also this week, in response to pressure from the American Association of Family Physicians, CMS announced that it will reprocess a significant number of Medicare fee-for-service claims to account for retroactive Medicare payment increases implemented in 2010.
The Government Accountability Office advised CMS to address inconsistencies in two incentive programs that encourage the use of health information technology. One program offers incentives for using electronic health records from 2011 to 2016, introducing penalties in 2015, and another offers incentives for utilizing the electronic prescribing program between 2009 and 2013, with penalties between 2012 and 2014.
In a new report from Friday (2/18), the Congressional Budget Office shows that repeal of the Patient Protection and Affordable Care Act would cut $1.4 trillion from projected federal spending over ten years and that greater cuts of $732 billion could result if the reductions in Medicare spending included in the Act were adopted separately. The CBO also says that repeal of the law would add $210 billion to the nation’s deficit over the next decade. Both Republicans and Democrats have pulled elements of the report to bolster their arguments.
Finally, the IRS is asking for $119 million in addition funds and 1,054 new auditors and staffers to enforce tax portions of the health care overhaul in fiscal 2012.
This week HHS will hold a number of meetings. On Wednesday (2/23), the National Advisory Committee on Rural Health (within HHS) will meet to hear presentations on key provisions in the health care overhaul law. Also on Wednesday, the HHS Health IT Standards Committee Workgroups will meet via web to discuss pending agenda items. On Thursday (2/24), HHS Health Resources and Services Administration Advisory Committee on Interdisciplinary, Community-Based Linkages will meet to discuss pending agenda items.
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.