CMS Promotes Medicaid Enrollment Under PPACA

CMS provided state Medicaid programs with a list of five targeted Medicaid Enrollment Strategies in an effort to expand the state programs under the PPACA rules. The strategies focus on individuals for whom states already have eligibility information on file, including: adopting 12-month continuous eligibility for parents and other adults; implementing the early adoption of Modified Adjusted Gross Income (MAGI)-based rules; extending the Medicaid renewal period so that renewals that would otherwise occur during January through March of 2014 occur later; and enrolling individuals into Medicaid based on Supplemental Nutrition Assistance Program (SNAP) eligibility. Subject to other requirements, CMS said that states using the strategies would be able to take advantage of the PPACA enhanced Federal Medical Assistance Percentages (FMAP) rules, 90% for developmental costs and 75% for operations.

New Medicare Doc Fix Legislation to be Released

The House Ways and Means and Energy and Commerce Committees announced that they intend to release new legislative language this week which would implement proposed changes to the current Medicare physician payment SGR system. On June 5th the House Energy and Commerce Health Subcommittee has scheduled a hearing to take testimony on the legislation. House Republicans are expected to insist that the cost of the legislation be offset, but that the form such pay-fors will take will be decided on later.

House W&Ms Health Subcommittee Discusses Medicare Reform

Witnesses at a House Ways and Means Health Subcommittee hearing testified that Medicare reform should take place as soon as possible given the program’s impending insolvency. Among the changes discussed that would help extend program solvency are measures to: increase the Part B deductible; raise Parts B and D premiums for higher-income individuals; limit Medigap coverage to help reduce unnecessary expenditures and create a public Medicare supplemental plan; introduce a home health care beneficiary copayment; and totally restructure the Medicare program (e.g. to provide one deductible for Part A and B, etc.). However, some witnesses cautioned that such cost-saving measures should only be considered together with broad structural reforms that would also provide new protections for low-income beneficiaries such as requiring drug companies to provide rebates for dual-eligibles. Chairman Kevin Brady (R-TX) said that that the main question is how Congress can act in 2013 to extend Medicare solvency for 20 years. Rep. Jim McDermott (D-WA), however, said that the several Medicare reforms in the President’s budget should not be cherry-picked but be considered only in connection with a grand, balanced budget deal.

GAO to Investigate Accuracy of Part D Online Plan Finder

Senators Bill Nelson (D-FL) and Susan Collins (R-ME) have asked the Government Accountability Office (GAO) to investigate whether information on Medicare Part D prescription drug plans and associated drug pricing on the Medicare Part D plan finder is complete and accurate and displayed in a consistent manner so as not to mislead beneficiaries. They also asked GAO to determine if plans are meeting the required CMS marketing guidelines. In a follow-up hearing held by the Senate Special Committee on Aging, witnesses from the drug industry and consumer interests generally praised the Part D program as providing necessary access for seniors and providing help in lowering beneficiary costs as well as other hospital and medical costs that beneficiaries might otherwise have incurred without the drug coverage. However, the AARP witness urged the passage of H.R. 1588 and S. 740, the “Medicare Drug Savings Act,” which would require drug manufacturers to offer new rebates for drugs provided to Medicare/Medicaid dual-eligibles.

Meaningful Use Incentive Payment Stats

HHS announced that Medicare and Medicaid Electronic Health Record Incentive programs will have been successful in providing incentive payments to over 50% of doctor offices and 80% of hospitals for adopting electronic health record systems through 2013. CMS has awarded $14.6 billion in such payments to date.

SAMHSA Comes Under Fire in House Hearing on Mental Health

At a House Energy and Commerce Oversight and Investigations Subcommittee hearing, Chairman Tim Murphy said that the Substance Abuse and Mental Health Services Administration (SAMHSA) “has not made the treatment of the seriously mentally ill a priority” in light of the Newtown, Connecticut elementary school shooting. The SAMHSA Administrator disagreed and said that about 21-25% of the agency’s budget is devoted to serious mental illnesses and emotional disturbances. Democrats noted that sequestration will have a negative effect on the agency’s priorities and that Congress can help alleviate the shortfall through the appropriations process.

Senate HELP Committee Approves Compounding and Drug Supply Chain Bills

The Senate HELP Committee has cleared for floor action a bill combining S. 959 (the Pharmaceutical Compounding Quality and Accountability Act) and S. 957 (the Drug Supply Chain Security Act). The compounding provisions would give the FDA authority to regulate “compounding manufacturers” which make sterile products without, or in advance of, a prescription and sell them on an interstate basis. The drug supply chain provisions would provide for a uniform federal standard for tracking drugs that would replace state laws and result in electronic, interoperable unit-level drug tracking for the entire country. While the House Energy and Commerce Committee has passed drug tracking legislation, H.R. 1919, the committee’s Republicans appear to be resisting legislation to further regulate drug compounding organizations with some suggesting that the FDA already has appropriate regulatory authority. At a House Energy and Commerce Health Subcommittee hearing on the latter issue, Rep. Michael Burgess (R-TX) maintained that the FDA did not take steps that might have stopped the fungal meningitis outbreak caused by a Massachusetts compounding center, even though the agency apparently knew the center was making “poor products for years.” He said the FDA has recently inspected more than 50 compounding pharmacies, indicating the agency either has the authority to oversee such compounding entities or is acting without authority and risking litigation. Rep. Joe Barton (R-TX) said that he is hesitant to preempt state regulatory authority which may be as effective as any new authority that may be given the FDA by means of legislation. Nonetheless, the Director of the FDA Center for Drug Evaluation and Research testified that new federal legislation is needed to give the FDA the tools to regulate high-risk compounding practices, particularly in light of resistance by compounders to provide the agency with access to their records.

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