Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


House Scheduled to Advance Appropriations and FDA Legislation

Having adopted the FY 2014 302(b) federal spending cap allocations, this week the House will move forward to consider the passage of H.R. 2216, the Military Construction and Veterans Affairs, and Related Agencies Appropriations Act, and H.R. 2217, the Department of Homeland Security Appropriations Act. The House republican majority intends to continue sequestration as contained in the Budget Control Act (BCA); however, several efforts are underway in the Senate to give the Administration more flexibility in shifting funds among various line items to help ameliorate the effects of sequestration. A plan being worked on by Senators Patrick Toomey (R-PA), Joe Manchin (D-WV) and James Inhofe (R-OK) would allow the President to make certain adjustments, while a plan being devised by Senator Susan Collins (R-ME) would allow each department and agency to make adjustments, subject to the approval of both the House and Senate appropriations committees. On Monday, June 3rd, the House is scheduled to take up the following legislation under the suspension calendar--H.R. 1919, the Safeguarding America’s Pharmaceuticals Act of 2013, legislation designed to help ensure drug safety by establishing a uniform national standard for securing the pharmaceutical distribution supply chain; and S. 622, the Animal Drug and Animal Generic Drug User Fee Reauthorization Act of 2013.

PPACA Bill Cleared for House Consideration

With the passage of H.R. 1549, the Helping Sick Americans Now Act, by the House Energy and Commerce Committee and with a rule for consideration in the House having already been adopted, the House could also soon take up this legislation. As currently constituted the bill would overturn the Department of Health and Human Services (HHS) freeze on new applications for health coverage under the PPACA Pre-Existing Condition Insurance Plan (PCIP) and provide funding of the program through CY 2013 by transferring amounts allocated to the PPACA Prevention and Public Health Fund during FY 2013-2015.

Republicans Again Ask for PPACA-Related Investigations

Senators Orrin Hatch (R-UT) and Lamar Alexander (R-TN) followed up their request for the Government Accountability Office (GAO) to investigate HHS Secretary Sebelius’ outreach to insurers to assist in informing the public about enrollment and exchange eligibility rules under the PPACA with another similar letter to the HHS Inspector General Daniel Levinson. They asked for a response by June 14 on whether appropriations or ethics laws were violated by Secretary Sebelius. Senator Hatch also sent a letter to Secretary Sebelius asking for an explanation on how HHS established priorities in reimbursing employer-sponsored health plans under the PPACA’s Early Retiree Reinsurance Program (ERRP). The Senator asked why the agency front-loaded payments so that funding ran out early and asked for the status of audits and other program claims information. In addition, Senator John Cornyn (R-TX) and Rep. Phil Roe (R-TN) sent a letter to the Secretary asking her to recuse herself from any involvement with the implementation of the PPACA’s Independent Payment Advisory Board (IPAB). House and Senate Republican leaders have refused to name their 3 members to the 15-member IPAB; however, the health law would allow the Secretary to intervene and name such members to allow the Board to obtain a majority for its establishment and operation.

Small Business SHOP Program Delays

The Centers for Medicare and Medicaid Services (CMS) issued a final rule which makes clear that in 2014 the PPACA’s Small Business Health Options Program (SHOP) will offer small business employees a single health plan, rather than multiple plans, in the 33 states in which the federal government has a role in operating health insurance marketplaces. In the 16 states and DC which will operate their own exchange marketplaces, the states may offer one or more than one plan. CMS said that beginning in 2015 all state and federally run marketplaces would be required to offer multiple health plans under the SHOP program.

Final Rules for Wellness Program Incentives

The Internal Revenue Service and Department of Labor released final rules for group health plan wellness incentive programs which are designed to prevent prohibited discrimination based on an individual’s health status. Among other things, in general the rule allows permissible rewards of up to 30% and allows up to 50% for wellness programs intended to prevent or reduce tobacco use. The agencies also sent to Congress a report on wellness programs.

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