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.


Medicare Physician Payment Reform and Fiscal Year 2015 Budget

Congress will need to reach consensus on how to offset the estimated $128 billion cost of reform over ten years in order to pass Medicare physician payment reform of the sustainable growth rate (SGR) formula. The enactment of S. 25, legislation to restore certain military pension cost of living adjustments (COLAs), included an extra $2.4 million in offsets earmarked to help offset the cost of SGR reform legislation. As the March 31st deadline to address the SGR nears, Congress will need to pursue another temporary patch or work to pass H.R. 4015/S. 2000, the SGR legislation introduced by the relevant health committees. Federal budget matters are also expected to heat up the week of March 4th when the President releases his fiscal year (FY) 2015 budget documents. It is reported that the Administration will abandon previous goals to reform entitlement programs which included limiting Social Security and other federal pension program COLAs by means of a “chained consumer price index (CPI)”. Budget hawks are certain to take note of a recent Government Accountability Office (GAO) study finding that in FY 2009 about 31.6% of total Medicare expenditures were related to expenses incurred by only 4.3% of all beneficiaries (largely new mothers with infants and those in long term care (LTC) facilities, having HIV/AIDS or disabilities). This week the House may also take up H.R. 2575, legislation reported by the House Ways and Means Committee that would increase the Patient Protection and Affordable Care Act’s (PPACA) 30-hour work week threshold to 40-hours.

Administration Lauds PPACA Enrollment Uptick Amid Renewed Oversight by House

Although the Congressional Budget Office (CBO) had originally estimated that enrollment under the PPACA would cover 7 million individuals, Vice President Biden said that it would be “a hell of a start” if enrollment reached five or six million by the end of March. While the Administration was encouraged by the recent acceleration in the number of individuals accessing coverage under HealthCare.gov, House Republicans continued their pursuit of fault-finding with the PPACA. House Energy and Commerce Committee Republican leaders sent a letter to GAO asking the agency to investigate the $304 million in federal funding that Oregon used in establishing its state-run health insurance exchange which Republicans said has resulted in the “catastrophic breakdown of Cover Oregon” that has failed to enroll a single individual electronically. In addition, Reps. Andy Harris (R-MD) and Jack Kingston (R-GA) asked the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) to determine whether federal funding can be recouped from the Maryland exchange which has experienced similar problems, leading Maryland legislators to consider abandoning the site in favor of HealthCare.gov. The Centers for Medicare and Medicaid Services (CMS) has also granted the troubled Massachusetts exchange three additional months, beginning April 1st, in an effort to help that exchange complete enrollment applications that remain unprocessed. While HHS did respond to Republican criticism of the narrowing of provider networks available under PPACA compliant plans, as reported last week, health insurers received bad news from Moody’s which said that this rule and the “keep your plan” ruling would be considered “further credit negatives for health insurers selling policies on the health care exchanges….”

Final Regulations on PPACA Waiting Periods Released

HHS/IRS/Department of Labor (DOL) released final regulations under the health law that requires group health plans and related health insurance issuers to comply with rules stating that such plans cannot include waiting periods that exceed 90 days from the end of an employment orientation period (no longer than one month). The rule also applies to rehires and employment reclassifications.

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