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 Proceedings on Budget Bills and CLASS Act

Last week the House voted 267 to 159 to pass H.R. 1173, legislation which would repeal the PPACA CLASS Act.  Also, the House passed H.R. 3578, the Baseline Reform Act of 2011, which would change CBO rules for setting the discretionary spending baseline by preventing the use of inflation and population growth in baseline determinations.  Although the Senate is unlikely to consider the legislation, the adoption of such a rule change would result in appropriations projections falling below the Budget Control Act statutory caps.  This week the House is expected to take up two additional budget bills: H.R. 3521, the Expedited Legislative Line-Item Veto and Rescissions Act of 2011; and H.R. 3581, the Budget and Accounting Transparency Act of 2011.  Also, the House could also consider possible motions to instruct conferees on H.R. 3650, the Temporary Payroll Tax Cut Continuation Act of 2011.  Conferees met on the latter bill last week and there appeared to be a push among several Republicans and Democrats to find $300+ billion over ten years in order to pay for a long-term fix to the Medicare Physician Payment System’s “sustainable growth rate” problem.  Several conferees suggested using unspent defense funding for the Iraq and Afghanistan wars (i.e. the Overseas Contingency Operations fund); however, the conference chairman, Rep. Dave Camp, said such funding would be outside the scope of the conference.  CBO also suggested that such a move could violate the PayGo budget rules.  Rep. Henry Waxman suggested that the funding could also come from the closing of corporate tax loopholes, cutting tax breaks for oil companies and increasing taxes on those with annual income of more than $1 million.  Senators Joseph Lieberman and Tom Coburn wrote Senate leaders asking them not to use the OCO to pay for a doc fix.  If the conference members, who are expected to meet three times this week, decide to seek a long-term fix, it is likely that the upcoming February 29, 2012 deadline will be extended in order for other payfors to be considered.  The CBO issued a report stating that just maintaining the current Medicare physician payment rates over ten years would cost about $316 billion.  The report also said that Medicare spending would rise 90% to over $1 trillion by 2022 and that Medicaid spending would amount to $605 billion in that year.

CMS Seeks to Maintain Current EMTALA Rule

CMS gave notice that it is seeking comment for the next 60 days on its decision to continue current hospital responsibilities to provide emergency care under the Emergency Medical Treatment and Labor Act (EMTALA).  The current policy states “if an individual ‘comes to the hospital’s emergency department’ as we have defined that term in regulation, and the hospital provides an appropriate medical screening examination and determines that an emergency medical condition exists, and then admits the individual in good faith in order to stabilize the EMC, that hospital has satisfied its EMTALA obligation towards that patient.”

IOM Recommendations on Chronic Disease

A report issued by the Institute of Medicine says that about 133 million Americans have a chronic disease--such as arthritis, cancer, dementia, depression, schizophrenia, Type 2 diabetes, etc.--with a quarter having two or more such conditions.  The IOM said that Medical costs associated with such conditions total about $1.5 trillion annually and constitute about 75% of all national health care spending.  The report makes seventeen recommendations to help streamline chronic disease care and to improve the quality of life for patients.  It recommends that the CDC target a variety of chronic illnesses and avoid addressing conditions that already have dedicated public health programs, such as cardiovascular disease; and that HHS help states develop comprehensive plans to manage chronic illnesses.

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