House Passes ACA Fix
On Friday, the House passed a bill (H.R. 3350) that would allow health insurers to sell individual health policies in 2014 that were in effect as of January 1, 2013, even if they don’t meet minimum coverage requirements set by the Affordable Care Act (“ACA”). Passage of the bill, comes a day after the President announced that insurers can offer consumers the option to renew their 2013 health plans next year.
One difference between the two plans is that the House bill would allow individuals who are not currently insured to sign up for new plans that do not meet the ACA’s minimum standards of coverage. The administration’s fix would not. In announcing the administrative fix, HHS informed congress they will consider the impact of their “transitional policy” in assessing whether to extend it beyond 2014.
Despite the bill passing the House with the support of 39 democrats, Senate leadership has indicated they would not bring the bill up for a vote, and the White House said President Obama would veto any version of the House bill that reached his desk.
HHS Report Calls for Increased Scrutiny on Hospital Outlier Payments
On Wednesday, HHS’s Office of Inspector General (“OIG”) released a report saying that a group of 158 hospitals, mostly larger urban hospitals and teaching institutions, received a much higher proportion of Medicare outlier payments than other hospitals. According to the report, the hospitals in study charged Medicare substantially more for the same conditions even though their patients had similar lengths of stay as the other hospitals receiving payment.
To combat the disparity in payment, OIG suggested increased monitoring of outlier payments and an examination of whether the codes for some conditions should be changed in order to discourage higher-than-appropriate billing. OIG also recommended including information about outlier payments in publicly reported CMS data.
Senate Passes Children’s Hospital Funding Legislation
On Tuesday, the U.S. Senate passed legislation (S. 1557) that would reauthorize the Children’s Hospitals Graduate Medical Education Payment Program for five years. The bill would fund the program through fiscal year (“FY”) 2018 at $300 million annually to support training physicians at children’s hospitals.
Specifically, the bill would enable the HHS Secretary to direct up to $7 million of any funding in excess of $245 million appropriated for the program to freestanding children’s hospitals that meet certain characteristics laid out in the bill. In February, the House passed a similar version of the Senate bill (H.R. 297) that would reauthorize the program through FY 2017.
MedPAC Refrains from SGR Recommendation
Late last Friday, Congress’ Medicare payment advisors (“MedPAC”) avoided making a recommendation to Congress on the Medicare physician payment formula. MedPAC noted that Congress has recently released SGR replacement packages consistent with the SGR principles that MedPAC has previously advocated. In the past, MedPAC has repeatedly warned Congress of the urgency to repeal the current payment formula.
The House Energy and Commerce Committee unanimously passed an SGR repeal bill late last summer and the Senate Finance and House Ways and Means committees released an SGR repeal and replace “framework” late last month. The framework includes a 10-year payment freeze for physicians. Neither SGR replacement proposal includes payment offsets.
Bills Introduced This Week
H.R. 3498: Rep. Sam Johnson (R-TX) introduced a bill that would allow individuals to choose to opt out of the Medicare part A benefit. The bill would allow those individuals opting out of the part A benefit to be eligible for health savings accounts.
S. 1666: Sen. Marco Rubio (R-FL) introduced a bill that amends the ACA that would impose minimum training and background check standards for employment as ACA website navigators. The bill would also impose criminal penalties for navigators who disclose confidential information.
Next Week in Washington
The Senate will attempt to complete work on compounding pharmacy legislation. The pharmacy measure would clarify the FDA’s oversight of compounding pharmacies and establish a national system for tracing drugs through the distribution chain.
For more information, please contact John F. Williams, III at 317.977.1462 or jwilliams@wp.hallrender.com.
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