recent developments
February 3, 2011: HHS Outlines State Flexibility for Medicaid
HHS Secretary Kathleen Sebelius distributed a letter to governors outlining the flexibility and support available to states that are examining how to make Medicaid programs more efficient while meeting pressing health care challenges in the face of difficult budget circumstances. The letter includes information on the options states have to design benefits, service delivery systems, and payment strategies without a waiver, and also describes new initiatives and state-specific technical support that HHS will pursue with the states. The full letter is available here: http://www.hhs.gov/news/press/2011pres/01/20110203c.html
February 2, 2011: CMS Announces Medicare Imaging Demonstration Project Participants
CMS announced that it has selected five participants in the Medicare Imaging Demonstration (MID), a demonstration project that promotes appropriate utilization of advanced imaging services. The project is a two-year demonstration, authorized by Section 135(b) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) that will assess the impact that decision support systems used by physician practices have on the appropriateness and utilization of advanced medical imaging services ordered for beneficiaries in original fee-for-service Medicare. For more information about the demonstration, please visit: http://www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1222075
February 2, 2011: Senate Votes to Remove 1099 Requirement from ACA
The Senate approved by unanimous consent, a motion to repeal a provision in the ACA requiring businesses to submit a 1099 form to the IRS for each vendor to whom they pay more than $600 each year for goods. The measure was offered by Sen. Stabenow (D-Mich.) as an amendment to the Federal Aviation Administration bill (S 223), and it offsets the $19.2 billion in revenue lost through repealing the 1099 provision by directing the Office of Management and Budget (OMB) to rescind $44 billion in unobligated discretionary funds over the next ten years, exempting the Department of Defense, Veterans Affairs, and the Social Security Administration.
February 2, 2011: Senate Rejects ACA Repeal
The Senate rejected, by a party-line vote of 47-51, a motion offered by Senate Minority Leader Mitch McConnell (R-Ky.) to repeal the ACA in its entirety. McConnell’s measure, which was offered as an amendment to the reauthorization of the Federal Aviation Administration (S 223), contained identical language to the repeal bill passed by the Republican-controlled House on January 19 (HR 2). Upon the motion’s failure to advance in the upper chamber, Senate Republicans vowed to continue trying to repeal the ACA as a whole, and promised to bring legislation designed to strike specific provisions from the law, such as the individual mandate.
February 2, 2011: CMS Publishes Final Rule on Fraud Prevention in Medicare, Medicaid and CHIP
CMS published a final rule with comment period implementing provisions of the ACA that address fraud, waste and abuse in the Medicare, Medicaid and CHIP programs by setting forth screening processes, compliance program requirements, and punitive initiatives targeted at suppliers and providers in these programs. The rule also includes guidance for states on implementation of the ACA provisions requiring the termination of certain providers and suppliers from Medicaid, CHIP and Medicare if said providers or suppliers have previously been terminated from one of the other applicable programs. Comments are due on April 4, 2011. The regulation, published in the February 2 Federal Register, is available here.
February 2, 2011: CMS Publishes Proposed Rule on New Requirements for Medicare Certified Providers and Suppliers
In the February 2 Federal Register, CMS published a proposed rule requiring Medicare certified providers and suppliers to make available to their Medicare beneficiaries information about their right to file a written complaint about the quality of care they are receiving, or have received, with the Quality Improvement Organization (QIO) in the state where health care services are being, or were, provided. The proposed rule would also require these suppliers and providers to provide their beneficiaries with written notice of the QIO’s contact information, and certain facilities would need to disclose State agency contact information to all patients. Comments are due April 4, 2011, and the proposed rule is available here.
February 2, 2011: HHS Requests Comments on Consumer Operated and Oriented Plan Program
HHS published a request for comments regarding the provisions in Section 1322 of the ACA that require the Secretary to establish the Consumer Operated and Oriented Plan program (CO-OP program). The program, when operational, will award loans and grants to provide assistance for the establishment of qualified nonprofit health insurance issuers in the individual and small group markets. Specifically, HHS is inviting public input to inform the development of regulations regarding this loan and grant program, and the notice outlines specific areas for public input, including potential organizations for involvement in the CO-OP program; feasibility and solvency; as well as other structural factors which may impact the program. Comments are due on March 4, 2011. The notice is available here.
February 2, 2011: HHS Releases FMAP Rates for the First Quarter of FY 2011
HHS released the state-by-state listing of the adjusted Federal Medical Assistance Percentage (FMAP) rate for the first quarter of Fiscal Year (FY) 2011, as required under Section 5001 of the American Recovery and Reinvestment Act (ARRA). The enhanced FMAP rates were originally scheduled to end December 31, 2010 under ARRA, but will extend to June 30, 2011 at a two-tiered phased-down rate. The rates are available here.
February 1, 2011: Disaster Assistance for SUAs and Tribal Organizations
AoA released a grant announcement to provide SUAs and Tribal Organizations with disaster reimbursement and assistance funds, CFDA Number 93.048. The funds only become available when the President declares and National Disaster and may only be used in those areas designated in the President’s Disaster Declaration. The deadline for submission of applications is September 15, 2011. The program announcement and grant application instructions are available here, and more information is available on AoA’s website, or by clicking here.
January 31, 2011: Florida District Judge Rules ACA Unconstitutional
A U.S. District Court Judge for the Northern District of Florida, Roger Vinson, released the court’s opinion in the case of Florida, et al v. United States Department of Health and Human Services, et al ,in which he ruled that the “Minimum Essential Coverage Provision,” or the individual mandate, found in Section 1501 of the Patient Protection and Affordable Care Act (P L 111-148) is unconstitutional and un-severable from the rest of the law, declaring that the entire Affordable Care Act should be struck down. At issue in this case, in part, is the basis of Congressional authority in enacting the individual mandate, with the Obama Administration asserting that the enumerated powers given to Congress to regulate interstate trade by the Commerce Clause, found in Article I of the U.S. Constitution, are sufficient to require most individuals to purchase insurance or pay a fine by 2014, and the Attorneys General from 26 states arguing that this is an improper expansion of the commerce power, and is therefore unconstitutional. The court, weighing arguments from the plaintiff-states and the Administration, concluded that the Minimum Essential Coverage provision exceeds the Constitutional boundaries of Congressional power by seeking to regulate ‘inactivity.’ In his opinion, Judge Vinson found that due to the inextricable relationship that the individual mandate has with the rest of the ACA, it would be impossible to sever this one provision from the law as a whole. Therefore, the court ruled that the entire Affordable Care Act is unconstitutional. To view the opinion, please click here.
January 31, 2011: HHS Announces New Dietary Guidelines
The Secretaries of Agriculture and HHS announced the release of the 2010 Dietary Guidelines for Americans, the federal government’s evidence-based nutritional guidance to promote health, reduce the risk of chronic diseases, and reduce the prevalence of overweight and obesity through improved nutrition and activity. The new set of guidelines include 23 Key Recommendations for the general population, and six additional Key Recommendations for specific population groups, including older adults and adults at high risk of chronic disease. The document, along with additional information, is available here.
January 31, 2011: OIG Announces Compliance Training Sessions
The Office of Inspector General (OIG) and HHS announced six free compliance training sessions to help prevent fraud, waste and abuse in the Medicare and Medicaid programs. The half-day sessions will be held in Houston, Tampa, Kansas City, Baton Rouge, Denver, and Washington, DC, for local health providers, compliance professionals, and their legal counsel. The first training will take place in Houston on February 16, 2011. To view the announcement, please click here.
January 28, 2011: AoA Establishes CLASS Office
AoA published a notice amending the Statement of Organization, Functions, and Delegations of Authority of the Department of Health and Human Services, Administration on Aging, to establish the Office of Community Living Assistance Services and Supports (Office of CLASS). The new office will have the primary focus of the efficient and effective implementation and management of the provisions of Title VIII of the ACA – The CLASS Act. The notice describes the functions of the new office, and states that the head of the Office of CLASS will report to the Assistant Secretary for Aging. To view the announcement, published in the January 28 Federal Register, please click here.
January 28, 2011: HHS Report Highlights ACA Savings for Families and Businesses
A new report released by HHS shows the potential savings to families and business on health insurance premiums and out-of-pocket costs under the Affordable Care Act in 2014, compared to what they would be paying without the law. The study outlines several provisions of the ACA that are currently being implemented that will help generate these savings, including provisions to increase transparency in the health insurance marketplace, while also emphasizing cost-controlling future provisions, such as the state-based Exchanges that will be designed to allow individuals and small businesses to pool their market strength and purchase coverage at a lower cost. The full report, Health Insurance Premiums: Past High Costs Will Become the Present and Future without Health Reform, is available here.
January 27, 2011: ONC Awards $16 Million in Health Information Exchange Challenge Grants
The Office of the National Coordinator for Health Information Technology (ONC) awarded an additional $16 million to states through the Challenge Grants program. This funding is to help states encourage breakthrough innovations for health information exchange that can be leveraged widely to support nationwide health information exchange and interoperability. To learn view the awards and learn more about the program please click here.
January 27, 2011: ONC Announces $32 Million for Regional Extension Centers
The Office of the National Coordinator for Health Information Technology (ONC) announced $32 million in additional funding for Regional Extension Centers (REC) to accelerate outreach to health care providers to continue to provide support and to encourage registration for the Electronic Health Record Incentive Program. For more information about the REC program, including a list of awards, click here.
January 27, 2011: CMS Publishes Proposed Rule on Medicare IFPs
The proposed rule, published in the January 27 Federal Register, would update the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs) for discharges occurring during the rate year beginning July 1, 2011 through September 30, 2012. The proposed rule would also change the IPF prospective payment system (PPS) payment rate update period to a rate year (RY) that coincides with a fiscal year (FY), and would rebase and revise the Rehabilitation, Psychiatric, and Long-Term Care (RPL) market basket. Comments are due on March 22, 2011. To view the proposed rule, please click here.
January 26, 2011: CMS Amends Statement of Organization, Functions, and Delegations of Authority
In the January 26 Federal Register, CMS published an amendment to Part F of the Statement of Organization, Functions and Delegations of Authority for the Department of Health and Human Services, Centers for Medicare & Medicaid Services. In part, the Statement is changed to reflect the establishment of a new Center for Consumer Information and Insurance Oversight within CMS, and the corresponding disestablishment of the Office of Consumer Information and Insurance Oversight within the Office of the Secretary. The amendment, which also outlines the duties and roles of the newly established office, is available here.
January 25, 2011: HHS Publishes Changes to HIT Extension Program
In the January 25 Federal Register, HHS published a notice announcing changes to the cost-sharing requirements of the Health Information Technology Extension Program, which assists providers seeking to adopt and become meaningful users of health information technology. To view the notice, click here.
January 25, 2011: HHS Announces New Teaching Health Centers Graduate Medical Education Program
HHS announced the designation of eleven new Teaching Health Centers in the Teaching Health Center Graduate Medical Education Program, a five-year program that will support an increased number of primary care medical and dental residents trained in community-based settings across the country. These Centers will be supported by ACA funds, and will help address the need to train primary care providers in communities. To view the press release, including a list of awards, please click here.
January 24, 2011: HHS Releases $200 Million in LIHEAP Funds
HHS announced the release of $200 million in emergency contingency funding to help eligible low-income homeowners and renters meet home energy costs. These Low-Income Home Energy Assistance Program (LIHEAP) contingency funds will provide states, territories, tribes and DC with additional assistance to pay heating and other home energy costs. For a complete listing of state allocations of the funds released today, please click here.
January 24, 2011: HHS and DOJ Release Report on Impact of ACA on Fraud Prevention
According to the annual Health Care Fraud and Abuse Control Program (HCFAC) report, the government’s health care fraud prevention and enforcement efforts recovered more than $4 billion in taxpayer dollars in FY 2010. The report is available here.
January 24, 2011: HHS Announces New Rules to Fight Fraud
HHS released a copy of a final rule with comment period, to be published in the Federal Register on February 2, 2011, which implements provisions of the ACA that authorize more rigorous screening, enrollment and payment processes for providers and suppliers wishing to participate in Medicare, Medicaid and CHIP. A fact sheet on the new rules is available here: http://www.healthcare.gov/news/factsheets/new_tools_to_fight_fraud.html. A copy of the regulation may be downloaded here: http://www.ofr.gov/OFRUpload/OFRData/2011-01686_PI.pdf, until several days after publication of the rule, at which point the regulation will be online here: http://www.archives.gov/federal-register/news.html.
January 21, 2011: Three Million Medicare Beneficiaries received $250 Rebate Check
HHS announced that the total number of Medicare beneficiaries nationwide who have received prescription drug cost relief through the ACA’s one-time, tax-free $250 rebate check has reached three million. This assistance, sent automatically to eligible beneficiaries who fell into the donut hole during 2010, is still being distributed, and people with Medicare are encouraged to visit www.Medicare.gov or call 1-800-MEDICARE to learn more about this one-time assistance, as well as about the provisions impacting beneficiaries as of January 1, 2011. The press release is available here: http://www.hhs.gov/news/press/2011pres/01/20110121a.html. A fact sheet on the donut hole checks distributed by state is located here: http://www.healthcare.gov/news/factsheets/donut_hole_checks_by_state.html
January 21, 2011: CMS Seeks to Amend Its Statement of Organization, Functions and Delegations of Authority
HHS released a Notice, to be published in the Federal Register on January 26, 2011, a notice amending Part F of the Statement of Organization, Functions, and Delegations of Authority for CMS to establish a new Center for Consumer Information and Insurance Oversight within CMS, and the disestablishment of the Office of Consumer Information and Insurance Oversight within the Office of the Secretary. The notice is available here: http://www.ofr.gov/OFRUpload/OFRData/2011-01580_PI.pdf. Once published in the Federal Register, the preceding link will be deactivated and the published version will be available here: http://www.archives.gov/federal-register/news.html.
January 20, 2011: HHS Announces New ACA Implementation Resources for States
HHS announced a new funding opportunity to help states implement the ACA’s Health Insurance Exchanges. States can use these Exchange establishment grants for a variety of activities, including conducting background research, consulting with stakeholders, making legislative and regulatory changes, and ensuring program integrity. This flexibility is intended to allow states to tailor the funds to their unique needs and challenges in developing the Exchanges, and states will have multiple opportunities to apply for the funding. To view the announcement, you may go to grants.gov and search for CFDA # 93.525, or follow this link. A fact sheet on the Health Insurance Exchange Establishment Grants is available here: http://www.healthcare.gov/news/factsheets/exchestannc.html.
January 20, 2011: House Instructs Committees to Develop ACA-Replacement Language
The day after the Republican-controlled House passed a largely symbolic measure to repeal the ACA, which is not expected to impact the law’s implementation, lawmakers in the lower chamber adopted a resolution (H Res 9) directing the Committees on Education and Workforce; Energy and Commerce; the Judiciary; and Ways and Means; to report out viable legislation to replace the ACA that adheres to a set of criteria set forth in the resolution, as amended to include a permanent doc fix to Medicare reimbursement rates for physicians. To view the legislation, please click here: http://www.gpo.gov/fdsys/pkg/BILLS-112hres9rh/pdf/BILLS-112hres9rh.pdf
January 19, 2011: House Passes HR 2
By a vote of 245-189, the House of Representatives passed legislation to repeal the ACA, titled, To Repeal the Job-Killing Health Care Law and Health Care-Related Provisions in the Health Care and Education Reconciliation Act of 2010 (HR 2). The vote is largely seen as symbolic of the newly GOP-controlled House leadership’s promise to work to repeal the ACA and impede its implementation, as the measure does not have the votes to pass in the Democratically-led Senate, and President Obama has made clear that he would use his veto power if such legislation were to clear both chambers. To view the legislation, please click here: http://www.gpo.gov/fdsys/pkg/BILLS-112hr2ih/pdf/BILLS-112hr2ih.pdf
January 18, 2011: New U.S. Preventive Services Task Force Final Recommendation
In an update to its 2002 recommendation, the U.S. Preventive Services Task Force (USPSTF) now recommends screening for osteoporosis in women ages 65 and older, and in younger women whose fracture risk is equal to or greater than that of a 65-year old white woman who has no additional risk factors. This is the first final Recommendation Statement to be published since the implementation of the USPSTF public comment process for draft Recommendation Statements. To view the recommendation, please visit the USPSTF website, here.
January 18, 2011: HHS Report on Impact of ACA Repeal on Americans with Pre-Existing Conditions
HHS released a new analysis showing that without ACA’s coverage protections, up to 129 million non-elderly Americans with pre-existing conditions would be at risk of either losing their health insurance, or of being denied coverage altogether. The analysis included pre-existing conditions such as heart disease, cancer, asthma, high blood pressure and arthritis, finding that anywhere from 19 to 50 percent of Americans under age 65 live with at least one such condition, making these individuals susceptible to a loss of health insurance if the ACA’s protections against such discrimination were repealed. To view the report in its entirety, please click here.
January 13, 2011: Tricare Young Adult Program Announced
The Department of Defense announced the introduction of the premium-based Tricare Young Adult Program (TYAP), which implements the National Defense Authorization Act of FY 2011 (NDAA). This new authority allows the DoD to expand medical coverage to eligible military family members up to the age of 26, thus offering similar benefits to adult children as civilian health plans are required under the ACA. The press release announcing the program is available here.
January 13, 2011: HHS Releases Data on Planned Adoption of EHR Technology
The Office of the National Coordinator for Health Information Technology (ONC) released survey data showing that four-fifths of the nation’s hospitals and 41 percent of office-based physicians currently intend to take advantage of federal incentive payments for adoption and meaningful use of certified electronic health records (EHR) technology. The press release, including links to the survey results and the incentive payments program, is available here.
January 12, 2011: U.S. Preventive Services Task Force Seeks Public Comment on Falls Prevention
Charged with the task of making recommendations regarding preventive services in primary care and the implementation of the ACA in the form of Recommendation Statements, the U.S. Preventive Services Task Force (USPSTF) is sharing all of its draft Recommendation Statements for public comment. To view and comment on the USPSTF Draft Recommendation Statements, including the recently-released Falls Prevention in Older Adults, click here. Please note that Comments on the Falls Prevention draft Recommendation are due by February 9, 2011.
January 12, 2011: HHS Announces Increased LIHEAP funding
HHS announced the availability of additional funding to states, tribes and territories under the Low Income Home Energy Assistance Program (LIHEAP) to help eligible low-income families meet their home energy needs, bringing the total made available since October 1, 2010 to $3.9 billion. The press release is available here, and for a complete list of the newly allocated funds, click here.
January 11, 2011: January Health Affairs Issue explores Health Reform Implementation
The most recent issue of Health Affairs focuses on the topic of Affordable Care Organizations (ACOs), integrated systems of care encouraged under the health reform law, as well as the idea of the Alternative Quality Contract, a new payment system connecting payments to quality, and also includes an analysis on the impact of the ACA on California. For more information, click here.
January 10, 2011: CMS Proposed Rule on Value-Based Incentive Payments for Hospitals
CMS published in the Federal Register a proposed rule to implement the Hospital Value-Based Purchasing program found in Section 3001 of the ACA, under which value-based incentive payments will be made in a fiscal year to hospitals that meet the applicable performance standards for that time frame. The program will apply to payments for discharge occurring on or after October 1, 2012. Comments are due on March 8, 2011. The proposed rule is located here.
January 6, 2011: CMS Actuary Releases Annual Report on National Health Spending
CMS released a new report showing that health care spending per person in the United States grew 4.0 percent in 2009 to $2.5 trillion, or $8,086 per person, the slowest rate of growth in 50 years. This slow growth rate is due in part to the economic recession, as is the finding that in 2009 health spending as a share of the nation’s Gross Domestic Product (GDP) continued to climb, reaching 17.6 percent in 2009, outpacing overall economic growth. To view the complete report, click here.
January 6, 2011: CBO Releases Preliminary Analysis of H.R. 2
The Congressional Budget Office (CBO) reviewed H.R. 2, the Repealing the Job-Killing Health Care Law Act, as introduced on January 5, 2011, and developed a detailed estimate of the budgetary impact of repealing the legislation, and is working with the staff of the Joint Committee on Taxation (JCT) to complete a more thorough estimate. In part, the CBO and JCT estimated that the March 2010 health care legislation would reduce budget deficits over the 2010-2019 period, and in subsequent years; consequently, they project that repealing that legislation would increase budget deficits by $230 billion over the same time period. To view the preliminary report, click here.
January 6, 2011: House Republicans Release Competing Analysis of HR 2
In response to the preliminary analysis released by the nonpartisan Congressional Budget Office (CBO), House Speaker John Boehner’s (R-Ohio) office released a competing analysis conducted by House Budget Committee Republicans. The report concludes, in part, that the ACA would cost $2.6 trillion when fully implemented, adding $701 billion to the deficit in its first ten years. To view the report, titled Obamacare: A Budget-Busting, Job-Killing Health Care Law, please click here: http://speaker.gov/UploadedFiles/ObamaCareReport.pdf
January 6, 2011: HUD and HHS Announce Joint Partnership
The Secretaries of HHS and HUD announced a joint effort to help non-elderly Americans with disabilities transition from facilities into the community. The interagency initiative will provide this population with a combination of rental assistance, health care, and other supportive services by linking HUD rental assistance vouchers with the services offered through the Money Follows the Person (MFP) grant program. For more information, click here.
January 5, 2011: CMS Amendment Rescinding End of Life Consultations during Medicare Annual Wellness Visits:
CMS published in the Federal Register an amendment rescinding the addition and definition of voluntary advance care planning as a specified element of the annual wellness visit that was finalized in the “Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011” that appeared in the November 29, 2010 publication of the Federal Register. The amendment, effective on January 10, 2011, is available here.
January 5, 2011: HHS announces OCIIO move to CMS
The Administration announced the move of the ACA-established Office of Consumer Information and Insurance Oversight (OCIIO) to CMS, where it will be referred to as the Center for Consumer Information and Insurance Oversight (CCIIO). To view a letter from HHS Secretary Sebelius to House Appropriations Chairman Harold Rogers (R-Ky.) regarding OCIIO’s restructuring, including a proposed organizational chart, please click here.
January 5, 2011: HHS announces CLASS Office in AoA
HHS announced its plans to formally launch an office to administer the Community Living Assistance Services and Supports (CLASS) Act, the voluntary long-term care insurance program created by the ACA. According to HHS, The Office of CLASS will be housed within the Administration on Aging (AoA), under the leadership of Assistant Secretary Greenlee. To view a letter from HHS Secretary Sebelius to House Appropriations Chairman Harold Rogers (R-Ky.) regarding the Office of CLASS, including a proposed organizational chart, please click here.
January 5, 2011: Secretaries Update Congress on ACA Implementation
The Secretaries of HHS, Labor and Treasury released a letter sent to House Speaker John Boehner (R-OH), detailing prior and planned ACA implementation efforts. To view the letter, click here.
January 5, 2011: Bill to Repeal ACA Introduced
Introduced by House Majority Leader Eric Cantor (R-Va.), the bill, “Repealing the Job-Killing Health Care Law Act,” (HR 2), sets to repeal the ACA (PL 111-148), and the provisions of the Reconciliation Act (PL 111-152) that relate to health care, restoring the provisions of law impacted by the repealed legislation. The bill text is available here.
January 4, 2011: CMS Updates Physician Directory to Include Quality Data
In accordance with the ACA, CMS released a new version of the physician directory tool, which allows Medicare beneficiaries to locate information regarding Medicare participating physicians, to include information about which physician practices have reported quality data to CMS through the Physician Quality Reporting Initiative (PQRI). The updated tool is available here.
January 4, 2011: State Resources for Health Care Reform Implementation
The Kaiser Family Foundation (KFF) posted an interactive ACA implementation timeline on its website, which explains how and when the provisions of the ACA will be implemented in the coming years. To view the timeline, please visit here.
January 3, 2011: New State-Specific ACA Implementation Resource
The National Academy for State Health Policy (NASHP) launched a website, The State Reforum, to organize and share state resources on ACA implementation, including state-specific analysis and work products. To view the website, click here.
January 3, 2011: ONC Issues Final Rule for Permanent Certification Program for Health IT
The Office of the National Coordinator for Health Information Technology (ONC) issued a final rule to establish the permanent certification program for health information technology. The temporary program will remain in effect until December 31, 2011. More information about the permanent program can be found here.