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.


Vice Presidential Debate Results in Counterpunches on Healthcare

Last week’s debate between Vice President Joe Biden and the Republican challenger Rep. Paul Ryan was intense when they discussed solutions to Medicare’s long-term solvency and the future of Obamacare. Rep. Ryan defended the Romney campaign approach in extending the solvency of Medicare by providing seniors with a choice of traditional Medicare as an option to private health coverage (through a so-called "premium support" model). Vice President Biden said that he and President Obama would not "be part of any voucher plan." He said the "voucher" would not guarantee coverage and would not keep up with health care costs "because if it did keep pace with health care costs, there would be no savings…."

Rep. Ryan called VP Biden's charge that premium support would increase beneficiary costs by $6,400 "completely misleading" and countered that the Republican plan would be affordable because "Medicare subsidizes your premiums, not as much for the wealthy people, more coverage for middle-income people, and total out-of-pocket coverage for the poor and the sick." As to Obamacare, Rep. Ryan argued that the law will take $716 billion out of the Medicare program in order to finance the new law. Vice President Biden, however, said the law will extend the life of the Medicare trust fund by cutting the cost of Medicare and stopping overpayments to providers while increasing benefits, including filling in the Part D "doughnut hole."

Rep. Ryan also criticized the Independent Payment Advisory Board stating that "We would rather have 50 million future seniors determine how their Medicare is delivered to them instead of 15 bureaucrats deciding what -- if, where, when, they get it…." This debate will continue even beyond the electionin that the Congress and whoever is President will have to address the coming insolvency of Medicare. In this connection the bipartisan "Gang of Eight" senators held three days of meetings in an effort to come to some consensus on the deficit and debt problems facing the nation. They met with former Senator Alan Simpson and former White House COS Erskine Bowles to seek their views, including the Medicare solutions contained in the Simpson/Bowles presidential commission’s 10-year deficit reduction plan.

MedPAC Discusses Caps on Therapy Services

MedPAC commissioners met to discuss recommendations on how to improve the Medicare payment methodology connected with physical, speech and occupational therapy. The chairman highlighted the conundrum related to the current system of caps, saying that "Returning to a system of hard caps, no exceptions, would, in fact, impede access to needed care….if we have no caps and do nothing else, we're talking about an increased Medicare expenditure above the current law baseline of roughly $1 billion a year or $10 billion over 10 years." Possible changes that were discussed include: reducing the certification period for the outpatient therapy plan of care from 90 days to 45 days and using PPACA authorities to target high-use geographic areas and aberrant providers; placing a temporary moratorium on the enrollment of new providers, requiring providers to re-enroll, or suspending payments for servicesthat show a high risk of fraud; and implementing payment edits at the national level that target implausible amounts of therapy. Another set of recommendations include: reducing therapy caps for physical therapy and speech language pathology services combined and for occupational therapy while implementing a manual review process for requests to exceed cap amounts; and including services delivered in hospital outpatient departments under therapy caps and applying a multiple procedure payment reduction of 50% to the practice expense portion of outpatient therapy services provided for the same therapy on the same day.

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