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.


FY 2014 Appropriations Process Still Contentious

The House continues to push through appropriations and defense authorization measures that save defense-related programs from the full effect of the Budget Control Act’s (BCA) sequestration levels while further squeezing domestic program spending. On the other hand, the Senate Appropriations Committee is scheduled on Thursday to set fiscal year (FY) 2014 302(b) spending allocation caps for each subcommittee that will test the resolve of Senate Republicans to hold firm in support of the BCA caps on discretionary spending. The intent of Committee Chairwoman Barbara Mikulski (D-MD) is to allocate $1.058 trillion, an amount that would set aside the BCA’s sequestration caps. Lacking a House/Senate agreement on total FY 2014 spending, the House passed the FY 2014 National Defense authorization bill, H.R. 1960, that would authorize spending above the $498 billion cap by $28.1 billion. With the spending cap in place, the House Appropriations Committee followed up by passing the FY 2014 defense appropriations bill providing $512.5 billion in non-war funding, a decrease of $5.1 billion below the FY 2013 enacted level and $3.4 billion below the President’s request. The House Appropriations Committee also passed the FY 2014 Agriculture/Food and Drug Administration (FDA) spending bill which allocates $2.5 billion to the FDA, an increase of $24 billion above the FY 2013 enacted level. Total FDA revenue would amount to $4.3 billion, including user fees.

Republicans Scrutinize PPACA Role by Contractors and IRS

The House Energy and Commerce Subcommittee on Oversight and Investigations sent a letter to the acting Internal Revenue Service (IRS) Commissioner requesting information regarding the agency’s ability to protect the confidential health information of millions of Americans and respect the safeguards imposed under the Health Insurance Portability and Accountability Act (HIPAA). Concerns arose in connection with a California health care provider who is suing the IRS after the agency executed a search warrant for financial data pertaining to a former employee, but insisted on also seizing patient medical records. Also, Republicans on the Senate Health, Education, Labor and Pensions (HELP) Committee sent a letter to Department of Health and Human Services (HHS) Secretary Kathleen Sebelius asking for an investigation of reports that California officials may be concealing the details of contracts awarded using Patient Protection and Affordable Care Act (PPACA) funds intended to help establish the state’s health insurance exchange.

PPACA Assister Program Under Attack

The House Oversight and Government Reform Committee again set its sights on the PPACA by requesting HHS to produce transcribed interviews with the Center for Consumer Information and Insurance Oversight (CCIIO) head and director of the unit’s consumer support group. The committee chairman, Rep. Darrel Issa (R-CA), said HHS intentionally circumvented an explicit federal funding ban by providing “assister” funding to states to help with enrollment under their health insurance exchanges.

Financial Integrity Rules for Health Insurance Exchanges

CMS issued proposed rules--Program Integrity: Exchange, Small Business Health Option Programs (SHOP), Premium Stabilization Programs, and Market Standards--that the agency said are intended to safeguard federal funds and to protect consumers by ensuring that issuers, Marketplaces, and other entities comply with federal standards meant to ensure consumers have access to quality, affordable health insurance. The rules include policies governing advance payments of the premium tax credit, cost-sharing reductions and premium stabilization programs for low/moderate-income individuals. The rules also include standards for agents and brokers, as well as premium standards based on geographic areas, guaranteed availability and renewability of plans.

Final IRS Rule on PPACA Tanning Excise Tax

The IRS issued a rule finalizing the PPACA’s provision which levies a 10% excise tax on indoor tanning services. The rule eases the scope of the provision somewhat by exempting tanning beds which are part of broader health fitness services.

Two House Committees Renew Cooperation to Develop Doc Fix

After the House Energy and Commerce Committee released draft legislation to reform the current Medicare physician payment system and held hearings on the legislation, the Chairman, Rep. Fred Upton (R-MI), and the Chairman of the House Ways and Means Committee, Rep. Dave Camp (R-MI), publicly stated that the two committees are again cooperating to formulate a final legislative product which they hope to move before the August congressional recess. A significant hurdle that remains is to find revenue enhancements or spending reductions sufficient to offset the $139 billion ten-year cost of the sustainable growth rate (SGR) reform.

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