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.


Clean Debt Limit Bill and Separate Measure Partially Funds SGR Reform

Sprinting to this week’s Presidents’ Day recess, the House (on a 221-201 vote) and the Senate (on a 55-43 vote) passed S. 540, legislation to extend the federal debt limit through March 15, 2015, taking the issue beyond this year’s mid-term elections. After House Republican leaders failed to garner the 218 votes necessary to pass the bill with extraneous provisions the Republican conference could coalesce around, the debt limit bill was passed without amendment. House Speaker John Boehner (R-OH) had kept open the possibility of adding to the debt bill a repeal of the omnibus 2-year budget deal’s 1% reduction of pre-age-62 military cost of living adjustments (COLAs) and/or the bipartisan reform of the Medicare physician payment system. Having to abandon the amendment route in connection with these measures, Republican leaders followed up the vote on the debt ceiling bill with another legislative move to restore the military pension COLAs together with a means to offset its cost plus some more. This resulted in the House voting 326-90 and the Senate voting 95-3 to pass S. 25, legislation to restore the COLAs with a total offset of about $8.4 billion. After taking into account the $6 billion COLA offset, the legislation left an excess of about $2.4 billion in spending “cuts” which Congress intends to help offset the cost of the long-term Medicare physician payment sustainable growth rate (SGR) formula overhaul expected to be taken up in March (the Congressional Budget Office (CBO) estimates that H.R. 4015/S. 2000 will cost ~$128 billion over ten years). Some in the health community were chagrined that the offset for the COLA portion of the legislation came about by an extension for one year (until 2024) of the Budget Control Act (BCA) sequestration rules requiring across-the-board cuts in discretionary health-related and certain other federal programs. It is expected that Senator Ron Wyden (D-OR), who was formally appointed by the Senate as the new chairman of the Senate Finance Committee, will make the passage of Medicare SGR reform a legislative priority when Congress returns next week. The major hurdle remaining for SGR reform will be for Congress to agree on spending/revenue offsets amounting to about $125.6 billion. This task will have to be accomplished in the face of the House Budget Committee’s intent to pass a fiscal year (FY) 2015 budget resolution to eliminate the projected federal deficit of $7.9 trillion over ten years.

House Set to Take Up PPACA Amendment

Clearing the way for consideration in the House, the House Ways and Means Committee voted 23-14 to pass H.R. 2575, legislation that would increase the Patient Protection and Affordable Care Act’s (PPACA) 30-hour work week threshold to 40-hours. The bill would adjust the Act’s definition of full-time worker status used for determining which employees must be offered employer-provided health coverage meeting the law’s minimum benefit standards.

Senate Passes Bill Delaying CMS Critical Access Hospital Rule

Before adjourning, the Senate also passed S. 1954, legislation that provides for the extension through 2014 of the Centers for Medicare and Medicaid Services (CMS) rule requiring that a supervising physician be present at all times when Medicare patients receive outpatient therapeutic services in critical access and small rural hospitals.

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