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.


House Budget Committee Report Expected this Week

House Republicans return from their week-long recess this week to discuss various budget options in an attempt to develop an FY 2013 budget resolution blueprint which Republicans could use to push through budget cuts under the reconciliation process.  However, the Senate is not expected to bring a budget resolution to the Senate floor for a vote, given that last year’s debt increase legislation already provides for a $1.047 trillion discretionary spending limit for FY 2013.  Whether the legislated limit is reduced by $19 billion, as some budget hawks desire, remains to be seen.  House Budget Committee Chairman Paul Ryan is not expected to back away from producing a plan which includes Medicare spending reductions and in this effort may move to advance the so-called Ryan-Wyden Medicare reform plan (which provides Medicare beneficiaries with subsidies to purchase private health coverage as an option).  House Republicans also want to avoid the sequestration of defense spending beginning in the next calendar year as dictated by the debt ceiling legislation, but are unlikely to do this by increasing taxes as proposed by House Democrats.  The lack of an agreement between the House and Senate will necessarily set up another showdown over FY 2013 spending only a few weeks before the November election.

House to Vote on Repealing IPAB

The House is scheduled to meet this Wednesday to vote to repeal the PPACA Independent Payment Advisory Board (IPAB).  Although the House Energy and Commerce Committee and Ways and Means Committee reports do not include a provision paying for the cost of the legislation, H.R. 452 (the Medicare Decisions Accountability Act), the House Rules Committee will package this bill with H.R. 5, the Protecting Access to Healthcare Act, as reported by the House Judiciary and Energy and Commerce committees, as a means to offset such costs.  H.R. 5 is estimated to more than offset the $3.1 billion ten-year cost of the repeal by providing for medical malpractice reforms that would: provide a three-year statute of limitations for malpractice claims beginning at the time of discovery of an injury; limit punitive damages and attorney contingency fees; and create a safe harbor from punitive damages for medical product manufacturers and distributors in certain cases, such as when such products are FDA approved.

Senate Passes Measure Increasing Unpaid Tax Penalties for Medicare Providers

The Senate voted 74-22 to pass a transportation funding bill, S. 1813, that includes a provision to increase the IRS levy from up to 15-100% on payments to Medicare providers having tax delinquencies.  CBO estimates the provision would raise revenues by $841 million over 10 years.  The House is also expected to take up similar legislation to reauthorize highway, transit and safety programs through FY 2013.

Final Rules on PPACA State Health Insurance Exchanges

The final rules (with parts issued as interim final rules with a 45 day comment period) released by HHS implementing the PPACA provisions creating state health insurance exchanges includes standards for: creating so-called one-stop marketplaces; the health insurance plans participating in the exchanges; determinations of individual and small business enrollment eligibility and related subsidies; and health plan participation in such exchanges.  The rules would allow states to determine how health insurance agents, brokers (including online brokers) are included in the enrollment process.  In addition, the rule allows states to adopt the PPACA’s American Health Benefit Exchanges for individuals and Small Business Health Options Program (SHOP) for small businesses, or a combination.  Of note, the rules do not set out the final timelines for states to receive federal certification for their exchanges (many states have yet to even begin the process in light of the Supreme Court case questioning the PPACA’s constitutionality).  HHS said that the rules for the establishment of federal exchanges in states which do not seek certification will be issued later.  Another final rule (Standards Related to Reinsurance, Risk Corridors and Risk Adjustment) defines the circumstances under which HHS, rather than state exchanges, will set the standards for programs designed to eliminate health insurance company anti-selection.  Also, CMS issued a final rule defining how states are to make eligibility determinations for Medicaid enrollees beginning in 2014.  The federal matching rate (FMAP) starts at 100% from 2014-2016 and gradually decreases to 90% by 2020.

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