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.


Senate Approves Sequestration Reporting Bill

Without a dissenting vote, the Senate approved the House-passed bill (H.R. 5872) that requires the Administration to detail how agency programs would be affected if the Budget Control Act’s $109 billion sequestration is allowed to be implemented next year. The Administration has 30 days from the date of enactment to provide Congress with the details. The dimming economic outlook, the looming tax increase from the expiring Bush tax cuts and sequestration puts Congress and the President in a tough post-election position to sort out a compromise on all of these matters. The House is scheduled to take up legislation that would fast-track tax reform next year, a move that may be acceptable to Senate Finance Committee Chairman Max Baucus.

Status of FY 2013 Appropriations Uncertain

Indicating that a House/Senate deal is in the making to push major decisions on FY 2013 appropriations past the election and possibly to next April via a continuing resolution, the House Appropriations Committee halted further consideration of the Labor/ HHS/Education FY 2013 appropriations bill. A six-month CR would probably force House Republican hawks to accept the BCA discretionary spending total and step back from the $19 billion reduction adopted in the House budget resolution. In another budget squabble, twenty-four House members asked Defense Secretary Leon Panetta for an explanation for why the department plans to redirect $708 million from the Defense Health Program after the department proposed to increase beneficiary fees under TRICARE.

House Passes Bill Imposing New Regulatory Restrictions

After a typo glitch, on a second attempt the House passed H.R. 4078, the Red Tape Reduction Act, which: would prohibit executive agencies from promulgating new regulations until the unemployment rate falls to or below 6%; would prohibit the promulgation of “midnight rules”; and includes other provisions intended to reduce or streamline the federal regulatory process. The bill also expands and modifies the Unfunded Mandates Reform Act by requiring independent agencies to conduct analyses of their proposed rules and by requiring all federal agencies to consult with the private sector when developing rules.

Rush to Exchange

T he CMS Center for Consumer Information and Insurance Oversight (CCIIO) has made it known that key elements necessary for states to establish PPACA health insurance exchanges will be unveiled in August. A proposed rule defining “essential health benefits” and additional guidance on the operational details of the “federally facilitated exchange” are likely to be released in August or early September. The minimum benefit information is essential for health insurers to develop their benefit plans to be offered in exchanges during the open enrollment period beginning in October, 2013. The fall-back federal exchange is also expected to be operational before the open enrollment period. Providers have questioned on what basis payment levels will be made under the exchanges--whether on Medicare, Medicaid or commercial insurance levels--but such details are apparently left to insurer/provider negotiations without further guidance under the PPACA. In related news, Virginia Governor Robert McDonnell has criticized as “wholly inadequate” the CMS response to the RNA’s “thirty questions” the governors said they need answered in order to make decisions on whether their states should participate in the PPACA Medicaid expansion. Such decisions will also have an impact on the establishment of state-run health insurance exchanges. The only substantive response so far from CMS is that the agency would not put a deadline on a state’s participation in Medicaid expansion.

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