CMS Schedules May 2015 Meetings on HCPCS Applications

CMS has announced that it is holding series of meetings in May 2015 to discuss pending  Healthcare Common Procedure Coding System (HCPCS) applications. The meeting dates are as follows:

May 7 & 8 -- Drugs/Biologicals/Radiopharmaceuticals/Radiologic Imaging Agents
May 21 & 22 -- Supplies and Other
May 27 -- Durable Medical Equipment (DME) and Accessories; and Orthotics and Prosthetics (O&P)

Deadlines and instructions for speaker and general registration and submission of comments are set forth in a notice to be published tomorrow.  Additional information, include preliminary coding determinations, will be posted in advance of each meeting at the CMS HCPCS website

Upcoming House Hearing on 340B Program

The House Energy and Commerce Subcommittee on Health will hold a hearing on Thursday, March 5, 2015 on “Examining the 340B Drug Pricing Program,” focusing on the functionality of the program and the extent to which it meets its goal of improving access to prescription drugs for needy patients at facilities serving these populations. Scheduled witnesses include officials from the Health Resources and Services Administration, the Government Accountability Office, and the Office of the Inspector General. 

New Postings on the Reed Smith Health Industry Washington Watch Blog

The Reed Smith Health Industry Washington Watch blog has been updated to report on recent health policy developments, including the following:

  • CMS Regulatory Developments. CMS has issued final rules on 2016 ACA Marketplace plan benefit and payment parameters, Medicare Advantage and Part D requirements for contract year 2016, and the 2016 funding methodology for the ACA Basic Health Program. CMS also has published corrections to the 2015 final Medicare OPPS/ASC rule, with an impact on payment rates. In addition, CMS has announced that it needs more time to finalize an ACA rule on return of Medicare overpayments.
  • Other CMS Developments. CMS has announced changes to the measurements used in the Nursing Home Compare Five Star Quality Rating System, and it is inviting applications for a new Oncology Care Model testing performance-based Medicare payment for episodes of care surrounding chemotherapy administration, along with proposals for Hospital Engagement Network Contracts.
  • GAO & OIG Developments. The GAO has reported on Medicare program risks and CMS activities to prepare the health industry for ICD-10.   The OIG has announced its plans for health reform oversight activities, and it issued a report on Medicare payments to providers with delinquent Medicare debts.
  • Legislative Developments. Today the Ways and Means Committee is marking up bills addressing Medicare program integrity, DMEPOS competitive bidding, hospital observation status, and EHR meaningful use in ASCs, and several Congressional committees are holding hearings on health policy issues. The Energy & Commerce Committee approved bipartisan public health bills, and the House passed an ACA repeal and replace bill. 
  • CMS Events. CMS is hosting a call on nursing home quality initiatives, and it is holding a meeting on hospital outpatient payment policy.

Ways and Means Committee to Markup Medicare Fraud, Competitive Bidding, and other Medicare Policy Bills

On February 26, 2015, the House Ways and Means Committee is scheduled to vote on the following bills:

  • H.R. 1021, “Protecting the Integrity of Medicare Act of 2015” – a sweeping bill to promote Medicare program integrity and efficiency. Among many other things, the bill would: eliminate civil money penalties for inducements to physicians to limit services that are not medically necessary; create a Part D drug management program for beneficiaries at risk of prescription drug abuse; require MACs to establish improper payment outreach and education programs for providers; expand the Senior Medicare Patrol program; require the HHS Secretary to issue guidance on the application of the “Common Rule” protecting individuals involved in research; and require the Secretary to issue a report on how to establish a permanent physician-hospital gainsharing program.
  • H.R. 284, “Medicare DMEPOS Competitive Bidding Improvement Act of 2015” -- which would require Medicare suppliers that bid under a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program to submit binding bids or risk forfeiture of a surety bond.
  • H.R. 876, “NOTICE Act” – which would require hospitals to provide certain notifications to individuals classified as being under observation status rather than admitted as inpatients.
  • H.R. 887, “Electronic Health Fairness Act of 2015” -- which addresses the treatment of patient encounters in ambulatory surgical centers in determining meaningful electronic health record use.

CMS Finalizes 2016 ACA Marketplace Plan Benefit & Payment Parameters

The Centers for Medicare & Medicaid Services (CMS) has finalized its Affordable Care Act (ACA) Marketplace health plan payment parameters and essential benefit standards for 2016. The rule addresses numerous policies, including: allocation of risk corridors collections for 2016; recalibration of risk adjustment factors; revisions to reinsurance and cost sharing parameters; user fees for federally-facilitated exchanges; standards for qualified health plans, including quality improvement strategy and provider directory requirements; Small Business Health Options Program requirements; conditions that trigger rate review; clarification that coverage satisfying the minimum value requirement must include substantial coverage of inpatient hospital and physician services; medical loss ratio program revisions; new policies and procedures for enrollee requests for prescription drugs not included on a plan’s formulary; and establishment of the 2016 annual open enrollment period as November 1, 2015 through January 31, 2016.  The final rule will be published on February 27, 2015. A related CMS fact sheet is available here.

OIG Announces Plans for Health Reform Oversight Activities

On February 24, 2015, the HHS Office of Inspector General (OIG) released its “Health Reform Oversight Plan” for FY 2015, which describes the OIG’s current and planned efforts to oversee the implementation and management of HHS programs under the ACA. The plan outlines the OIG’s key tactical considerations (e.g., assessing relative risks; monitoring emerging issues and trends, conducting reviews, and addressing allegations of fraud); identifies primary focus areas, both in the health insurance Marketplaces and in other ACA-related HHS programs; and sets forth target timeframes for issuing reports on reviews related to the Marketplaces. While the report focuses on audits and evaluations, the OIG notes that it is prepared for and engaged in law enforcement operations related to ACA programs.

CMS Invites Applications for Oncology Care Model

CMS is soliciting applications for organizations to participate in a new Oncology Care Model (OCM), which will test performance-based Medicare payment for episodes of care surrounding chemotherapy administration to cancer patients beginning in 2016. The model features a two-part payment system for participating practices: (1) a $160 monthly per-beneficiary-per-month payment for the duration of the episode, and (2) the potential for a performance-based payment for episodes of chemotherapy care to encourage practices to lower the total cost of care and improve care for beneficiaries during treatment episodes. The OCM is expected to start in the spring of 2016, and will last five years.

GAO Evaluates CMS Activities to Prepare Health Industry for ICD-10 Launch

According to a recent GAO report, CMS has taken numerous steps to prepare industry for the October 1, 2015 transition to ICD-10 codes, such as developing checklists, timelines, and other educational materials and hosting training sessions for Medicare providers. CMS also has monitored covered entity and vendor readiness through stakeholder collaboration meetings, focus group testing, and surveys. With regard to Medicaid, CMS has provided technical assistance to Medicaid agencies, although GAO observes that as of November 2014, not all state Medicaid agencies had started testing their systems’ abilities to accept and adjudicate claims with ICD-10 codes. Stakeholder organizations continue to have concerns about the comprehensiveness of CMS testing and the extent to which entities are using CMS educational materials. The GAO notes that CMS has taken steps to address these concerns by expanding end-to-end testing, promoting awareness of its educational materials, and developing more training options.

Note that CMS announced on February 25, 2015 that Medicare FFS providers, clearinghouses, and billing agencies successfully participated in the first successful ICD-10 end-to-end testing week (from January 26 through February 3, 2015) with all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor. CMS was able to accommodate all volunteers, which represented a broad cross-section of provider, claim, and submitter types.

Final Medicare Advantage/Part D Rule for Contract Year (CY) 2016

CMS has published a final rule revising Medicare Advantage (MA) and Part D prescription drug benefit regulations for CY 2016. Among other things, the final rule:

  • Implements a statutory provision requiring MA and Part D contracts to provide the right to “timely”’ inspection and audit and allowing CMS to require MA organizations or Part D prescription drug plan (PDP) sponsors to hire an independent auditor to validate correction of CMS audit findings.
  • Establishes U.S. citizenship and lawful presence as an eligibility requirement for enrollment in MA and Part D plans (effective June 1, 2015).
  • Makes several policy changes intended to promote efficient dispensing of drugs in long-term care (LTC) facilities, including prohibiting payment arrangements that penalize the adoption of more efficient LTC dispensing techniques by prorating dispensing fees based on days’ supply or quantity dispensed, and requiring that any difference in payment methodology among LTC pharmacies incentivizes more efficient dispensing techniques.
  • Requires MA Prescription Drug (MA-PD) plans to establish and maintain a process with network pharmacies to ensure timely and accurate point-of-sale transactions and coordinate Part A, Part B, and Part D drug benefits administered by the MA PD plan.
  • Requires a sponsor’s Pharmacy & Therapeutics committee to document its process for an objective party to determine whether disclosed financial interests are conflicts of interest and management of any recusals due to conflicts.

Other provisions of the rule address, among other things, business continuity for MA organizations and PDP sponsors; codification of recent quality improvement program policies; and notification requirements related to changes to Part D plans. CMS is not finalizing a number of proposals included in the January 2014 proposed rule, including provisions that would have: lifted the protected class designation on three drug classes; required Medicare Part D sponsors to include in preferred networks any pharmacy willing to accept the sponsor’s terms and conditions; reduced the number of Part D plans a sponsor may offer; and codified CMS interpretation of the Part D non-interference clause.

CMS Issues Final 2016 Funding Methodology for ACA Basic Health Program

On February 24, 2015, CMS published its final methodology and data sources for determining federal payment amounts for states that elect to use the Basic Health Program to offer health benefits to low-income individuals otherwise eligible to purchase coverage through an Affordable Insurance Exchange/Marketplace for 2016. CMS is using the same methodology in 2016 as was established in the final 2015 payment notice, with updated values for several factors.

CMS Made Payments to Providers with Delinquent Medicare Debts

The OIG has issued a report on its findings that Medicare in some cases continued to make payments to physicians who have delinquent Medicare debts that have been referred to Treasury for collection. For instance, CMS paid a total of $10.7 million to 23 individual physicians who collectively owed CMS a total of $8.84 million. The OIG recommended that CMS take a series of steps to ensure that it does not pay individual physicians with delinquent debts after referring their Medicare debts to Treasury for collection; CMS concurred. For more information, see the full report, “CMS Made Payments Associated With Providers After Referring Individual Providers' Debts to the Department of the Treasury for Collection.”

Hospital Engagement Network Contract Solicitation

CMS is requesting proposals for Hospital Engagement Network (HEN) contracts from qualified entities to work on reducing preventable hospital acquired conditions and readmissions through the Partnership for Patients initiative. HENs will engage the hospital, provider, and broader care-giver communities to quickly implement tested, evidence-based, and measured best practices in order to reduce hospital-based harm and preventable readmissions. 

Energy & Commerce Committee Approves Bipartisan Public Health Bills

On February 11, 2015, the House Energy and Commerce Committee approved the following bipartisan public health bills:

  • H.R. 471, Ensuring Patient Access to Effective Drug Enforcement Act (to improve enforcement efforts regarding prescription drug diversion and abuse); 
  • H.R. 639, Improving Regulatory Transparency for New Medical Therapies Act, as amended (to amend the Controlled Substances Act to improve the efficiency, transparency, and consistency of the Drug Enforcement Agency’s process for scheduling new drugs); 
  • H.R. 647, Access to Life-Saving Trauma Care for All Americans Act (to reauthorize language from the Public Health Service Act to fund trauma care centers); and
  • H.R. 648, Trauma Systems and Regionalization of Emergency Care Reauthorization Act (to reauthorize grants supporting state and rural development of trauma systems and authorize new regionalized emergency care model pilot projects).

Congressional Health Policy Hearings

The following Congressional panels have held hearings recently on various health policy issues:

House Approves ACA Repeal/Replace Bill

Earlier this month, the House of Representatives approved H.R. 596, a bill to repeal the Patient Protection and Affordable Care Act (PPACA) and health care-related provisions in the Health Care and Education Reconciliation Act of 2010 and restore the laws as if the health reform provisions had never been enacted. The bill also directs the House Committees on Education and the Workforce, Energy and Commerce, Judiciary, and Ways and Means to develop alternative legislation to, among other things, lower health care premiums, ensure access to affordable health coverage for people with pre-existing conditions, and reform.  The President has promised to veto the bill if it reaches his desk.  

 

Congressional Hearings to Focus on HHS Budget, Medical Preparedness, ACA Implementation

Three health policy hearings are scheduled for February 26, 2015:

CMS Raises the Bar for Nursing Home Quality Ratings under "Nursing Home Compare 3.0"

CMS has made revisions to the measurements used in the Nursing Home Compare Five Star Quality Rating System that have resulted in a decline in the star rating for about one-third of nursing homes. Specifically, on February 20, 2015, CMS added quality measures regarding the use of antipsychotics, revised the calculation of nursing home staffing levels, and strengthened the criteria for nursing homes to achieve top “star” ratings. According to CMS, before this “recalibration” (dubbed Nursing Home Compare 3.0), about 80% of nursing homes received either a 4 or 5-star quality rating; now about 49% will receive these top star ratings. The number of nursing homes receiving one star has increased from 8.5% to 13% after the recalibration. CMS advises consumers to rely on multiple factors in selecting a nursing home, however, including star ratings, visits, and reputation.

CMS Call on the Improving Medicare Post-Acute Care Transformation Act (Feb. 25)

CMS is hosting a call on Wednesday, February 25, to discuss implementation of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act).  The IMPACT Act requires the submission of standardized data by long-term care hospitals, skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities. On the call, CMS will provide an overview of the requirements related to the use of standardized data for both the quality measures and the assessment instrument domains.  CMS will also accept comments on this topic. Additional information is posted on the CMS Impact Act web page.

CMS Corrects 2015 Medicare OPPS/ASC Final Rule, Impacts Rates

Today CMS published a notice correcting its November 10, 2014 final rule updating the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year 2015. In addition to fixing various technical errors (e.g., status indicator and addenda corrections for specific codes), the notice increases the OPPS conversion factor from $74.144 to $74.173, which will slightly increase payment rates for most ambulatory payment classifications. On the other hand, CMS is reducing the 2015 ASC conversion factor slightly, from $44.071 to $44.058. 

CMS Hospital Industry Call Today to Focus on RAC Improvements

Today CMS is hosting an Open Door Forum call to discuss several Medicare developments impacting hospitals, including changes CMS has made to the recovery audit program to strengthen oversight, reduce the provider burden, and enhance program transparency. The call begins at 2:00 eastern.

CMS Needs More Time to Finalize ACA Rule on Return of Medicare Overpayments

CMS warns requirement to report/return overpayments is in effect even without regulations

The Centers for Medicare & Medicaid Services (CMS) needs more time to finalize its February 16, 2012 proposed rule on reporting and returning of Medicare overpayments, according to a CMS notice to be published on February 17, 2015. The 2012 rule would provide details on implementation of an Affordable Care Act (ACA) provision requiring enrolled providers and suppliers (and certain other enrollees) receiving Medicare funds to report and return Medicare overpayments by the later of 60 days after the date on which the overpayment was identified or, if applicable, the date any corresponding cost report is due. Although the requirement to refund an overpayment already exists in federal law, the proposed rule would clarify what constitutes “identification” of an overpayment, the mechanics of when and how an overpayment must be returned, and the period of time subject to repayment. CMS had received a large number of comments from providers and suppliers and their industry associations that the proposed rule’s refund reporting policies and procedures would impose significant administrative burdens.

The Social Security Act requires public notice if an agency will take more than three years to finalize a proposed rule. CMS states that “the complexity of the rule and scope of comments warrants the extension of the timeline for publication” for an additional year (until February 16, 2016). Specifically, CMS has “determined that there are significant policy and operational issues that need to be resolved in order to address all of the issues raised by comments to the proposed rule and to ensure appropriate coordination with other government agencies.” The agency warns stakeholders, however, that “even without a final regulation they are subject to the statutory requirements found in section 1128J(d) of the Act and could face potential False Claims Act liability, Civil Monetary Penalties Law liability, and exclusion from Federal health care programs for failure to report and return an overpayment.”

GAO Highlights Medicare Program Risks and Recommends Program Integrity Actions

The Government Accountability Office (GAO) has released its latest update to its “High-Risk Series” reports, which again lists Medicare as a high-risk program, in part because of the program’s substantial size and scope, and its wide-ranging effects on beneficiaries, the health care industry, and the U.S. economy. The latest report highlights five areas of particular concern to the GAO: 

  1. Payments and provider incentives in original Medicare (specifically referencing physician feedback reports, physician self-referral policy, high-expenditure Part B drugs, end stage renal disease (ESRD) bundled payments, and low-volume payment adjustments for dialysis facilities);
  2. Medicare Advantage (MA) and other Medicare health plans (including concerns about MA plan payment adjustments and excess payments to Special Needs Plans);
  3. Program design effects on beneficiaries (addressing coordination for dual-eligible beneficiaries, dual-eligible special needs plans, and access to preventive services);
  4. Program management (including implementation of durable medical equipment competitive bidding and oversight of Centers for Medicare & Medicaid Services (CMS) contracts); and
  5. Oversight of patient care and safety (including the use of clinical data registries and oversight of vulnerable Medicare beneficiaries in nursing homes and long-term care hospitals (LTCHs)).

The GAO makes a series of recommendations to Congress and CMS to address program risks. Specifically, GAO recommends that Congress consider directing the HHS Secretary to require providers who self-refer intensity-modulated radiation therapy services to disclose to their patients that they have a financial interest in the service. The GAO also recommends that Congress better align Medicare beneficiary cost-sharing requirements with U.S. Preventive Task Force recommendations.

Specific recommendations for CMS include:

Continue Reading...

New Postings on the Reed Smith Health Industry Washington Watch Blog

The Reed Smith Health Industry Washington Watch blog has been updated to report on recent health policy developments, including the following:

  • Obama Budget Proposal. The Obama Administration has released its proposed fiscal year 2016 budget, including numerous provisions impacting Medicare, Medicaid, and other federal health programs.
  • CMS Regulatory Developments. CMS has extended its moratoria on enrollment of home health agencies and ambulance suppliers in designated areas, and the Agency has announced its intention to issue regulations to modify the Medicare and Medicaid Electronic Health Record Incentive Program meaningful use requirements.
  • Other HHS Developments. HHS has set goals for adoption of Medicare value-based purchasing and alternative payment models, and the HHS ONC is seeking comments on its draft health information technology interoperability “Roadmap.” CMS has added star ratings to Dialysis Facility Compare, and it is accepting bids for the latest round of Medicare DMEPOS competitive bidding.
  • GAO & OIG Developments. The GAO has examined geographic variation in private payer spending on high-cost procedures. OIG reports have addressed Medicare payments to hospitals for clinic visits, hospital quality improvement efforts, compounded pharmaceuticals used in hospitals, and power mobility device claims. The OIG also has responded to concerns raised about its hospital compliance review policies. 
  • Legislative Developments. House panels are taking steps to speed patient access to medical innovation. The House is scheduled to vote on a bill to repeal and replace the Affordable Care Act. Congressional hearings have been focusing on health policy issues. 
  • Odds & Ends. MedPAC has voiced concerns about the growing volume and burden of Medicare quality measures.
  • Health Industry Events. CMS is hosting calls on Medicare payment, quality, and coding topics; the FTC and DOJ are holding a workshop on health care competition; FDA is holding a workshop on regulation of next generation sequencing diagnostic tests; and CMS is holding a meeting on hospital outpatient payment policy.

Obama Administration Releases FY 2016 Budget Proposal with Medicare/Medicaid Provisions

On February 2, 2015, the Obama Administration released its proposed federal budget for fiscal year (FY) 2016. The budget would impact all types of health care providers, health plans, and drug manufacturers if adopted as proposed – which is unlikely given Republican control of the House and Senate. Nevertheless, Congress can be expected to consider the Medicare and Medicaid savings proposals (many of which are carry-overs from prior budgets) during expected debate in the coming months on Medicare physician fee schedule (MPFS) reform legislation or during future budget negotiations.

The following is a summary of the major Medicare, Medicaid, and related policy proposals contained in the FY 2016 budget proposal.

Continue Reading...

ONC Seeks Comments on Draft Health IT Interoperability Roadmap, Standards Advisory

On January 30, 2015, the HHS Office of the National Coordinator for Health Information Technology (ONC) released a draft “Roadmap” to promote safe and secure exchange and use of electronic health information. The document “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0,” focuses on actions intended to reach the ambitious goal of enabling a majority of individuals and providers to send, receive, find, and use a common set of electronic clinical information at the nationwide level by the end of 2017. To that end, the report focuses on: (1) establishing a coordinated governance framework and process for nationwide health IT interoperability; (2) improving technical standards and implementation guidance for sharing and using a common clinical data set; (3) enhancing incentives for sharing electronic health information according to common technical standards; and (4) clarifying privacy and security requirements that enable interoperability. Comments on the draft Roadmap document will be accepted until April 3, 2015.

ONC also released a draft of the 2015 Interoperability Standards Advisory, containing an initial version of what ONC currently considers to be the best available standards and implementation specifications for many clinical health data interoperability purposes. The public comment period for the Standards Advisory closes May 1, 2015.

CMS Plans Spring Rulemaking to Modify Meaningful Use Requirements

CMS has announced that it plans to issue regulations this spring to address provider concerns about the burden associated with compliance with Medicare and Medicaid Electronic Health Record (EHR) Incentive Program meaningful use requirements. Specifically, in a January 29, 2015 blog post by Patrick Conway, MD, Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, CMS announced that upcoming regulations would:

  • Realign hospital EHR reporting periods to the calendar year facilitate hospitals incorporation of 2014 Edition software into their workflows and better align with other CMS quality programs;
  • Modify other aspects of the program to reduce complexity and lessen providers’ reporting burdens; and
  • Reduce the EHR reporting period in 2015 to 90 days to accommodate these changes.

These changes are separate from another rulemaking expected to be released next month that would address the Stage 3 meaningful use criteria for 2017 and subsequent years.

OIG Reviews Oversight of Compounded Pharmaceuticals Used in Hospitals

The OIG has issued another report examining the safety of compounded sterile preparations (CSPs) used in hospitals, in response to a 2012 meningitis outbreak caused by contaminated injections. This report, "Medicare’s Oversight of Compounded Pharmaceuticals Used in Hospitals," assesses the extent to which Medicare's oversight of hospitals addresses 55 practices for CSP oversight in acute-care hospitals recommended by various expert guidelines. While CMS and the four CMS-approved hospital accreditors addressed most of the recommended CSP-related practices at least some of the time, the OIG identified certain gaps, particularly with regard to review of hospital contracts with stand-alone compounding pharmacies. The OIG also questioned the human capital available by oversight entities to thoroughly review hospitals' preparation and use of CSPs, and the adequacy of surveyor training related to compounding. The OIG recommends that CMS: (1) ensure that hospital surveyors receive training on standards from nationally recognized organizations related to safe compounding practices; and (2) amend its interpretive guidelines to address hospitals' contracts with standalone compounding pharmacies. CMS concurred with the recommendations.

OIG Report: Medicare Payments for Power Mobility Device Claims that Did Not Meet Physician Face-To-Face Exam Rules

As a condition of Medicare coverage for power mobility devices (PMDs), a physician must conduct and document a face-to-face examination of the beneficiary and write a prescription for the PMD. CMS established an optional Healthcare Common Procedure Coding System (HCPCS) code, G0372, for a physician to report the need for a PMD. Based on a review of a limited sample of claims (200 total), the OIG determined that while PMD claims with a corresponding physician G-code claim generally conformed with requirements for face-to-face examinations of beneficiaries, almost half of the 100 PMD claims without a corresponding physician G-code claim did not meet the face-to-face examination requirement. On the basis of its sample results, the OIG estimates that Medicare paid approximately $35.2 million in 2010 for PMD claims that did not meet federal requirements. The OIG recommends that CMS, among other things, adjust the sampled claims representing overpayments to the extent allowable; require physicians to use the G0372 code when prescribing PMDs; and educate physicians on the use of the G0372 code and the documentation requirements for face-to-face examinations. The report, “Medicare Paid Suppliers for Power Mobility Device Claims That Did Not Meet Federal Requirements for Physicians' Face-to-Face Examinations of Beneficiaries,” is available at http://oig.hhs.gov/oas/reports/region9/91202068.pdf.

House to Vote on ACA Repeal/Replace Bill; CBO Won't Score It

Next week, the House is expected to take up H.R. 596, a bill to repeal the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act of 2010 and restore the laws as if the health reform provisions had never been enacted. The bill also directs the House Committees on Education and the Workforce, Energy and Commerce, Judiciary, and Ways and Means to develop alternative legislation that meets various policy goals, including, among others:  lowering health care premiums through increased competition and choice; preserving a patient's ability to keep his or her health plan if he or she likes it; providing people with pre-existing conditions access to affordable health coverage; reforming the medical liability system; increasing the number of insured Americans; expanding state flexibility to administer the Medicaid program; and expanding incentives to encourage personal responsibility for health care coverage and costs.

Although the Congressional Budget Office (CBO) typically releases a budget estimate for legislation scheduled for a floor vote, CBO announced today that it is unable to do so in this case. CBO explains that estimating the budget impact of this legislation would take weeks of CBO and Joint Committee on Taxation staff time “because there are hundreds of provisions in the laws that would be repealed and those provisions are in various stages of implementation.” The CBO did not point out that President Obama would undoubtedly veto the legislation if it were to reach his desk.
 

CMS Announces New 6-Month Extension of Moratoria on Enrollment of HHAs, Ambulance Suppliers in Designated Areas

CMS is extending -- for another 6 months -- its current enrollment moratoria for new ground ambulance suppliers and home health agencies (HHAs) in designated metropolitan areas. The moratoria, which affect enrollment in Medicare, Medicaid, and the Children’s Health Insurance Program, apply to new ground ambulances in the Houston and Philadelphia metropolitan areas and new HHAs in the metropolitan areas of Fort Lauderdale, Miami, Chicago, Detroit, Dallas, and Houston. CMS discusses its rationale for extending the enrollment moratoria, including the factors suggesting a high risk of fraud, waste, or abuse, in a notice to be published on February 2, 2015. The extension is effective January 29, 2015. CMS may lift the moratoria before the end of the 6-month period or announce additional extensions.