The Senate Committee on Health, Education, Labor, and Pensions is holding a series of hearings in September 2017 to focus on “actions Congress should take to stabilize and strengthen the individual health insurance markets.” Specifically, a September 6 hearing will feature five state insurance commissioners, and second hearing on September 7 will include testimony from

In a tacit acknowledgement of the hurdles ahead for enactment of Affordable Care Act (ACA) repeal/replace legislation, the Trump Administration is soliciting suggestion for changes that could be made within the current legal framework to improve health insurance markets and meet Administration reform goals. In particular, the Department of Health and Human Services (HHS) is

The House Judiciary Committee has approved HR 1215, the “Protecting Access to Care Act of 2017.” The bill includes a variety of medical liability reforms, including a $250,000 cap on noneconomic damages, limits on contingency fees, and allocation of damages in direct proportion to fault. The provisions would apply only to claims concerning the

Citing “differences between providers’ and suppliers’ financial interests and patients’ interests” that “may result in providers and suppliers taking actions that put patients’ lives and wellbeing at risk,” CMS is imposing stringent new requirements on Medicare-certified dialysis facilities that seek to make payments of premiums for individual market health plans.

By way of background, earlier this year CMS received anecdotal reports that some dialysis providers were paying Medicare- or Medicaid-eligible patients’ private insurance premiums to take advantage of higher private payer reimbursement rates. According to a CMS fact sheet, individual market reimbursement for dialysis treatment can be four times higher than Medicare and Medicaid rates – a difference of $100,000 to $200,000 or more per patient per year, which “easily dwarfs the several thousand dollar cost of providing premium assistance.” CMS published a request for information on August 23, 2016 to receive more information on the prevalence of such arrangements, which CMS believed could increase health system costs and be financially disadvantageous for beneficiaries.

In an interim final rule with comment period published December 14, 2016, CMS states that commenters indicated widespread facility involvement in end-stage renal disease (ESRD) patients’ coverage decisions. While the agency acknowledged receiving letters from patients satisfied with such premium arrangements, CMS cited other commenters who documented that providers and suppliers were “influencing enrollment decisions in ways that put the financial interest of the supplier above the needs of patients.” Commenters argued that such arrangements can harm patients by negatively impacting their determination of readiness for a kidney transplant; potentially exposing patients to additional costs for health care services; and putting them at significant risk of a mid-year disruption in health care coverage.Continue Reading Conflict of Interest Concerns Prompt New CMS Restrictions on Dialysis Facility Payment of Beneficiary Health Plan Premiums; Allows Plans to Reject Third-Party Payments

A number of Congressional committees have recently considered legislation and/or held hearings on various health policy proposals.

  •  The Ways and Means Committee approved seven bills related to health care coverage and tax policy, including various bills to: expand access to health reimbursement arrangements and health savings accounts; ease employer insurance coverage mandates for students and certain tribally-owned businesses; and modify an Affordable Care Act provision related to deduction of medical expenses. The Committee also held a hearing on various legislative proposals “to improve and sustain the Medicare program.”
  • The Energy & Commerce Health Subcommittee approved H.R. 921, the Sports Medicine Licensure Clarity Act of 2015, to clarify medical liability rules for athletic trainers and medical professionals. The panel also approved H.R. 3299, the Strengthening Public Health Emergency Response Act of 2015, to incentivize the development of medical countermeasures for public health emergencies and biochemical attacks. Furthermore, the Committee held hearings focusing on legislation to modernize the health insurance market and the public health responses to antibiotic resistance.

Continue Reading Recent Congressional Health Policy Hearings and Markups

The Department of Health and Human Services (HHS) has published a final rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in any health program or activity that receives financial assistance from or is administered by HHS or

On December 2, 2015, CMS is publishing its annual proposed Notice of Benefit and Payment Parameters, which would govern participation in the Affordable Care Act (ACA) Health Insurance Marketplaces for 2017. The wide-ranging rule includes a number of provisions intended to protect consumers enrolled in Marketplace plans, enhance transparency, improve marketplace premium stabilization programs, and make other refinements to Marketplace requirements. Of particular note, the proposed rule would:
Continue Reading Obama Administration Proposes 2017 ACA Marketplace Plan Benefit and Payment Parameters

On November 18, 2015, the Obama Administration published final regulations to update requirements for group health plans and health insurance issuers under the ACA, particularly with regard to the changes they can make to the terms of their plan/coverage while retaining their “grandfathered” status. The regulations also address preexisting condition exclusions, lifetime and annual

Today the House of Representatives approved H.R. 3762, budget “reconciliation” legislation that would repeal four provisions of the Affordable Care Act (ACA).  Specifically, the legislation would repeal the ACA employer and individual insurance mandates, the medical device excise tax, and the so-called “Cadillac tax” on high-cost health plans (an earlier House Ways and Means Committee

The House and Senate have approved a bill (H.R. 1624) that would amend the Affordable Care Act’s definition of “small employer” to reduce the number of employers covered by new health insurance coverage requirements set to go into effect in 2016. The legislation would define small employers as those with 50 or fewer

On September 9, 2015, the House Energy and Commerce Committee is holding a hearing on H.R. 1624, Protecting Affordable Coverage for Employees Act of 2015. The legislation would amend the Public Health Service Act to redefine small employer for purposes of Affordable Care Act (ACA) health insurance coverage provisions as one with 50 or fewer

Two Congressional hearings are scheduled this week on health policy issues:

  • On July 7, 2015, the Senate Health, Education, Labor and Pensions Committee has scheduled a hearing on “Small Business Health Care Challenges and Opportunities”; and
  • On July 8, the House Energy & Commerce Health Subcommittee will focus on “Medicaid at 50: Strengthening

On June 12, 2015, the Internal Revenue Service, Employee Benefits Security Administration, and Centers for Medicare & Medicaid Services released final regulations regarding the summary of benefits and coverage (SBC) and the uniform glossary requirements for group health plans and health insurance coverage in the group and individual markets under the Affordable Care Act. The

On January 8, 2015, the House of Representatives approved H.R. 30, the “Save American Workers Act.”  The legislation would amend the ACA’s definition of “full-time employee” for purposes of the requirement that certain employers provide health care coverage for their full-time employees. Specifically, the bill, which was approved on a 252 to 172 vote, would

Recent Congressional hearings on health policy issues include the following:

  • A House Energy and Commerce Health Subcommittee “21st Century Cures Roundtable” discussed steps Congress can take to bridge the gap between medical advances and the regulatory policies that govern them, and ultimately advance digital and personalized health care. The panel also released a related white

HHS has released a report on premiums, tax credits, and health plan choices on the ACA federal Marketplace for plans operating in 2014.  In addition, CMS has launched an initiative, dubbed “From Coverage to Care,” designed to answer questions consumers may have about their new health coverage under the ACA and to help individuals

The Senate Appropriations Committee has scheduled a May 7, 2014 hearing to review the Administration’s FY 2015 budget request for the Department of Health and Human Services (HHS). Also on May 7, the House Energy and Commerce Oversight Subcommittee will examine the status of health insurance enrollment under the ACA, and the Senate Aging Committee

A number of Congressional committees have held hearings recently to address various health policy issues, including the following:

  • The House Energy and Commerce Committee conducted hearings on Medicare Part D drug policy, the role CMS contractors play in management of the Medicare program, and the public health threat of counterfeit drugs;
  • The House Education and

This post was written by Nancy Sheliga.

The Government Accountability Office (GAO) has released a report examining the effect of prior health insurance coverage on Medicare beneficiaries. The report specifically focuses on the health status, program spending, and use of services by Medicare beneficiaries with and without continuous health insurance coverage before Medicare enrollment.