RushNotes Header
Your security software may block the RushNotes template. Please remember to right-click to download images.
A Weekly Publication of the Department of Government Relations  Week of December 12, 2011 
In This Issue
SGR Fix Remains Caught Up in Political Melee
Federal Appropriations Update
HHS Issues Details on Essential Health Benefits
APA Issues Strong Disapproval for Proposed Medicare-Medicaid Hospitals Conditions of Participation Rule

Quick Links

DGR Telephone: 

703-907-7800
 
DGR Fax:
703-907-1083

DGR Email:

View our profile on LinkedIn  Like us on Facebook  Follow us on Twitter

SGR Fix Remains Caught Up in Political Melee over Payroll Tax Break Extension Legislation

 

The House, Senate, and Obama Administration remain at odds over how to extend the Social Security payroll tax break - a political logjam that directly threatens the ability of Congress to fix the flawed Sustainable Growth Rate (SGR) formula before January 1, when physicians who treat Medicare patients will face a 27% Medicare update cut.

 

Last week, the House voted on a measure to extend the payroll tax break by one year.  Included in this bill was a two-year fix to the SGR.  On Saturday, the Senate amended the House bill and provided for only a two-month payroll tax break and SGR fix.  Senate leaders were at odds over how to pay for a longer extensions.  Over the weekend House Speaker John Boehner (R-OH) indicated that House Republicans are objecting to a two-month extension of the payroll tax break and are likely to reject the Senate language.  The House is expected to take action today.  

 

The Department of Government Relations will issue updates and developments as they occur.

Federal Appropriations Update

 

On December 16th, the House passed H.R. 2055, which contains 9 spending bills to fund federal programs in 2012 by a vote of 296-121. The next day, the Senate agreed to the measure by a vote of 67 - 32, the agreement avoids a government shutdown and provides the Department of Health and Human Services with a total of $69.7 billion, which is nearly $700 million below FY 2011. The Labor-HHS section also has a 0.189 percent across-the-board cut to all discretionary programs, except for the Pell Grant student aid program. The bill provides the National Institute of Health with $30.7 billion in funding, which is $299 million above last year's level and $758 million below the President's request. The bill funds the Substance Abuse and Mental Health Services Administration at a program level of $3.5 billion - $27 million below last year's level and $73 million below the President's budget request.

 

House leadership has announced that it wishes to negotiate further with the Senate and the White House this week on further cuts to domestic spending to off-set disaster aid funding.

 

We will keep you updated as events develop furthers. 

 

HHS Issues Details on Essential Health Benefits

 

The Department of Health and Human Services aims for states to be able to use existing health plans as benchmarks for benefits that must be offered in individual and small group health insurance plans that are to start in 2014 under the health care reform law. The agency requested public comments on the approach outlined by Jan. 31.

 

HHS said it intends to allow states to choose for their benchmark plan among one of the following:

 

* one of the three largest small group plans in the state;

* one of the three largest state employee health plans;

* one of the three largest federal employee health plan options; or

* the largest health maintenance organization in the state's commercial market.

 

The benefits included in the health plan selected by a state would be the essential health benefits package, HHS said. Plans could modify coverage within a benefit category as long as they do not reduce the value of the coverage, it said.

 

Under PPACA, the essential health benefits package must cover services in at least 10 categories, including hospital and physician services, and prescription drugs. The Institute of Medicine in October sent a report to HHS recommending that the essential health benefits package be based on small group plans in order to keep plans affordable.

 

Initially the exchanges will offer individual and small group plans, but in 2017, states will have the option of allowing large group plans in the exchanges.

APA Issues Strong Criticism of Proposed Medicare-Medicaid Hospitals Conditions of Participation 

 

On Friday, December 16, 2011, the APA submitted comments in response to CMS's proposed rule titled "Medicare and Medicaid Programs; Reform of Hospital and Critical Access Hospital Conditions of Participation."  The APA also joined the American Medical Association's regulatory comments. The APA expressed strong disapproval of CMS's proposed revisions to current medical staffing rules which would attempt to replace physicians with non-physician practitioners. APA noted that CMS's intent to reduce regulatory burden and improve patient access to care by replacing physicians with non-physician practitioners runs contrary to the purpose of conditions of participation, which should be to provide a safe hospital setting for Medicare and Medicaid patients.  

 

APA opposed portions of the rule that would provide hospitals with the ability to establish policies allowing for patient self-administration of medication out of concern for patient safety. The APA asked CMS to rework portions of the medical staffing, single governing body, and nursing sections of the rule so patient safety may be promoted. APA members may access the APA's comments here.