Roll Call: Latest News on Capitol Hill, Congress, Politics and Elections
October 2, 2014

Posts by Paul Jenks

132 Posts

October 1, 2014

FDA Unveils Draft Plans for Regulating Lab-Tests

The FDA has signaled its initial foray into regulating laboratory-developed tests, which are high-tech procedures used by an independent laboratory to test for high-risk diseases and offer a foray into the world of personalized medicine. Often the tests are marketed to the general public to examine genes and DNA to see if they indicate the presence of, or risk for developing, particular diseases or disorders, which then can be used to develop treatment plans.

The drug and device supervision agency on Tuesday, responding to some congressional pressure, announced draft guidance on a framework for regulating the tests, plus the process for a clinical laboratory to notify the FDA of a laboratory developed product. The documents are early drafts and official notices seeking public comments on the framework and notification guidance will be published on Friday.

 

 

 

GAO Opinion Bolsters GOP Case on Insurer Risk Payments

A group of Republican lawmakers on Tuesday obtained a legal opinion on legislative instructions for funding a key factor enticing health insurance participation in the state and federal exchanges. Exchange health plans can be obtained without restrictions due to preexisting health conditions and eliminating insurance limitations on preexisting conditions is a primary objective of the Affordable Care Act.

However, to avoid a catastrophic insurance market breakdown, the law instituted an individual coverage mandate, which broadens the coverage pool.  Also, the law added a temporary premium stabilization program for insurers to re-balance the coverage risk. The federal government subsidizes plans that have losses above a set amount and recovers money from plans that have gains.

CQ Health Beat’s (@CQHealthTweet) Rebecca Adams reported that the Centers for Medicare and Medicaid Services, in insurance exchange rules issued in May, tweaked the amounts this year given to insurers to cover losses and offset the cost of caring for high-cost patients. CMS expects the insurer subsidies and recouped payments to offset each other, but the final rule text notes:

In the unlikely event of a shortfall for the 2015 program year, HHS recognizes that the Affordable Care Act requires the Secretary to make full payments to issuers. In that event, HHS will use other sources of funding for the risk corridors payments, subject to the availability of appropriations.

On Tuesday, the Government Accountability Office provided Alabama Sen. Jeff Sessions and Michigan Rep. Fred Upton with an opinion noting that legislation covering fiscal year 2015 spending, which begins today and is funded through a stopgap spending resolution through Dec. 11, should also include special funding instructions for risk payments.

 

September 30, 2014

State Supervision Varies for Medicaid Managed Care

Many states provide Medicaid managed care plans and the states give the plans wide leeway when it comes to supervising standards for access to health care services. The bulk of persons enrolled in state Medicaid programs are covered by some kind of managed care program. The Department of Health and Human Services Inspector General, in a report on Monday, surveyed the diversity of state approaches to regulating managed care programs.

States allow different types of managed care options, which typically limit patients to a network of medical providers, but the states also provide varying levels of supervision. The inspector general found different standards for access to care and differing levels of effort in identifying violations. Federal supervision of the state Medicaid managed care plans is limited and the National Association of Medicaid Directors last week offered some suggestions to federal officials on improved federal and state supervision of the plans.

 

House Committee Issues Subpoena on Exchange Subsidy Decision

While Congress is on recess, committees can continue to prepare for hearings and ongoing investigations.

Last week, the House Oversight and Government Reform Committee quietly issued a subpoena to Treasury Department officials for documents regarding internal decision-making on allowing subsidies for health insurance plans offered through the federal insurance exchange.

The House panel has been investigating the subsidy decision for several years and the subpoena is the committee’s first formal effort to compel the administration to produce documents in relation to the subsidies. The Treasury Department outlined the premium tax credit in rules published in 2012.

The House panel is seeking internal documents on how the Treasury Department justified the decision to offer premium tax credits for policies purchased on the federal exchange.

CQ Roll Call’s John Reichard reports that the committee investigation dovetails with ongoing legal challenges to the legality of the subsidies. The separate legal challenges, one of which is currently under review by an appeals court, claim that the 2010 health care overhaul law only allows subsidies for policies purchased on state-operated exchanges.

 

 

 

September 29, 2014

Payment Database Set to Document Physician Financial Relationships

Details emerge this week on the murky world financial relationships between physicians and drug manufacturers. The Department of Health and Human Services on Sept. 30 is slated to open access for the general public to a searchable database of payments to physicians and hospitals from the medical industry for research, consulting, meals, travel and other gifts. The 2010 health care overhaul law authorized the public database.

HHS notes that the disclosure of payments from health companies is not intended to signify an inappropriate relationship and that the law does nothing to prohibit such transactions. The relationships could contribute to the design and delivery of life-saving drugs and devices but also could influence physician health care treatment decisions.

CQ HealthBeat’s Kerry Young (@CQHealthTweet) reported last month that the American Medical Association sought to delay the release of the database. The doctors group noted that the registration process is cumbersome and the time required to review the information for accuracy should push the release into next year.

 

Ebola Patient Arrives at NIH; Congress Slowly Releases Ebola Response Funds

On Sunday afternoon, the National Institutes of Health received its first Ebola patient. An American physician who was volunteering services in an Ebola treatment unit in Sierra Leone and was exposed to the virus was admitted to the NIH Clinical Center’s high-level isolation unit.

Meanwhile, congressional appropriators are slowly releasing the requested transfer of funding for the U.S. Ebola response effort in West Africa. Roll Call’s Humberto Sanchez and Niels Lesniewski reported on Friday that the approval of the transfer of the entire $1 billion request is held up pending further details on Pentagon plans to keep soldiers from contracting the illness.

Appropriations and defense committee leaders have released only portions of the request. The partial release of funding, which would have expired at the end of the last week, allows the Pentagon to spend $100 million of the funds while lawmakers await details of how the funds will be used.

 

 

 

 

September 26, 2014

Exchange Watch: Reports Review and Tally Healthcare.gov Spending

This week, federal investigators added some additional details to recent security concerns about the federal health insurance exchange website, healthcare.gov. However, separate concerns about burgeoning health care overhaul law implementation costs were also reinforced this week by several independent reports on spending on the development of the federal insurance exchange. A Government Accountability Office report released this week questioned Health and Human Services accounting procedures on health insurance exchange development expenditures. House Ways and Means Committee Republicans quickly responded to the report and it prompted the House Energy and Commerce GOP to update its tally of exchange costs and woes. Meanwhile, an accounting of current website contracting compiled by Bloomberg pegged the total cost for healthcare.gov at $2.1 billion.

 

 

 

Weekly Spotlight: Ebola Crisis Entices a Global Health Focus

President Barack Obama today address a summit of international health leaders at the White Hosue. The president and cabinet officials will tout the administration’s global health agenda, which is shadowed by the ongoing Ebola crisis in West Africa. On Thursday, the assembled health leaders met (view broadcast) to encourage non-governmental organizations to join in on an effort to create a worldwide system to get ahead of threats like Ebola. In a Thursday speech at the UN, Obama exhorted world leaders to ramp up their response efforts on Ebola.

However, an expanded international health crisis response program will require Congress to appropriate funds beyond the $1 billion the administration is seeking to establish treatment units and train and equip health care workers in West Africa. This week, a quirky funding transfer approval process inched toward final approval of shifting Pentagon funds toward the U.S. Ebola response plan.

Committee chiefs from congressional defense and appropriations panels must sign off on the transfer requests. CQ Roll Call’s Megan Scully reported on Wednesday that House appropriators have approved the request subject to additional details on goals and a mission timeline. A separate Associated Press report on Wednesday noted that a Senate defense committee transfer request sign off is still pending.

Meanwhile, CDC Director Tom Frieden this week spoke to congressional staffers at a seminar on the Ebola outbreak (view C-Span broadcast) and Roll Call’s Hannah Hess reported on the reaction to a display of Ebola containment devices on display in a House office building.

 

 

 

 

 

 

 

September 25, 2014

Feds Continue to Cite Healthcare.gov Security Concerns

Federal watchdog agencies are piling up concerns about limited security features of the healthcare.gov website, the primary portal for consumers in 36 states to sign up for federally subsidized health plans. Last week, a Government Accountability Office (GAO) report noted that despite efforts to shore up security, the site is still vulnerable to attacks that could expose sensitive personal information. GAO officials responded to questions from lawmakers on security concerns last week in a House committee hearing (view committee session video).

This week, a Department of Health and Human Services Inspector General report also weighed in on website security concerns. The internal HHS watchdog agency acknowledged ongoing improvements to website security, but investigators found a flaw that could allow a hacker to execute commands on the server and obtain or change information on the site. The report also noted concerns about the state-operated insurance exchange websites of New Mexico and Kentucky.

 

 

 

 

HHS Reports a Decline in Uncompensated Hospital Care

An objective of the health care overhaul’s provisions allowing states to expand coverage offered through the Medicaid program is the reduction in the burden on hospitals treating uninsured patients and the resulting hospital write-offs for uncompensated care. Hospitals are now beginning to recoup some the cost of treatment of previously uninsured patients through Medicaid, especially in states that have expanded the qualifications for Medicaid coverage.

The Department of Health and Human Services on Wednesday detailed the savings impact on hospitals, noting $4.2 billion in savings in states that have expanded the Medicaid program and $1.5 billion in states that have avoided an expansion. The federal government will pick up all of the expanded Medicaid program costs through 2016 and phase down to 90 percent of costs in 2020.

CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reported that the authors of the law expected a decline in charity care and bad debt as consumers gained insurance coverage. That was also one of reasons why Congress included in the health law billions of dollars in cuts in Medicare and Medicaid payments for hospitals that care for a large share of low-income patients. Additionally, the Affordable Care Act added requirements on charitable hospitals to document and justify policies and limit charges for uncompensated care.

 

 

 

 

 

September 24, 2014

Health Law Tax Forms Hint at Complex Tax Season

Earlier this year the IRS unveiled draft individual and business tax forms for documenting compliance with requirements of the Affordable Care Act. The law imposes a tax penalty on persons that do have health insurance coverage but the provision is likely to impact only little more than 1 percent of taxpayers due to a wide-range of exemptions.

However, CQ HealthBeat’s (@CQHealthTweet) John Reichard reported this week on concerns about the complex instructions for claiming the tax exemptions, especially for taxpayers that are only familiar with filing the simplest tax return — or have never filed a tax return. Additionally, taxpayers who received a subsidy — really a premium tax credit — for health insurance exchange plan coverage will have to reconcile the tax credit on their tax forms. The instructions for the form used to adjust the premium tax credit pose additional taxpayer demands and possibly additional taxes.

 

 

 

Young Adult Health Spending Surges After Parent Health Plan Expansion

On Sept. 23, 2010, one of the first elements of the 2010 health care overhaul law started and it turned out to be one of the most popular features — at least in terms of driving access to health care services. The law allowed parents to add adult children on employer-sponsored family health plans.

A new study released today by the Health Care Cost Institute reveals that young adult health care services spending in 2011 grew by 8.3 percent compared to other adult spending growth of 3.8 percent. Shortly after the insurance plan expansion allowance began, young adult emergency room visits increased along with spending on mental health services. The study also notes that health care spending grew faster for young adult men.

The study acknowledges that other factors, besides the Affordable Care Act, could also be attributed to the increase in young adult health care spending starting in 2011.  However, the report found a distinct surge in spending starting after implementation of the parent policy coverage provision.

By Paul Jenks Posted at 11:34 a.m.
Insurance

September 23, 2014

Pressure Mounts for Medicaid and Medicare Physician Payment Fixes

Doctors have long-held a prominent lobbying role in Congress. Most of the focus of recent efforts by physician groups revolves around pressing to continue temporary adjustments to several Medicare and Medicaid payment formulas.

In November, members of a  physician group are planning visits to lawmakers on Capitol Hill to urge an extension — beyond the scheduled year-end expiration — of a temporary Medicaid payment boost for primary care doctors. The payment increase was an attempt to reduce the gap between Medicaid and Medicare payment levels. The administration, earlier this month in its stopgap spending bill request, urged lawmakers to extend the primary care payments. But the adopted continuing resolution ignored the White House suggestion. CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reports on plans for the physician visits organized by the American Congress of Obstetricians and Gynecologists.

Also looming on the congressional agenda is the renewal of extended relief from planned cuts slated for next year to the broader Medicare physician payment formula. Congress has acted to thwart a scheduled physician payment cut each year for more than a decade. CQ Roll Call’s Melissa Attias reports that some lawmakers hope to permanently fix the payment formula during this year’s lame duck session. However, a permanent fix has long been a bipartisan objective but has been thwarted by disagreement on how to pay for the payment formula adjustment.

Burwell Addresses Health Law; Conferences Examine Ebola & New SCOTUS Term

This afternoon, as Department of Health and Human Services staff prepare the healthcare.gov website for the Nov. 15 start of a new enrollment period for health insurance exchange plans, HHS Secretary Sylvia Burwell will deliver remarks on the Affordable Care Act. The event is hosted by the Brookings Institution and the speech will be webcast online but requires registration. Health care economist Alice M. Rivlin will offer introductory comments.

Also today, Georgetown University hosts a conference on the background and economic implications of the Ebola crisis. The President of Liberia, Ellen Johnson Sirleaf, will address the conference this morning via Skype. Liberia lies near the center of the Ebola virus outbreak in West Africa.

Later this week, a Heritage Foundation conference on Thursday examines the Supreme Court’s upcoming term, which begins next week and could address lower court decisions on legal challenges to insurance subsidies offered through the federal health insurance exchange.

 

September 22, 2014

Health Insurance Auto-Renewal Process Omits Medicaid Plans

Over the next several weeks, 95 percent of people who signed up last year for a health plan through the federal insurance website, healthcare.gov, will be notified that their insurance will automatically renew for 2015. Earlier this year, the Department of Health and Human Service announced the process for the auto-renewal of policies.

However, people who signed up for a Medicaid plan may not know that they must take action to renew their coverage. CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reports that Medicaid recipients must reapply for coverage, even if their personal circumstances have not changed. The Medicaid program, which is largely administered by the states, requires each state to explain the renewal process. The varying state processes and accompanied documentation could result in some people losing coverage.

 

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