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February 13, 2016

Posts by Paul Jenks

322 Posts

March 27, 2015

Thank You for Reading

This is the last posting for Healthopolis. Thank you for reading! Please feel free to continue keeping up with congressional health care topics on Roll Call. Also, CQ’s HealthBeat provides a detailed diary of congressional and regulatory developments regarding health care policy-making.

The 114th: CQ Roll Call’s Guide to the New Congress

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By Paul Jenks Posted at 12:22 p.m.

February 25, 2015

HHS Auditor Prepares ACA Oversight Plan

The inspector general of the Health and Human Services Department  has devoted a large chunk of its annual work plan to monitoring the implementation of the Affordable Care Act, and this week released a health law oversight plan to focus on fraud, waste and abuse, program value, consumer safety and agency efforts to promote innovation. The IG expects 5-10 reports this year specifically focusing on the ACA.

The top priority will be reviews of insurance exchange operations and examination of exchange infrastructure, management and spending, plus the security of plan enrollment information. The IG also will examine internal federal and state process relating to an expanded Medicaid program, Medicare and Medicaid payment changes and program integrity, plus reviews of public health and preventive health grant programs

Initial reports planned for delivery over the next few months include a review of the accuracy of payments to health plans for premium tax credits and payments to federal insurance exchange contractors. Other reports this year include security reviews of state exchanges and an audit of grants to states to establish exchanges.


National Health Security Plan

When a natural or man-made disaster strikes, a local medical crisis usually follows. Health care facilities and public health agencies normally have disaster plans in place but often need higher level assistance. The Department of Health and Human Services this week released a revised national health security plan.

The goal of the National Health Security Strategy is to “strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from disasters and emergencies.” The national plan is a fundamental element of federal public health policy and sets specific objectives for the next four years. The strategic objectives are:

  • Build and sustain healthy, resilient communities.
  • Enhance the national capability to produce and effectively use both medical countermeasures and non-pharmaceutical interventions.
  • Ensure comprehensive health situational awareness to support decision-making before incidents and during response and recovery operations.
  • Enhance the integration and effectiveness of the public health, healthcare, and emergency management systems.
  • Strengthen global health security.


February 24, 2015

IRS Offers Guidance on Health Insurer and Cadillac Plan Taxes

The Internal Revenue Service is offering guidance on two complicated tax topics initiated by the 2010 Affordable Care Act. The health law is partially funded by an annual fee on health insurers. The fee has been in place since 2013 and new rules set to be published on Thursday set regulations for the fee for 2015. The tax is not applicable to employers who self-insure, non-profit insurers and voluntary employee benefit groups. The new rule notice offers guidance on the tax agency’s effort to clarify the definition of an entity covered by the tax. Last week, Louisiana Republican Rep. Charles Boustany, Jr. blasted the whole idea of the insurer fee as one of the ways the health law increases the cost of insurance premiums. Boustany touted legislation repealing the fee.

Separately,the health law seeks to cull the use of expensive health plans that add to health system spending. On Monday, the IRS issued a notice describing the process it will use to determine a new excise tax on high-cost, employer-sponsored plans. The tax adds a 40 percent charge on “excess benefits” in plans often dubbed “Cadillac” plans. The excise tax is due to start in 2018. The IRS is seeking comments on how the tax agency will define applicable coverage, the amount categorized as “high cost” and dollar limits on coverage.

By Paul Jenks Posted at 8:44 a.m.

February 23, 2015

Mulling Implications of Not Renewing CHIP Funding

The State Children’s Health Insurance Program (CHIP) is poised for a possible rocky-road ahead if Congress does not renew funding later this year. The CHIP program is a means-tested program providing health insurance coverage to low-income children and pregnant women. It is a joint project to the federal government and the states. Federal regulations set basic requirements and the states can design their own programs. In 2013 CHIP enrollment totaled 8.4 million and federal and state CHIP expenditures totaled $13.2 billion.

Federal funding for the CHIP program expires on Sept. 30, 2015 and funding renewal is a high bipartisan congressional priority but debate on a re-authorization bill is likely to extend to close to the deadline. If lawmakers are unable to agree on a renewal bill, the portion of federal CHIP funding assigned to the ongoing effort to expand Medicaid will be covered through regular Medicaid funding, but other state CHIP programs are subject to funding restrictions covered by ‘maintenance of effort’ rules included in the Affordable Care Act. The program maintenance rules require states to maintain current eligibility levels for CHIP children.

The Congressional Research Service recently provided lawmakers with a report (CQ subscription) describing the impact to maintenance of effort rules for ongoing CHIP programs if funding expires in September. The report notes:

The states are provided a couple of exceptions to the MOE requirement: (1) states may impose waiting lists or enrollment caps to limit CHIP expenditures, and (2) after September 1, 2015, states may enroll CHIP-eligible children in qualified health plans in the health insurance exchanges. In addition, in the event that a state’s CHIP allotment is insufficient to fund CHIP coverage for all eligible children, a state must establish procedures to screen children for Medicaid eligibility and enroll those who are Medicaid eligible. For children not eligible for Medicaid, the state must establish procedures to enroll CHIP children in qualified health plans in the health insurance exchanges that have been certified by the Secretary of Health and Human Services to be “at least comparable” to CHIP in terms of benefits and cost sharing.

By Paul Jenks Posted at 11:58 a.m.
Children, Insurance

This Week: HHS Budget Hearings Shadowed by Exchange Enrollment Tax Woes

Congress returns from a recess break and this week dives into an examination of fiscal 2016 spending bill requirements. Health and Human Services Secretary Sylvia Burwell will defend HHS agency funding at Wednesday and Thursday House committee hearings. However, Burwell will likely be quizzed mostly on other topics such as health exchange enrollment estimates plus exchange development and contingency planning. Burwell will also get an opportunity to explain a recently announced expanded enrollment period for people who didn’t comply with the health law’s individual mandate in 2014 and the release of erroneous subsidy data to 800,000 tax filers currently preparing their 2014 tax forms. A House hearing this week will focus on the tax implications of the exchange enrollment process. Also, a Senate hearing on Thursday reviews medical and public health preparedness.

The Senate Commerce, Science and Transportation Committee on Thursday is scheduled to mark up legislation (S 142) sponsored by Democratic Sen. Bill Nelson of Florida that would direct the Consumer Product Safety Commission to issue a childproof packaging rule for liquid nicotine, which is used to refill electronic cigarettes.

Today, the US Department of Agriculture and the Department of Health and Human Services formally published a notice seeking public feedback on the 2015 Dietary Guidelines Advisory Committee Scientific Report. The new guidelines seek to change public behavior on sugary drinks and continues an effort to reduce meat consumption.

February 20, 2015

HHS Offers Enrollment Reprieve

Health and Human Services officials said on Friday that the department will give consumers who face a tax penalty for not having health care coverage in 2014 almost another seven weeks, from March 15 through April 30, to buy health insurance this year.

The original deadline for buying insurance was Feb. 15, although people who did not finish their application have until Feb. 22 to complete it.

HHS officials also said that the administration sent 800,000 people incorrect information in January about the subsidies they got in 2014, which would affect their tax refunds. The administration will send out corrected forms in March.

By Paul Jenks Posted at 11:12 a.m.

Dietary Guidelines Target Sugar and Meat

A federal dietary policy advisory committee on Thursday announced recommendations that “seek a paradigm shift to an environment in which population health is a national priority.” The panel’s recommendations are included in Dietary Guidelines for Americans in 2015, which updates recommendations offered in 2010. The new guidelines stress a need for a cultural change for individuals and communities toward healthier lifestyle choices. The release of the new recommendations kicks off a 45-day comment period, where the food industry, agriculture groups, and public health advocates will weigh in.

The report offers Americans a specific target for change: sugar. The committee says that sugar-sweetened beverages should be replaced with healthier options like water and not drinks with low-calorie sweeteners. However, the report spares coffee and alcoholic drinks and even suggests some benefits from including coffee and alcohol in a dietary program.

The report also adds to earlier guidelines and urges continuing the dietary shift from meat-heavy meals to more plant-based foods to improve health and the environment. The report does not call for the end of meat in U.S. diets, adding, “that no food groups need to be eliminated completely to improve sustainability outcomes over the current status.” But the committee defined a healthy diet as one “lower in red and processed meats; and low in sugar-sweetened foods and drinks and refined grains.”

February 19, 2015

IRS Offers Some Relief on Employer Coverage Reimbursement

The administration has quietly bowed to pressure from small businesses on taxing employers who offer cash reimbursement to employees to purchase health insurance. The IRS and Department of Labor reminded taxpayers last year that premium reimbursement through health reimbursement accounts does not absolve the employer from the requirement to offer health coverage. The employer will still be subject to an excise tax for failure to provide coverage.

On Wednesday, the IRS announced transition relief from the tax until June 30, 2015. The tax agency justified the delay due to the slow development of small business insurance exchanges and some employers may need more time to obtain group health coverage. Iowa Republican Sen. Charles E. Grassley quickly welcomed the tax enforcement delay and Louisiana Republican Rep. Charles Boustany, Jr. urged a permanent delay of the tax.

By Paul Jenks Posted at 8:15 a.m.

February 18, 2015

Next Month in Congress: Physician Payment Fix

When Congress returns for a new legislative work period next week, lawmakers will be forced to make a decision on extending, adjusting or overhauling the Medicare physician payment system. Doctors treating Medicare beneficiaries would see their fees reduced by about 21 percent if Congress doesn’t act before a current payment adjustment expires on March 31. The payment formula has been adjusted to avoid a payment cut 17 times since 2003.

Action on the payment change will not be easy. The Congressional Budget Office earlier this month increased by $30.5 billion the price tag of a repeal and replacement of the current payment formula. According to the updated CBO estimates, a nine-month patch that freezes current payment rates would cost $12 billion over the fiscal 2015 to 2025 time span, while a freeze through the end of 2016 would cost $30.4 billion over the same period.

The price tag calculations are important because Republican lawmakers have generally insisted that any payment adjustment or overall fix must be paid for with other spending cuts or new taxes.  Previous physician payment measures have usually tagged other Medicare provider payments to offset the cost of fixing physician payments.

By Paul Jenks Posted at 8:13 a.m.

February 17, 2015

Raw Milk Outbreaks on the Rise, CDC Says

By Georgina Gustin, CQ Roll Call

Consumption of raw milk has led to more outbreaks of illness, especially in states where its sale is legal, according to a new report from the Centers for Disease Control and Prevention.

The numbers could fire up the debate over raw milk, which both the CDC and the Food and Drug Administration warn against, but some consumers insist has curative properties.

In 2014, 23 states considered bills to legalize raw milk. In Congress last year, Rep. Thomas Massie, R-Ky., introduced two bills that would prevent the FDA from enforcing bans on interstate sales.

The CDC study, released Thursday, found that 26 states reported 81 outbreaks traced to raw milk, leading to 979 illnesses and 73 hospitalizations. Most of the outbreaks were linked to campylobacter bacteria.

The study noted a rise in outbreaks from 30 between 2007 and 2009, to 51 between 2010 and 2012.  More than 80 percent of the outbreaks were in the 26 states where sales are legal. The number of outbreaks has gone up from an average of 3.3 per year from 1993 to 2006, to 13.5 per year from 2007 to 2012.

Proponents of raw milk consumption maintain that pasteurization kills nutritive enzymes that can cure everything from asthma to autism.  Advocacy groups, many with a libertarian bent, have called the government’s position on raw milk “pasteurization without representation.”

But federal and state health agencies warn against consuming raw milk because, without pasteurization, the milk can easily become contaminated by feces, dirt, insects, cow illnesses and bacteria living on an animal’s skin.  “Milk cannot be collected without introducing some bacteria – even under ideal conditions of cleanliness,” the CDC says.


By Paul Jenks Posted at 8:45 a.m.
Food Safety

February 13, 2015

This Week: Auditing Health Programs

Congress this week largely focused on defense policy and the Keystone Pipeline, and the respite gave committees time to weigh in on a range of health topics.

The Government Accountability Office had a busy day Wednesday on Capitol Hill. Reports from the audit agency provided fodder for House committees to criticize the Department of Health and Human Services for lapses in the coordination and evaluation of federal mental health programs. House Energy and Commerce subcommittee on health, Joe Pitts, R-Pa.,  largely accepted a separate report on the HHS implementation of a new batch of medical diagnostic codes (ICD-10). Pitts urged no further delays with the implementation of a new medical billing system, making it more likely a planned Oct. 1 deadline will stick for a switchover to the ICD-10 codes. Separately, the GAO updated its list of high-risk programs and added the veterans’ health system to the vulnerable federal program watch list.

The House Energy and Commerce Committee on Thursday considered a batch of bills, including measures regulating  (HR 638) and managing (HR 471) controlled substances and renewing trauma systems programs (HR 647 and HR 648).

House appropriators this week examined funding for the Ebola response mission to West Africa and new domestic Ebola research and preparedness programs. The administration told lawmakers that emergency spending passed by Congress last year helped slow the rate of new Ebola cases. Additionally, the Senate Health, Education, Pensions and Labor Committee examined the divide between parental rights and public health requirements when addressing vaccines for preventable diseases.

February 12, 2015

Another Health Care Program Added to Federal High Risk List

The complexities and cumbersome operations of federal programs were highlighted on Wednesday, as the Government Accountability Office updated its ongoing list of high-risk programs. The special tally identifies the most troublesome government programs due to vulnerabilities that can lead to waste, fraud, abuse, or mismanagement. The programs are deemed a high risk not only for the vulnerabilities but also an apparent lack of an effective policy for improvement. This year, after a year-long scandal over veterans’ treatment wait times, the Veterans Administration’s medical system has been added to high-risk list. The GAO notes that while Congress has passed legislation that addresses VA system problems and adds funding, the audit agency still needs to monitor how the VA implements the changes.

Adding the VA health system to the list adds another vulnerable health care concern to the 31 other worrisome programs. The Medicare program is a charter member and has been on the high risk list since the GAO began monitoring risky programs in 1990 – and it has not been removed from the list. Other programs currently programs on the tally are the Medicaid program, federal food safety monitoring and FDA oversight of medical products.

By Paul Jenks Posted at 9:31 a.m.
Medicaid, Medicare

Embedded Connections in the Health Insurance Exchange Website

Several House science panels assemble this afternoon to examine the security and privacy concerns about the federal health insurance exchange website, The committee is particularly interested in reports of embedded data mining connections included in the website that can collect consumer health and financial information. The hidden website connections, first reported by the Associated Press last month, let third-party companies monitor consumer behavior on the website and assemble personal details, such as age and income. The connections can also register reported health risk factors. The committee will quiz several privacy experts not only on the possible security threat but also ponder the justification for allowing data mining companies access to the data flow on the website.



By Paul Jenks Posted at 7:17 a.m.
Health IT

February 11, 2015

Auditing Health Programs is a Full-Time Job

Four different congressional panels today focus on Government Accountability Office (GAO) efforts to monitor program implementation within the Department of Health and Human Services. The GAO is the main outside agency that examines HHS operations and its audit reports are frequently critical of the agency.

Two House Energy and Commerce subcommittees today cast a spotlight on recent audit reports. An oversight panel reviews a report on HHS leadership on mental health programs (view GAO report released on Feb. 5) which pegged HHS inter-agency coordination of programs supporting individuals with serious mental illness as “lacking.” The health subcommittee examines a report on HHS implementation of new health care disease codes (ICD-10, view GAO report released on Feb. 6). Additionally, a Senate panel this morning and a House subcommittee this afternoon mull the GAO’s efforts to monitor high-risk programs. The Medicare and Medicaid programs are charter topics for the auditor’s annual compilation of federal programs that are prone to fraud and waste risks.

The GAO on Tuesday provided lawmakers with additional fodder for more committee hearings, with two new audits calling for better planning and coordination of programs that address prenatal prescription drug abuse and action to improve the collection of money from third-parties covering health expenses of Medicaid recipients.

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