Federal Exchange Scrutinized

The federal default exchange (the federally facilitated health insurance exchange) and the contractor selected by HHS to develop the infrastructure of the federal data hub have come under fire by Republicans. House Oversight and Government Reform Committee Chairman Darrell Issa and Senator Orrin Hatch have written to HHS Secretary Kathleen Sebelius seeking information about what they see as potential conflicts of interest the contractor may have in that it has been acquired by one of the largest health insurers who may participate in such exchanges. The members also criticized HHS saying that "it remains unclear how the administration plans to administer key aspects of the law, particularly the design, management, and implementation of the federally-facilitated health insurance exchanges ... and the federal-state partnership exchanges."

PPACA Employer Mandate Regulations Proposed

The IRS released proposed regulations under IRC section 4980H spelling out details relating to the PPACA requirement that employers with at least 50 full-time and/or full-time equivalent employees offer "affordable" minimum health care coverage to such employees and "dependents" or pay a penalty. Under the rule an employee would have to be offered coverage if the employee works 30 or more hours per week and 130 hours of service in a calendar month would be considered as the monthly equivalent of 30 hours of service per week. Three alternative methods for calculating full time equivalents (FTEs) are provided for employees who do not work on an hourly basis. For purposes of the rule, the term "dependent" does not include a spouse but includes "an employee's child (as defined in section 152(f)(1)) who is under 26 years of age." Comments on the rule are due by March 18.

Court Rulings on PPACA Cases

The U.S. Supreme Court has denied an application by Hobby Lobby Stores Inc. and another employer for an injunction that would prevent the federal government from enforcing the PPACA's mandate that non-grandfathered group health plans provide no-cost coverage for contraceptives, contraceptive devices, sterilization procedures and patient education and counseling. In another case, the U.S. District Court for the District of Arizona dismissed claims by individuals that the PPACA individual mandate violates their due process rights to privacy and medical autonomy. The court said that neither claim was actionable in that the plaintiffs retain the right, by paying the tax imposed on those who decline to purchase health insurance, to choose their medical providers and to forego the submission of personal information to insurers and the federal government.

GAO Reports on Medicare Quality and Medicaid Legal Authority

The GAO issued a report requested by Senators Baucus and Hatch--Medicaid: More Transparency of and Accountability for Supplemental Payments Are Needed (GAO-13-48)--which suggests that Congress may need to enact legislation to give CMS authority to require states to submit annual reports and independent audits on their supplemental "non-DSH" payments to providers under the disproportionate share hospital (DSH) program. In another GAO report--Private-Sector Initiatives Can Help Inform CMS Quality and Efficiency Incentive Efforts (GAO-13-160)--the agency recommended that CMS take steps to conform its Medicare value modifier program for physicians to similar to quality initiatives in the private sector. GAO also said CMS lacks a strategy for applying the Medicare value modifier program to solo and small-practice physician groups in a manner that ensures measurement credibility.

Comments Due on Medicare Clinical Quality Data

CMS is requesting comments by January 22nd on the readiness of hospital electronic health record systems for their use to collect and report clinical quality measures as a means to qualify for meaningful use incentive payments in 2014.

Health Legislation Recently Introduced

H.R. 6710 (NHSC): A bill to include geriatrics and gerontology in the definition of "primary health services" under the National Health Service Corps program; RICHARDSON, to the Committee on Energy and Commerce, Dec. 27.

H.R. 6712 (MENTAL HEALTH): A bill to require the disclosure to parents of information regarding mental illness treatment for their children under the age of 26; RICHARDSON, to the Committee on Energy and Commerce, Dec. 27.

H.R. 6714 (CHILDRENS' HEALTH): A bill to establish a grant program for automated external defibrillators in schools; RICHARDSON, to the Committee on Education and the Workforce, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned, Dec. 27.

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