House Looks at PPACA Provisions as Part of Tax Code Overhaul

The House Ways and Means Oversight Subcommittee held a hearing which included testimony on the effects of the PPACA medical device tax and the employer mandate to offer health insurance and other provisions. A home care service owner testified that the employer mandate has led some small businesses to reduce workers’ hours in an effort to get under the 50 full-time employee trigger for the mandate. Democrats and their witnesses said the PPACA tax credits and cost-sharing subsidies will make health insurance more affordable for millions of middle-class families. In related news, a Treasury Department spokesperson said that the final regulations for the “shared responsibility” employer mandate do not have a definite timetable for release, but that employers will be given a period of time to comply after the final rules are promulgated. In other news, House Speaker John Boehner and several other Republicans sent a letter to HHS asking the agency to continue funding under the PPACA for the state high-risk program (PCIP) which in the past has been a preferred alternative to the PPACA for Republicans.

Health Insurance Exchanges Expected to Offer Coverage in October

HHS announced that Iowa, Michigan, New Hampshire and West Virginia will operate so-called State Partnership Marketplaces in cooperation with the federal government bringing the total of such arrangements to seven. Twenty four states and the District of Columbia are on track to operate their own health insurance exchanges under the PPACA. HHS and CMS officials have said that the federal government will be ready to implement federally facilitated exchanges (FFEs) in all other states by the deadline.

CCTP Participants Announced

CMS said that 20 new participants will join 82 others under the Community-based Care Transitions Program (CCTP) designed to reduce hospital readmissions and improve the quality of care. Participant agreements under the 5-year PPACA program will run for two years.

Physician Payments under Medicare

The Chairman of the House Ways and Means Health Subcommittee, Rep. Kevin Brady (R-TX), has indicated that the efforts of his committee and the House Energy and Commerce Committee to reform the current sustainable growth rate (SGR) physician payment formula should result in legislation that he hopes will be passed before the August congressional recess. House Republicans have previously insisted that the legislation be fully paid-for, but without indicating which programs would be targeted for the spending cuts. OMB recently estimated that the 10-year spending cuts needed would amount to $138 billion; about $100 billion lower that under previous estimates. In related news, the Medicare Payment Advisory Commission (MedPAC) announced that their June report to Congress will not include a recommendation equalizing payments between physician offices owned by hospitals and freestanding offices. MedPAC also projected that Medicare spending on evaluation and management visits would increase by $1.2 billion annually and beneficiary cost sharing by $310 million by 2021, if the shift away from physician offices to hospitals continues at the current rate.

Health IT RFI

The Office of the National Coordinator for Health Information Technology and CMS have released a request for information on how policy and program changes to the “meaningful use” program and other existing programs could promote interoperability of electronic health record systems, provide incentives to caregivers for participating in health information exchange (HIE) and improve consumer and patient use of their electronic records.

GAO Says Medicare Advantage Plans are Overpaid

In a recent Government Accountability Office (GAO) report, Medicare Advantage: Substantial Excess Payments Underscore Need for CMS to Improve Accuracy of Risk Score Adjustments, the agency estimates that Medicare Advantage (MA) plans received excess payments amounting to between $3.2 billion and $5.1 billion over 2010-2012. GAO said the excess payments were due to the inaccuracy of the risk scoring system used to pay more to MA plans when MA beneficiary health risks exceed the average risks experienced by traditional Medicare beneficiaries. In the past, Republicans have criticized the cuts in MA payments as scheduled under the PPACA.

Upcoming Health Hearings

House Budget Committee: “Mark Up of the Concurrent Resolution On The Budget For Fiscal Year 2014”, 10:30 a.m., 210 Cannon Bldg, March 13

House Energy and Commerce Health Subcommittee: will hold a hearing titled “Unaffordable: Impact of Obamacare on Americans’ Health Insurance Premiums”; 10:00 a.m., 2123 Rayburn Bldg; March 13.

House Appropriations Labor, Health and Human Services, Education, and Related Agencies Subcommittee: will hold hearings on proposed fiscal 2013 appropriations for programs under its jurisdiction; 10:00 a.m., 2358-C Rayburn Bldg; March 13.

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