PPACA Navigator Rules

CMS issued a proposed rule defining the requirements that so-called “navigators” will have to meet in order for them to help eligible individuals obtain coverage under health insurance exchanges, including the federally facilitated exchange, beginning in the open season this October. Standards for such navigators relate to: the collection of information, avoiding conflicts of interest, training and certification, and ensuring access for the disabled. Rep. Kenny Marchant (R-TX) questioned why HHS and the Office of Management and Budget (OMB) assumed that navigators would be paid between $20-48 per hour in their estimate of the regulatory burden of the proposed rule. The agencies said that the rule would not set the level of wages for such individuals.

Delay in SHOP Choice of Coverage for Workers

HHS announced that it is delaying until 2015 the provision that employees be given a choice of health insurance options under the PPACA Small Business Health Options Program (SHOP). The agency said that, for 2014, small businesses in the thirty-three states with health insurance exchanges run fully by or in partnership with the federal government need to offer only one plan to their employees. The seventeen states operating their own exchanges can also abide by the small business rule.

IRS Issues Proposed CHNA Rules

The Internal Revenue Service (IRS) released a proposed rule under the PPACA which sets forth community health needs assessment (CHNA) provisions that charitable hospitals must meet. The IRS said that the written assessment by each facility must be made publicly available or be subject to a $50,000 excise tax for failing to meet such CHNA requirements.

House Committees Propose Medicare Physician Payment Reform

The House Ways and Means and Energy and Commerce Committees released a second draft of possible reforms to the “sustainable growth rate” (SGR) methodology used under the existing Medicare physician payment system. The new draft reflects comments on the previous proposal released in February. The second iteration of the framework includes: an unspecified transitional period of stable payments; payments based on the quality of care delivered to beneficiaries; risk adjustments for quality measures to avoid penalizing physicians who treat sicker patients; financial rewards for providing efficient care, and a means for physicians to remain in fee-for-service Medicare or opt for a new care model. The proposal anticipates a revenue-neutral approach, but does not specify any potential pay-fors. Legislation is expected to be introduced and hearings held by early May.

HHS Gives MA Plans Reprieve on 2014 Payment Cuts

Following intense lobbying by insurers, beneficiaries and congressional members, HHS Secretary Kathleen Sebelius overruled the CMS Office of the Actuary recommendations that Medicare Advantage (MA) plans be paid 2.2% less in 2014. The revision will result in such payments increasing by an average of about 3.3% as a result of recalculations that assume the scheduled 25% cut in 2014 physician payments will be overridden by Congress this year. In related news, CMS announced that it will delay making changes to the “star” rating system for MA plans after receiving criticism from insurers and congressional members. CMS said it will do further research on the star system and release the results sometime this summer.

President and NIH Announce New Spending for Human Brain Research

The President and NIH Director Francis Collins, MD, PhD announced a new multi-year “transformative” project to give scientists “the tools they need to get a dynamic picture of the brain in action and better understand how we think and how we learn and how we remember.” The FY 2014 $110 million in funding is expected to come from several federal sources: $40 million from NIH; $50 million from the Defense Advanced Research Projects Agency; and $20 million from the National Science Foundation. The project is expected to induce private partners to contribute a similar amount per year (e.g. $60 million from the Allen Institute for Brain Science; $30 million from the Howard Hughes Medical Institute; and $28 million from the Salk Institute for Biological Studies). The goal is to find treatments or cures for such conditions as post-traumatic stress disorder (PTSD), Alzheimer’s disease, epilepsy, etc.

Increased CMS Oversight of Accreditation Organizations

CMS released a proposed ruling that is intended to increase the agency’s oversight of the seven accreditation organizations which are used in 19 CMS-approved accreditation programs. CMS evaluations would be based on new documentation and informational reporting requirements.

Senator Grassley Questions HRSA on 340B Program

Senator Charles Grassley (R-IA) sent a letter to the Health Resources and Services Administration (HRSA) containing his concerns that certain hospitals are short-changing uninsured and low-income patients under the 340B program which requires drug manufacturers to provide outpatient drugs at reduced prices to disproportionate share hospitals. He asked the agency for answers by April 22nd regarding HRSA data collection programs to prevent 340B savings from accruing to others than those intended under the law. In other HRSA news, the agency announced that the Healthcare Integrity and Protection Data Bank (HIPDB) will be shut down after transferring all HIPDB data to the National Practitioner Data Bank (NPDB).

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