POLICY BRIEFINGS


State-Run Exchange Commission Rules


The CMS Center for Consumer Information and Insurance Oversight (CCIIO) issued guidance on broker/agent payments with respect to states approved to operate their own online health insurance exchanges next year. In general, the CCIIO said that State-Based Marketplaces may establish parameters for compensating agents and brokers, by direct compensation from the Marketplace, or by having health insurance issuers pay commissions. On the other hand, broker/agent compensation would continue to be negotiated between issuers and their broker/agents with respect to health coverage offered under federally-facilitated-exchanges and state-partnership-exchanges.


Medicare SGR Reform


On Tuesday the House Ways and Means Health Subcommittee will hold a hearing on proposals that would repeal the Medicare Physician Payment System’s Sustainable Growth Rate (SGR) formula and overhaul the Medicare Physician Payment System. The House Ways and Means and Energy and Commerce Committees jointly released a second draft of a legislative framework for the reform of the Medicare Physician Payment System. House Energy and Commerce Committee Chairman Fred Upton (R-MI) stated that his committee intends to ready such legislation for floor action before the August congressional recess.


Medicare Payments to Increase for Hospices, IRFs and SNFs


CMS issued proposed rules under which Medicare reimbursements to hospices would increase 1.1% in FY 2014. CMS is also seeking comments on a proposal which would eliminate the pain management and quality assessment and performance improvement program and replace them with other quality measures. CMS also proposed to increase FY 2014 Medicare payments by 2% for inpatient rehabilitation facilities (IRFs) under the prospective payment system as well as to update the 60% rule for determining whether a hospital is eligible for the higher IRF PPS rate. Quality reporting for IRFs would also be updated to include three new National Quality Forum endorsed quality measures. CMS also proposed that payments to skilled nursing facilities (SNFs) be increased by 1.4% in FY 2014 using a new SNF market-basket index that includes the most commonly used cost categories for SNF routine services, ancillary services and capital-related expenses. Comments are generally due by June 1.


MA and Part D Plan Contracts with Providers Override Medicare Sequestration


CMS has alerted Medicare Advantage and Part D plans that their existing payment contracts with providers must be followed despite the 2% reduction of Medicare payments under the BCA sequestration mandate applicable to the Medicare fee-for-service program (FFS). However, CMS states that a non-contract provider is required to accept as payment in full the amount determined as if the beneficiary provided service is enrolled in the Medicare FFS program. Nonetheless, plans can exceed the FFS payment floor. Special rules apply to net capitation payments, including Medicare Advantage rebates, Part D direct subsidy payments and coverage gap discount payments. Also, Part D risk corridor payments are not subject to the 2% sequestration.


White House Reports that Health IT Lags for Minorities


A White House report summarizing the White House Summit on Achieving eHealth Equity concludes that policy reforms are needed to “leverage existing policies such as the Medicare and Medicaid EHR Incentive Programs to develop outcomes-focused goals for minority and other underserved populations….” The report says that a number of barriers, such as limited access to culturally appropriate Health IT systems, have hindered the widespread adoption of electronic health information technology among underserved and minority populations. The Summit also suggested further means to promote Health IT equality among all populations.


Upcoming Health-Related Hearings/Markups


House Ways and Means Health Subcommittee: will hold a hearing on proposals that would repeal the Medicare Physician Payment System’s Sustainable Growth Rate formula and overhaul the Medicare Physician Payment System; 10:00 a.m., 1100 Longworth Bldg; May 7.

House Energy and Commerce Health Subcommittee will hear opening statements for mark up of H.R. 1407, legislation to reauthorize the Animal Drug User Fee Act (ADUFA) and the Animal Generic Drug User Fee Act (AGDUFA), and a bill to amend the Federal Food, Drug, and Cosmetic Act (FDC&A) with respect to the pharmaceutical distribution supply chain; 4:00 p.m., 2123 Rayburn Bldg; May 7.

House Energy and Commerce Health Subcommittee will mark up H.R. 1407, ADUFA/AGDUFA reauthorization, and a bill to amend the Federal Food, Drug, and Cosmetic Act (FDC&A) with respect to the pharmaceutical distribution supply chain); 9:00 a.m., 2123 Rayburn Bldg; May 8.

Senate Veterans’ Affairs Committee: will hold a hearing to examine pending health care legislation; 10:00 a.m., 418 Russell Bldg; May 9.

House Small Business Subcommittee on Health and Technology: will hold a hearing titled “The Health Insurance Fee: Impact on Small Business.” 10 a.m., 2360 Rayburn Bldg; May 9.



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