State Challenges to PPACA

Last week the Virginia AG, Ken Cuccinelli, testified before the House Judiciary Committee regarding the state’s suit and the PPACA individual mandate.  He said that by passing the PPACA, Congress asserted an unprecedented use of the commerce clause by compelling citizens to purchase insurance from private vendors or pay a penalty to the government.  He said his lawsuit is about liberty and not health care.  Other witnesses said the individual mandate is constitutional and fits within the application of the commerce clause.  In other news, the Department of Justice has asked the U.S. District Court for the Northern District of Florida to clarify the effect of its ruling declaring the PPACA individual mandate unconstitutional.  The judge also said the entire law invalid, due to the lack of a severability clause and the inability to unwind the various provisions, but refused to agree to a declaratory judgment order asked for by the 26 state plaintiffs.  He said that such an order is unnecessary because of a “long-standing presumption that the federal government will comply” with such judicial rulings.  Some states maintain that they do not have to go forward with implementing provisions of the PPACA, thus DOJ is seeking a ruling to clarify the matter.  Judge Vinson gives plaintiffs three days to given their comments on the DOJ request.

SCHIP Quality Improvements/Allotments

Last week CMS wrote states providing them with an update on requirements of CHIPRA to improve health care quality for children under SCHIP.  States are expected to submit data by the end of 2013 on the quality of health care and consumer satisfaction measures through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Medicaid Survey.  CMS also released final SCHIP rules explaining the methodology for determining FY 2009-2015 state CHIP allotments.

Medicaid Issues

Last week CMS issued proposed regulations under the PPACA which would deny federal funding to state Medicaid programs for provider payments in cases in which care was given for preventable conditions, such as treatment of a catheter-associated infection.  States must give notice to CMS about plan amendments that modify their current policy or implement nonpayment for the first time by September 30th.

Nursing Home Closure Rules

CMS issued an interim final rule providing new closure procedures for long-term care facilities that participate in Medicare and Medicaid.  As required under the PPACA, Medicare skilled nursing facilities and Medicaid nursing facilities that are closing must submit written notification of the closure to HHS, the state’s LTC ombudsman and residents of the facility and their legal representatives.  The interim final rule takes effect March 23.

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