Third-Party Premium Payments Allowed Under PPACA

In a new interim final rule (with comments due within 60 days) relating to the ability specific third-party payers have to make premium or cost-sharing payments for individuals covered under the PPACA’s exchanges, CMS said that related health insurers should “immediately begin accepting third party payments for enrollee premiums and cost sharing from Indian tribes, tribal organizations, urban Indian organizations, the Ryan White HIV/AIDS programs, and state and federal government programs….”

House to Proceed on Legislation Despite CMS Relief on Medicare Part D Drug Class Changes

Responding to Republican congressional criticism that previously proposed CMS regulations that would remove “protected class” status for three of six Medicare Part D drug categories would “destroy Medicare Part D as we know it”, CMS Administrator Marilyn Tavenner notified Congress that her agency will not finalize “at this time” the rules relating to the “protected classes” definition, standards for preferred pharmacy networks, the number of Part D plans sponsors may offer and clarifications to the non-interference provision. Nonetheless, House Ways and Means Committee Chairman Dave Camp said that “While this announcement provides limited relief in the short-term, it should lay the groundwork for strong bipartisan support for legislation expressing Congress’ disapproval of these proposals. As Part D approaches a decade of providing access to affordable prescriptions for seniors, Congress must redouble its efforts to work with all parties to ensure the long-term viability of the successful Part D program.” In this regard, Rep. Renee Ellmers (R-NC) has sponsored H.R. 4160, the “Keep the Promise to Seniors Act”, legislation that would prevent the Administration from making the proposed changes among other things.

CMS Guidance on Meaningful Use Rules

CMS released guidance on how eligible professionals and hospitals can apply for meaningful use hardship exemptions for the 2014 reporting period based on “2014 Vendor Issues”. The applications for professionals for the 2014 reporting period will be available after July 1, 2014 and will be due by July 1, 2015. For eligible hospitals, hardship applications for the 2014 reporting period will be available after April 1, 2014 and due by April 1, 2015.

Medicare Advantage Cuts Criticized

At a House Energy and Commerce Health Subcommittee hearing on the payment cuts scheduled for Medicare Advantage (MA) under the PPACA, Chairman Joe Pitts (R-PA) said that the Administration’s policies are going to harm seniors by limiting their choice of high quality care. The hearing featured testimony from five Republican members who have sponsored legislation highlighting the problem. However, committee Democrats countered that the program is as strong as ever, citing their staff report finding that analyses by independent experts and others say that “Medicare Advantage enrollment will continue to grow, that insurers’ business will remain highly profitable and that many of the changes announced by CMS will be positive for Medicare Advantage plans.” Nonetheless, the estimated 2% payment reduction in 2015 has led Reps. Bill Cassidy (R-LA) and John Barrow (D-GA) and 188 other House members to send a letter to the CMS Administrator seeking changes and saying that “We believe that the cuts in the advance notice are inconsistent with our health care policy goals to promote more high quality coordinated care for Medicare beneficiaries….” In related news, the Medicare Payment Advisory Commission (MedPAC) report to Congress maintains that the MA program is healthy despite the PPACA’s cuts to the program.

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