POLICY BRIEFINGS


Appropriations Matters


The House of Representatives is scheduled on Tuesday to vote on H.R. 4800, the fiscal year (FY) 2015 Agriculture, Rural Development, Food and Drug Administration (FDA) and Related Agencies Appropriations Act which provides the FDA with $4.5 billion in total funding ($2.6 billion in discretionary funding which is an increase of $23 million over FY 2014). To expedite the consideration of appropriations bills in the Senate this month, the Appropriations Committee Chair Barbara Mikulski (D-MD) is seeking to cluster several FY 2015 spending bills into “minibuses” which could include the Agriculture/FDA bill, as was the case for the FY 2012 spending bill.


Eligibility of Many PPACA "Enrollees" Still in Doubt


HHS gave notice that individuals who are required to submit additional information to verify their eligibility while enrolling under the HealthCare.gov website during open enrollment have 90 days to comply, while those who were given an extended period for enrollment will have their compliance period extended in a similar fashion. The House Energy and Commerce Committee also said that documents show that up to 4 million individuals may have outstanding problems with their applications with respect to income, citizenship and other issues. HHS warned that, without sufficient proof of eligibility, up to 2.1 million applicants will have their coverage terminated. The process HHS uses is still reported to be a manual one. The issue will be aired on Tuesday by two House Ways and Means subcommittees. The problems that seven state-based health insurance exchanges have had also came under fire from Republicans on the House Energy and Commerce Committee. The committee has asked HHS for information on the extent to which the agency supervised the state marketplaces while awarding them $1.3 billion in Patient Protection and Affordable Care Act (PPACA) start-up funds. The chairman of the House Small Business Committee also sent a letter to the Center for Medicare and Medicaid Services (CMS) to obtain information related to the enrollment of individuals under the SHOP program (Small Business Health Options Program). CMS also released figures showing that an additional 6 million individuals were enrolled under Medicaid and the Children’s Health Insurance Program (CHIP) than before the open enrollment season began. However, the Administration’s relaxation of the rules for meeting the PPACA’s exemption from the individual mandate has led the Congressional Budget Office (CBO) to reduce its estimate of the number of non-compliers from 4 million to 2 million which is expected to reduce Internal Revenue Service (IRS) penalty collections to about $4.2 billion in 2016.


Medicaid AMP Figures Delayed


CMS gave notice that it is still in the process of formulating guidance for the states in connection with the determination of the final Medicaid average manufacturer price (AMP) federal upper limits (so-called FULs). Pending notice to the states, the agency will delay giving a new date when the maximum Medicaid reimbursement rate for multiple-source drugs will be provided to pharmacies and other affected parties. Senators Mark Warner (D-VA) and Johnny Isakson (R-GA) have urged HHS to allow a one-year transition period for states to fully implement the federal upper limits.



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