Administration Issues PPACA Rules Clarifying Enrollment and Tax Credits

The U.S. Department of Health and Human Services (HHS) issued proposed rules that would allow those who enrolled under HealthCare.gov this year to continue their enrollment as long as they do not change their coverage choices or amount of tax credit subsidies. However, if individuals seek to change either one of the above they would have to again use the HealthCare.gov website or otherwise renew coverage through federal call centers or an insurance broker or application counselor. State-run exchanges can choose to follow the same rules or write their own rules for renewal. The Internal Revenue Service (IRS) also issued final regulations spelling out the rules when small employers (taxable and tax exempt) having 25 or fewer employees are entitled to tax credits when they pay at least 50% of the premiums for their covered employees.

Senators Ask CMS to Reveal Changes to Medicare MD Payment Codes

Senators Johnny Isakson (R-GA), John McCain (R-AZ), John Thune (R-SD), Kay Hagen (D-NC) and seven others sent a letter to the Centers for Medicare and Medicaid Services (CMS) Administrator requesting that the agency be more “transparent” in resetting Medicare physician payment codes by including the modifications in the upcoming proposed Medicare Part B fee schedule rather than in the final rule so providers can better provide feedback and have more time to adjust to the changes.

Medicare Improper Payments Under Fire in House Hearing

At a House Energy and Commerce Oversight and Investigations Subcommittee hearing the Chairman, Tim Murphy (R-PA), expressed his displeasure that the Government Accountability Office (GAO) continues to include the nation’s health programs among the government’s “high-risk” programs with about $50 billion in misspent payments in 2013 alone. He complained that providers can still participate in Medicare even if they have had a history of fraudulent activity. The recovery audit contractor (RAC) program also came under fire by several members for what they said was the cause for payment delays to their supplier constituents. Testimony was given that full funding for the Office of Inspector General (OIG) would greatly help the effort to combat Medicare fraud and GAO testified that greater use of prepayment claims review could help reduce improper payments. In related news, the HHS OIG published a special fraud alert which warns that laboratories that make payments to physicians to collect, process and package patient specimens or to establish databases to collect patient testing data could violate the Stark anti-kickback law.

House E&C Committee 21st Century Cures Roundtable on Health Data

Responding to the House Energy and Commerce Committee’s White Paper seeking comments on “developing a digital health care ecosystem”, the Food and Drug Administration (FDA) witness said that digital health data has to be accurate and reliable as well as interoperable with health information systems, and that the FDA tries to engage in “smart” regulation which means knowing when to just stay out of the way of new technologies when it makes sense to do so. The Cleveland Clinic witness also indicated that such data should be used to “seek out patients who need care, rather than waiting until they get an illness that brings them through our doors.” The issue of FDA approval for the marketing of genetic testing services to individuals was discussed with several members indicating their concern with the privacy of this and other digital health information.

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