HHS OIG Audit Flags PPACA Enrollment Inconsistencies

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) performed an audit of the internal controls of the federal Patient Protection and Affordable Care Act (PPACA) marketplace and the state marketplaces run by California and Connecticut; the OIG’s first of two reports found that the various exchanges failed to properly resolve inconsistencies found in connection with applicants’ income, citizenship and other information. HHS reported that more than 2 million inconsistencies still remained during the month of May. Senator Lamar Alexander (R-TN) said the report demonstrates that the Administration was more interested in “appearances” than getting the enrollment job “right”. The OIG also said it will perform an audit of the procedures the marketplaces used to determine enrollee eligibility for premium tax credits and cost-sharing reductions and also look into the use of exchange grant funding. Rep. Dave Camp (R-MI), the House Ways and Means Committee Chairman, said the Administration “sent billions of taxpayer dollars out the door” knowing that the government will not be able to fully recuperate the money sent in error. Senator Tom Harkin (D-IA) echoed congressional Democrats’ sentiment stating that “With the Administration already improving marketplace operations, now is the time to look ahead….”

Supreme Court Issues "Very Specific" Decision to Narrow PPACA Contraceptive Mandate

The Supreme Court issued a five to four decision in Burwell v. Hobby Lobby Stores, Inc. which Justice Samuel Alito, Jr. said is a “very specific” ruling that the PPACA’s contraceptive coverage regulations violate the Religious Freedom Restoration Act (RFRA) with respect to only non-publicly-traded closely held corporations. However, in her dissent Justice Ruth Bader Ginsburg said the majority opinion had “startling breadth” giving “commercial organizations” the right to opt out of any general legislation that they deem contrary to their religious beliefs. Justice Anthony Kennedy added that the opinion is simply one which “held that the government hadn’t proved that the contraceptive mandate was the least restrictive means of promoting the government’s interest”. In addition, Justice Alito said the “accommodation” given to non-profit religious organizations by HHS could have also been extended to closely held corporations; however, some such organizations, e.g. the Little Sisters of the Poor, have also objected in court to this regulatory accommodation as also violating their RFRA rights. Several Senators objected to the opinion with Senator Tom Harkin (D-IA) saying that “While the Supreme Court has ruled, this fight is far from over. Along with my colleagues in Congress, I am deeply committed to ensuring that all Americans, men and women alike, can get the health coverage they need, and we will be exploring legislative remedies to ensure that affordable contraceptive coverage remains available and accessible….” Senator Dick Durbin (D-(IL) said he will introduce legislation which would require corporations denying insurance coverage to employees pursuant to the Hobby Lobby case to disclose such to current employees and applicants as well. Through his spokesman, the President hinted that he would support legislation to ensure that women keep their mandated coverage and that corrective regulatory action might also be considered.

CMS Proposes Payment Rules for 2015

The Centers for Medicare and Medicaid Services (CMS) proposed Medicare payment rules for outpatient hospitals which in 2015 would provide for a 2.1% increase and for ambulatory surgical centers which would provide an update of 1.2%. For physicians, CMS said that there would be a “zero update” for January through March next year and that the Administration supports legislation to provide a permanent fix to the current sustainable growth rate (SGR) formula. In addition, CMS intends to have future physician payment changes, beginning for 2016, go through a public notice and comment period before the rules are finalized. The agency also said that “screening colonoscopies” will now include associated anesthesia when performed by an anesthesiologist which will allow beneficiaries to forego a second coinsurance payment for this procedure. In addition, the agency proposed to simplify the requirements for face-to-face encounters when patients transition from acute care settings to home care by eliminating the current narrative requirement and using only the medical records of the certifying physician or discharging facility for eligibility certification purposes. CMS also proposed that payments for home health agencies be reduced by $58 million or about 0.3% for CY 2015. The agency’s proposed payment change for end-stage renal disease facilities would amount to a 0.3% increase while payments in 2017-18 would be adjusted downward for facilities not meeting specific quality criteria. Comments on the rules, which also include rules for adjusting payments for durable medical equipment (DME) in areas in which competitive bidding does not exist, are due by September 2nd.

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