POLICY BRIEFINGS


FY 2015 Omnibus or No Omnibus Spending Bill?


If the Administration requests additional funding for Ebola, House and Senate appropriators will encounter another hurdle in the lame-duck session when attempting to negotiate an extension of federal funding for fiscal year (FY) 2015. If and when several large pharmaceutical companies manufacture approved doses of an Ebola vaccine, it can be expected that the Administration will seek additional funding at that time to engage in an emergency vaccination program. A change in the Senate majority party will also weigh into the decision whether the House and Senate can agree on an omnibus bill or whether they will resort to another continuing resolution (CR) to extend funding into 2015 and beyond the December 11th expiration date of the current CR. Ebola funding would also make less likely any potential effort to pass permanent legislation to reform the Medicare physician payment system. Of note, the Administration also announced a temporary suspension of so-called “gain-of-function” research for the flu, SARS and Middle East Respiratory Syndrome (MERS) viruses. Funded researchers were asked to voluntarily give pause to their work on the viruses which could potentially be used for bioterrorism.


Administration Ramps Up PPACA Enrollment Efforts


As the 2015 enrollment period for the Patient Protection and Affordable Care Act (PPACA) opens between November 15-February 15, HHS is encouraging physicians and other organizations to encourage enrollment under the exchange program. Aware that the Supreme Court has yet to take up or rule on the validity of suits challenging the Internal Revenue Service (IRS) ruling which allows PPACA tax-credit subsidies to be paid to HealthCare.gov enrollees in states that do not run their own exchanges, the Centers for Medicare and Medicaid Services (CMS) said that agreements with qualified health plans enrolling such individuals will allow the plans to terminate coverage if, for any reason, the subsidies are no longer made available. CMS also issued guidance under which PPACA eligibility appeals can be processed using a paper form for at least another year, given the problems that the exchanges have had in making enrollment seamless electronically. The agency also gave notice of proposed methods and data sources that states can use in 2016 to receive payments under the Basic Health Program which provides for an alternative means for low-income individuals to obtain health coverage meeting PPACA standards. CMS said the PPACA helped expand enrollment under Medicaid and the Children’s Health Insurance Program (CHIP) by 8.7 million to a total of nearly 68 million through the end of August, 2014.


Grants for Transforming Clinical Practice


CMS is taking applications for the PPACA Transforming Clinical Practice Initiative which is intended to support 150,000 clinicians and their colleagues to move from volume-driven systems to value-based, patient-centered and coordinated health-care services. A total of $840 million will be available for two network systems: Practice Transformation Networks and Support and Alignment Networks.


Open Payments System Search Tool Released


CMS launched an initial search tool on its Open Payments System website which will allow users to search for payments made to physicians using a physician’s name, location and specialty as well as for payments made to teaching hospitals and the companies making the payments.


NIH Grants for Under-represented Groups


NIH announced that it has awarded a total of $31 million to twelve universities which is intended to assist over three dozen researchers to find new avenues for individuals in under-represented racial and ethnic groups to be employed in biomedical research endeavors.



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