POLICY BRIEFINGS


Supreme Court to Review Legality of Certain Individual Tax Subsidies


Last Friday the U.S. Supreme Court granted a petition for certiorari in the King v. Burwell case in which the U.S. Court of Appeals for the District of Columbia Circuit held that the IRS did not adhere to the black letter of the health care law when it ruled that individuals who buy health insurance on the federal HealthCare.gov exchange are eligible for tax credit subsidies even though they reside in states electing not to establish their own health insurance exchanges. The Supreme Court action preempts an en banc hearing in the D.C. Circuit Court that the Administration hoped would overturn the decision and prevent a conflict among the circuit courts, thus making the issue moot for Supreme Court review. The Administration was quick to tell the public that the law is working and that the individual tax credits in question will still be available for coverage obtained in the open season beginning November 15th. In another case, Sissel v. HHS, the Department of Justice (DOJ) argued that an en banc rehearing of the holding that the individual mandate does not violate the origination clause of the Constitution should not be taken up by the U.S. Court of Appeals for the District of Columbia Circuit. The DOJ said that the original decision was correct and did not conflict with any other decision by the Supreme Court or any other court. In a third case, Coons V. Lew, the plaintiffs petitioned the U.S. Supreme Court to review an appeals court decision that dismissed their challenge to the PPACA’s provisions establishing the Independent Payment Advisory Board (IPAB). In that decision the U.S. Court of Appeals for the Ninth Circuit ruled that the issue was not ripe for judicial resolution because the Board has yet to be constituted and is prohibited from taking any action before January 1, 2019.


MedPAC Considers Site-Neutral Payments and Primary MD Bonuses


Anticipating votes in January on possible changes to Medicare payments to be recommended to Congress in a March report, the Medicare Payment Advisory Commission (MedPAC) met last week and apparently agreed on eliminating differences in Medicare payments in different Inpatient Rehabilitation Facility (IRF) and Skilled Nursing Facility (SNF) settings for the treatment of certain orthopedic, pulmonary, cardiac and infectious conditions. A decision on payment differences for stroke patients was deferred. The commissioners also discussed a potential policy change to the 10% bonus for primary care practitioners which would in the alternative provide for a payment of $30 annually per beneficiary. Draft recommendations will be taken up in MedPAC’s upcoming December 18-19 meeting.


CMS Finalizes Dialysis Facility Compare Star Rating System


The Centers for Medicare and Medicaid Services (CMS) released the final methodology the agency will use to rate dialysis facilities under the Dialysis Facility Compare (DFC) Star Rating program. Ratings will be posted in January and dialysis facilities will have 15 days to review their ratings and provide comment. The data used in the program will be updated next October.


CMS Updates Open Payments Data


CMS announced that it will release in December an additional 9,000 payment records that were previously in dispute under the Open Payments System website.


HRSA Announces Grants for Mental Health Service Expansion


The Health Resources and Services Administration (HRSA) announced the award of over $51 million in grants to 210 health centers in 47 states, DC and Puerto Rico to establish and expand mental health and substance abuse behavioral health services.



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