House Republicans Challenge Employer Mandate Delay in Court

Last week House Republicans opened another front in their challenge to various provisions of the PPACA and actions taken by the Administration in implementing the law. The latest suit brought in the U.S. District Court for the District of Columbia claims that: (1) the President unilaterally delayed the PPACA employer mandate; and (2) the Administration funded insurance companies for reduced cost-sharing for certain individuals without obtaining appropriations for the provision (but used funds designated for the individual tax credit subsidies instead). House Speaker John Boehner (R-OH) said “If this President can get away with making his own laws, future Presidents will have the ability to as well….[Congress] has an obligation to stand up for the Constitution, and that is exactly why we are pursuing this course of action.” Federal courts continue to deal with other provisions of the PPACA, including whether or not the revised regulations relating to women’s health services provide adequate accommodation for privately-held corporations who object to certain contraceptive mandates and whether or not lower courts should proceed with suits against the IRS rule allowing for tax credit subsidies for individuals residing in states who did not establish their own exchange (in light of a related case to be decided by the Supreme Court next year).

Doc Fix in Lame Duck or 2015?

While Senate Finance Committee Chairman Ron Wyden (D-OR) said that congressional action needs to be taken now to permanently fix the Medicare physician payment system before it becomes too expensive, many House supporters appear to be resigned to reintroducing and taking up legislation early next year before the March 31st temporary patch expires. However, it is reported that some Republicans are putting forth the idea that the legislation be passed without including provisions to offset the cost of the permanent replacement of the sustainable growth rate (SGR) regime and encouraging that the momentum of this Congress not be lost. Congress will return to session December 1-12, leaving little time to address comprehensive repeal and replacement of the SGR.

MACPAC Urges Extension of CHIP

In a comment letter to HHS and congressional committees of jurisdiction, the commissioners of the Medicaid and CHIP Payment and Access Commission (MACPAC) said that funding for the Children’s Health Insurance Program (CHIP) needs to be extended to ensure that covered children do not lose access to care in the future. MACPAC suggested means to improve the health-care quality for low-income adults and children and that the CHIP performance bonus funding formulas be updated.

CMS Oxygen Therapy Services Prior-Authorization Test

CMS announced the adoption of the “Prior Authorization Model for Non-Emergent Hyperbaric Oxygen (HBO) Therapy” model which is slated to begin March 1st in Illinois, Michigan and New Jersey. The goal is to determine if prior authorization for such services will help in reducing expenditures while maintaining or improving quality of care.

GAO Finds Flaws in CMS Compare Websites

After an investigation of the CMS websites--Nursing Home Compare, Dialysis Facility Compare, Home Health Compare, Hospital Compare and Physician Compare—the Government Accountability Office (GAO) said it found critical weaknesses and that the websites reflected provider rather than consumer interests. GAO said the websites “lack relevant information on cost and provide limited information on key differences in quality of care, which hinders consumers’ ability to make meaningful distinctions among providers based on their performance….” CMS concurred that the agency should improve the information in its transparency tools and develop procedures and metrics to ensure that tools address consumer needs.

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