POLICY BRIEFINGS


Republicans Again Ask Supreme Court to Strike Down IPAB


Rep. Phil Roe (R-TN) and twenty three other Republican members filed an amicus brief with the U.S. Supreme Court which argues that the PPACA’s Independent Payment Advisory Board (IPAB) is inconsistent with the Constitution’s separation of powers doctrine and should be considered by the court despite a ruling by the U.S. Court of Appeals for the Ninth Circuit that the issue is not yet ripe for judicial review because the Board has not been named and cannot take action before 2019. Rep. Roe previously introduced H.R. 351, legislation seeking to repeal the IPAB has 227 bipartisan cosponsors.


Final Rule on Denial of Medicare Participation


CMS issued a final rule under which providers and suppliers can be excluded from enrolling in Medicare if they were previously affiliated with any organization having unpaid Medicare debts which was also terminated from the program. Such an entity can still be enrolled if it agrees to repay the debt. In addition, the rule contains additional restrictions allowing CMS to deny or revoke a provider’s billing privileges: if a managing employee is found to have been convicted of certain state or federal felonies within the previous 10 years; and if a provider’s billing patterns don’t meet Medicare requirements.

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House Hearing on CHIP Reauthorization


At last week’s House Energy and Commerce Health Subcommittee hearing on the status of the Children’s Health Insurance Program (CHIP), Republican and Democrat members expressed a desire to reauthorize CHIP beyond FY 2015. They cited the need by states to set their budgets early next year for the next fiscal year. The executive director of the Medicaid and CHIP Payment and Access Commission (MACPAC) testified that the program should be reauthorized for a transitional period of two years. Rep. Frank Pallone Jr. (D-NJ) said the program should be reauthorized for four years as his bill, H.R. 5364, would provide. Chairman Joe Pitts (R-PA) said “I believe we need to extend funding for this program in some fashion….If we don’t, current enrollees will lose their CHIP coverage and many will wind up in Medicaid and on the exchanges, programs which may offer poorer access to care or higher cost-sharing for lower income families. Some will lose access to their insurance altogether.” Some members indicated they would like to see other changes made to the program before Congress acts. Among the suggested changes would be to: increase the cap on out-of-pocket costs; restrict eligibility to only lower-income households; and better complement CHIP coverage with private health insurance. A letter from 39 governors also asked Congress to act soon on an extension.


CMS Advises on Part-D Prescription Coverage Eligibility


CMS alerted Medicare Advantage (MA) and Part D plans that the agency will not enforce until December 1, 2015 certain prescription drug prohibitions. At such time CMS will require physicians and eligible professionals who write prescriptions for covered plans to be enrolled in Medicare or have a valid record of opting out of Medicare.


Revisions Made to Drug-Labeling Rules for Certain Women


The Food and Drug Administration (FDA) said that pharmaceutical companies, in connection with all new prescriptions and biologics, will have to provide additional information about the risks of taking medications during pregnancy, while breastfeeding or which might affect fertility. The risk information would have to be provided in detailed summaries rather than the current letter system.



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SERVICES




BRIEFING ARCHIVE


 -  2018


 +  2017


 +  2016


 +  2015


 +  2014


 +  2013


 +  2012


 +  2011