POLICY BRIEFINGS


Sixth Circuit Declares PPACA Individual Mandate Constitutional


In the first higher court decision on the constitutional validity of the PPACA individual mandate, the U.S. Court of Appeals for the Sixth Circuit held 3-1 that the PPACA individual mandate is a valid exercise of congressional authority under the commerce clause.  The court said that Congress can regulate even wholly intrastate economic activity, so long as it would substantially affect interstate commerce, and that Congress can also regulate noneconomic intrastate activity if doing so would be essential to a larger scheme that regulates economic activity.  A statement from the Department of Justice said that DOJ will continue to vigorously defend the health care reform statute in any litigation challenging it.


Health Insurance Agents Win NAIC Task Force Vote


The Professional Health Insurance Advisors Task Force of the NAIC has voted to support House legislation introduced by Reps. Mike Rogers and John Barrow that would remove agent commissions from the “medical loss ratio” that insurance companies must meet under the PPACA.  The executive committee of the NAIC will now consider this move as a potential recommendation for HHS to change the medical loss ratio definition accordingly.


CMS Proposes Medicare Physician Payment Cut Next Year


CMS issued a proposed rule under which Medicare Part B physician payments would be cut by 29.5% under the current sustainable growth rate formula.  The proposal also includes measures that would be used in establishing a new value-based modifier that would reward physicians for providing higher quality and more efficient care.  CMS also said that “While the Congress has provided temporary relief from these reductions for every year since 2003, a long-term solution is critical….”


OPPS and Dialysis Provider Payments to Increase


CMS issued a proposed rule under which payments beginning next year would increase by 1.5% to more than four thousand outpatient hospitals subject to the outpatient prospective payment system.  CMS also issued a proposed rule under which ESRD-related payments to dialysis providers will increase by 1.8% next year.  The proposal will also set out requirements for the ESRD quality incentive program (QIP).  Comments on both proposals are due by August 30th and final rules are expected to be issued by November.


HHS Primary Care Survey Put on Hold


HHS announced that “now is not the time” to proceed with priory plans for a primary care survey that was going to involve fake patients trying to see how long it would take them to get appointments with doctors.  The reason for the survey was never disclosed.


Grants for Disaster Preparedness


HHS announced that more than $352 million in grant funding has been awarded under the Hospital Preparedness Program to improve disaster preparedness of hospitals and health care systems in all states.  HPP funding was most recently used in aiding hospitals treating Joplin Missouri tornado victims.


New HHS Health Study Data Standards


HHS Secretary Kathleen Sebelius announced that the agency has proposed new standards on the collection of data on race, ethnicity, sex, primary language and disability status in an effort to improve the monitoring of health data and address health disparities among minorities.


Medicare Coverage of Provenge for Prostate Cancer


CMS released a final decision memorandum stating that Medicare will now cover Provenge (sipuleucel-T) for the treatment of prostate cancer, but only for those indications supported by evidence and consistent with the FDA label.


HHS Issues HIPAA Interim Final Rule


HHS released an interim final rule under which health plans, health care clearinghouses and certain health care providers would have to abide by new HIPPA operating rules in 2013 for two electronic health care transactions.  To help simplify administration of claims, the rules would make it easier for providers to determine whether a patient is eligible for health care coverage and the status of health care claims submitted to health insurers.  HHS said the new rules could save such entities $12 billion over 10 years by reducing transaction costs between providers and insurers.



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