Appropriations Issues

House Appropriations Committee Chairman Harold Rogers announced that consideration of the FY 2012 Labor/HHS/Education Appropriations legislation will be delayed until after the August congressional recess.  The House has approved only six of the nine spending bills to date with the Legislative Branch appropriations bill being the last bill approved.  The House voted 252-159 to pass the bill which cuts most legislative branch agencies by about seven percent.  The Senate has passed only one appropriations measure, the FY 2012 Military Construction/Veterans-Affairs bill (H.R. 2055), thus putting into question just how many spending bills will be passed by the beginning of the new fiscal year October 1st.  Action on FY 2012 appropriations bills has been severely interrupted due to the debt- ceiling/budget negotiations and the lack of a Senate budget resolution allocating total spending among the several Senate appropriations panels.

IOM Recommendations on "Essential Benefits"

The Institute of Medicine issued recommendations to HHS on certain medical services that should be considered “essential benefits” under PPACA mandated health plans.  The IOM recommended that following services be included without participant cost-sharing: FDA-approved contraception; domestic violence screening and counseling services; human papillomavirus testing; counseling for sexually transmitted infections; screening for gestational diabetes; and lactation equipment.  Senate HELP Committee member Richard Burr said “I’m not sure you could point to any area of health care that I believe should be free.  All of health care should have some out-of-pocket cost-sharing.  One reason why health care spending is at the level it is is because a lot of people perceive it to be free.  That’s a utilization nightmare.”

PPACA "CO-OP" Regulations Proposed

HHS proposed regulatory requirements that private, nonprofit organizations would have to meet in order to offer PPACA health coverage in 2014 as Consumer Operated and Oriented Plans (CO-OP).  The proposal includes information on how such entities can apply for up to $3.8 billion in PPACA loans to develop co-ops.  To be approved, co-ops must be newly established, meet state insurance regulations and plow back any profits to benefit plan participants.

PCORI Seeks Comments on Comparative Effectiveness

The Patient-Centered Outcomes Research Institute (PCORI) has requested comments on how the agency should conduct comparative effectiveness research using the $600 million annually provided under the PPACA.  Comments are due by September 2nd on patient-centered research that would “help people make informed health care decisions and allow their voice to be heard in assessing the value of health care options.”

Senate Hearing on "Reducing Medicare Drug Costs"

At a Senate Aging Committee hearing members suggested that legislation is needed to help reduce the costs of drugs under Medicare.  The panel released a report making several recommendations, including requiring: the negotiation of drug prices under Part D; prescription drug manufacturers to provide drug discounts for low-income Medicare recipients; and the negotiation of drug prices under Medicare Part B when it is the majority purchaser.

Insurance Agents Get Support from NCIL

The executive committee of the National Conference of Insurance Legislators adopted a resolution supporting H.R. 1206, the Access to Professional Health Insurance Advisors Act, which would change the PPACA definition of minimum loss ratio to allow for agent and broker commissions to be included as administrative expenses in computing the MLR.  The NAIC has refused to make a similar recommendation to HHS for the adjustment.

Proposed Medicare Coverage for Screening of Depression

CMS proposed that Medicare benefits be expanded to include coverage of the annual screening for depression for beneficiaries in primary care settings that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment and follow-up.  CMS did not place a deadline on requested comments.

Medicare Payment Bundling Model

The White House announced that CMS will soon begin the first of several models under which providers will receive Medicare payments for bundled services.  Under the model, CMS will negotiate payments with doctors, hospitals, and other providers for a set of health care services constituting an “episode of care.”  A second bundled payment program will be initiated in 2013.

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