POLICY BRIEFINGS


TAA Health Tax Credits Extended


President Obama signed H.R. 2832 into law (P.L. 112-40).  This trade legislation includes an extension of the Trade Adjustment Assistance Act health program which now will provide a tax credit of 72.5% of health insurance premiums for qualified individuals who are adversely affected by unfair trade practices.  The effective date applies to coverage periods ending on or after November 20, 2011.


ACO Rules Released


The Administration released several rules relating to the formation and tax status of accountable care organizations (ACOs). CMS released a final rule which makes the formation of ACOs more likely with fewer qualifications: e.g. the beneficiary assignment process is made prospective, the number of quality measures that providers are required to report was reduced, a rolling admissions process was established and the one sided-model was allowed to be completely risk-free for the entire length of the agreement. CMS and the HHS OIG also released an interim final rule establishing waivers under the Stark law and civil monetary penalty law for ACOs that participate in the Medicare Shared Savings Program.  In addition, the Federal Trade Commission and Department of Justice issued a final statement on antitrust enforcement that will benefit ACOs.  Among the policies is the elimination of a mandatory antitrust review requirement under a proposed rule. The IRS also gave ACOs some relief in that distributions from ACOs do not necessarily need to be proportional to capital investment.


Supreme Court Review of PPACA


The Department of Justice filed a consolidated response brief with the high court which agrees with the state plaintiffs (NFIB, Florida, et al) that the ruling in the Eleventh Circuit, that the PPACA individual mandate is unconstitutional under the commerce clause, should be taken up and that the issue of severability should be reviewed if the court finds for the plaintiffs.  DOJ argued that, if the individual mandate is held invalid, so should the PPACA provisions requiring coverage for preexisting conditions and allowing higher premiums for high risk individuals.  DOJ also said it agreed with the Eleventh Circuit finding that the PPACA Medicaid provisions are constitutional and should, therefore, not be reviewed.  In another case, Liberty University v. Geithner, DOJ said the court should refrain from granting review of the Fourth Circuit ruling that the Anti-injunction Act barred the court from considering the constitutionality of the individual mandate (because the provision does not go into effect until 2014).


Reduced Regulations?


In accordance with an executive order for agencies to reduce regulatory burdens, CMS announced proposed delivery system regulatory revisions for hospitals and other providers that CMS said would save hospitals and health care providers nearly $1.1 billion each year and over $5 billion over five years.  The “Medicare and Medicaid Program; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction” would affect various health care facilities, including end-stage renal disease (ESRD) facilities, organ procurement and ambulatory surgical centers (ASCs).  In a related action, CMS issued additional guidance for hospitals on “meaningful use” requirements which allows clinical data to be considered complete and accurate when generated from certified EHR technology.



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