CBO Scores SOTUS Decision on PPACA Costs

C BO’s latest estimate of the costs of the PPACA states that federal Medicaid and SCHIP costs will decrease by about $289 billion over ten years. The decrease is due to an assumption that all states will not implement the Medicaid expansion as defined under the law. However, the lack of Medicaid expansion would make individuals otherwise eligible for Medicaid to be newly eligible for coverage and federal tax credits and subsidies under health exchanges (at a cost of about $210 billion). CBO also said the entire repeal of the law, as pushed by Republicans and presidential candidate Mitt Romney, would result in an increase in federal deficits amounting to about $109 billion over ten years.

Additional Guidance on ACOs

CMS released additional guidance in the form of Q&As for the Medicare Shared Savings Program and accountable care organization mergers and acquisitions.

Another Hearing on Medicare MD Payment Reform

A t a House Ways and Means Health Subcommittee hearing, six physician group witnesses offered numerous means for Congress to develop an alternative Medicare physician payment system to replace the current SGR-based system. Calling the current system “broken”, they said a new system is needed to offer physicians incentives to encourage team-based care and to create a culture of quality. They agreed that the current fee-for-service system is defective and should be replaced eventually. They said that performance based payments should be made, especially for participating in medical home and coordinated care. It was said that health information technology improvements are essential in successfully managing quality initiatives. Subcommittee Chairman Wally Herger said that, while current provider incentive programs, such as e-prescribing, are a step in the right direction, he is concerned that Congress not take a “top down government-centered” approach to rewarding improvements in the quality of care. In another hearing held by the House Oversight and Government Reform Committee, Republicans continued their relentless criticism of the PPACA, this time accusing the Administration of delaying PPACA driven Medicare managed care cuts through the MA Quality Bonus Payment Demonstration project. They said the GAO-criticized demo was politically driven by delaying potential PPACA MA cuts until after the November elections.

Anti-Fraud Partnership Announced

H HS and DOJ announced a new initiative, the National Fraud Prevention Partnership, under which CMS and major health insurance organizations will share information and compare claims data in an effort to reduce health care fraud. The names of providers and suppliers being investigated for fraud will become a focus of the effort.

Medicare Payment Increases for IRFs/Hospices/Nursing Homes

CMS announced that FY 2013 payment rates for inpatient rehabilitation facilities will be increased by 2.1%. The $140 million increase will apply to Medicare beneficiary discharges beginning on or after October 1st. CMS also announced that FY 2013 Medicare payments to nursing homes will increase by 1.8%, or about $670 million. In addition, CMS said that FY 2013 payments to hospice facilities will increase by 0.9% percent.

POLICY BRIEFINGS Recently Introduced Health Legislation

H.R. 6176 (HOSPITALS), amend the Social Security Act to permit hospitals to make incentive payments to physicians to promote quality and efficiency; BOUSTANY; jointly, to the committees on Energy and Commerce, Ways and Means, and the Judiciary, July 24.

S. 3430 (DIABETES),
to amend the Public Health Service Act to foster more effective implementation and coordination of clinical care for people with pre-diabetes and diabetes; SHAHEEN; to the Committee on Health, Education, Labor and Pensions, July 25.

to amend the Controlled Substances Act to more effectively regulate anabolic steroids; WHITEHOUSE; to the Committee on the Judiciary, July 25. .

R. 6187 (HIV/AIDS),
to establish a research program under the Congressionally Directed Medical Research Program of the Department of Defense to discover a cure for HIV/AIDS; HIMES; jointly, to the committees on Armed Services and Energy and Commerce, July 25.

to provide for the establishment of the Autoimmune Diseases Interdepartmental Coordinating Committee, and for other purposes; BUERKLE; to the Committee on Energy and Commerce, July 26.

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