Health Care Reform Implementation Update - August 19, 2013

by Cozen O'Connor
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With less than 50 days until open enrollment begins, tensions in Washington and around the country are high among health care stakeholders.  Businesses, individuals and even some in the government are concerned about whether all the pieces of the Affordable Care Act (ACA) will come together in time for individuals to enroll in exchange plans come October 1. The administration is working around the clock to ensure health reform works, but problems abound. The administration has delayed another key provision of the ACA by a year so that limits on consumer out-of-pocket costs will not kick in until 2015. The Inspector General’s Office at HHS released a report showing that the government is several months behind on testing data security for the exchanges. The heads of health information technology and patient-centered outcomes research who have both been heavily involved in ACA implementation are stepping down from their posts. Partisan tensions continue to boil, especially with respect to the ACA, which many fear will lead to difficulties in passing a budget to keep the government running.

AT THE AGENCIES

The Obama administration delayed another key provision of the Affordable Care Act until 2015. The ACA includes a consumer protection that caps the out-of-pocket insurance costs for consumers. The limit on these costs, which include deductibles and co-payments, is $6,350 for an individual and $12,700 for a family, but is now delayed. The delay, buried in pages of language on the Department of Labor’s website went largely unnoticed until this week.

On August 7, the Office of Personnel Management proposed a rule that amends the Federal Employees Health Benefits Program regulation regarding coverage for members of Congress and congressional staff and details how the federal government can continue to contribute to their health insurance plans. The proposed rule would allow the government to continue to pay for a significant part of their health insurance. Public comments on the rule are due September 9. Committee on Ways and Means Chairman Dave Camp issued a statement in response arguing that the proposed rule is another indicator of the ACA not working.  A day later, the chief of the D.C. health exchange said she welcomed Capitol Hill staff onto the D.C. exchange.

On August 2, the Centers for Medicare and Medicaid Services (CMS) issued final Medicare 2014 payment rules for inpatient stays at acute-care hospitals and long-term care facilities, as well as for hospice care. The rules increase hospital inpatient payments by 0.7 percent, increase long-term care hospital payments by 1.3 percent, and increase hospice payments by 1.7 percent.

On August 15, HHS announced $67 million in approximately 120 navigator grants to 105 organizations. Navigators are tasked with educating the public about the ACA. A list of the navigator grant recipients by state can be found here.

On August 2, the Inspector General’s Office at HHS released a report showing the federal government is several months behind on testing data security for the insurance exchanges scheduled to launch October 1. The report warns that the data hub may contain unidentified security risks when open enrollment in the marketplaces begins.

On August 5, HHS announced the launch of a new feature on Healthcare.gov, My Account. According to HHS, consumers can now open accounts on Healthcare.gov, which is the first step in purchasing coverage through the federal exchange.

It became public this week that Dr. Farzad Mostashari, who has served as the head of the Office of the National Coordinator for Health Information Technology at HHS for the past four years, will leave his post. Additionally, the first chairman of the Patient-Centered Outcomes Research Institute, which was created by the ACA, will step down at the end of the year.

On August 1, HHS’s Office for Civil Rights published a request for information for a rulemaking on non-discrimination requirements under Section 1557 of the ACA.

In a final rule on disclosure of taxpayer information under the ACA, the Internal Revenue Service announced that it would share “return information” with states and other agencies to help verify income, which can help determine eligibility for tax credits through the insurance exchanges.

ON THE HILL

On August 2, the House Ways and Means Committee released draft legislation of President Obama's proposals to strengthen Medicare. The proposal addresses the following changes to post-acute care (PAC): 1) Reducing market basket updates for home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals; 2) Creating site neutral payments between IRFs and SNFs for certain procedures; 3) Modifying the criteria required for IRF status; 4) Establishing an SNF readmissions program; and 5) Creating PAC bundled payments. The committee encourages the public to submit comments to any of the draft legislative proposals at entitlementreform@mail.house.gov.

On August 4, House Budget Committee Chairman Republican Rep. Paul Ryan cautioned his party that they would be better off “delaying and ultimately replacing” the ACA rather than threatening a government shutdown over funding.

More than 200 House members signed a letter to CMS expressing concern over CMS’s proposed rule from July 1 that would cut funding for dialysis by 9.4 percent.

IN THE STATES

On August 6, Arkansas submitted a waiver application to CMS requesting to expand the Medicaid population through the state’s health insurance exchange.

Massachusettsresidents are paying more for their insurance, despite the plans decrease in value, a report from the Center for Health Information and Analysis found.

IN THE WHITE HOUSE

On August 9, President Obama held a press conference at which he accused Republicans of making repeal of the ACA their “holy grail” and said that Republicans’ “unifying principle is making sure 30 million people don’t have health care.”

On August 6, the White House launched a new website that helps employers determine the requirements and penalties they face.

IN THIRD PARTIES

On August 5, The Employers for Flexibility in Healthcare Coalition, which is led by the Retail Industry Leaders association, sent a letter to HHS, the Treasury Department, and the Labor Department expressing appreciation of the one-year delay in the employer mandate and requesting more information on it.

On August 6, WebMD announced the launch its new online Health Care Reform Center, which will educate consumers on the ACA and guide them through purchasing coverage in the insurance exchanges. The site incorporates videos, subsidy calculators, countdowns and state-specific information to help simplify the ACA.

According to a Kaiser Family Foundation report released on August 14, nearly half of those who currently buy their own health insurance would be eligible for tax credits next year under the ACA.

On August 15, Organizing for Action released a television advertisement touting the ACA. The ad is the group’s third this summer in support of the law.

IN THE COURTS

On August 6, Liberty University requested that the 4th Circuit Court of Appeals stay its ruling upholding the health care law in Liberty’s case while Liberty applies to have the Supreme Court hear it. On the same day, the court granted Liberty’s request, leading some to believe that the 4th Circuit believed the Supreme Court was considering taking the case. Then on August 7, the 4th Circuit Court of Appeals reversed itself and denied the stay.

To view our compilation of recent health care reform implementation news, click here.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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