United States: Weekly Washington Healthcare Update - November 18, 2013

Last Updated: November 25 2013
Article by Stephanie A. Kennan and Brian J. Looser

This Week: Additional Congressional hearings focus on ACA launch... Senate approves reauthorization of children's hospital medical education bill... White House releases early health insurance enrollment figures

1. Congress


House Passes Bill to Preserve Previously Canceled Health Plans

Last week, the House passed legislation that would permit insurers to continue selling, through 2014, health plans previously canceled under the ACA due to noncompliance with the law's minimum essential benefit requirements. The bill, H.R. 3350, the "Keep Your Health Plan Act of 2013," passed by a vote of 261-157, with 39 House Democrats joining 222 Republicans in voting in favor of the bill. According to a Statement of Administrative Policy, President Obama would veto the bill because it "rolls back the progress made by allowing insurers to continue to sell new plans that deploy practices such as not offering coverage for people with pre-existing conditions, charging women more than men, and continuing yearly caps on the amount of care that enrollees receive."

Oversight Committee Hearing Explores Healthcare.gov Launch

On Nov. 13, the House Committee on Oversight & Government Reform held a hearing entitled "ObamaCare Implementation: The Rollout of Healthcare.gov." The hearing focused on issues associated with the troubled rollout of the federal government's web portal for individuals to view and purchase qualifying health insurance, as required by the ACA. Republicans pressed witnesses on the degree to which the website underwent security testing before being launched, and whether the decision to disable a "window-shopping" feature was politically motivated.


Mr. Frank Baitman
Deputy Assistant Secretary for Information Technology
Department of Health and Human Services

Mr. Henry Chao
Deputy Chief Information Officer and Deputy Director of the Office of Information Services
Centers for Medicare and Medicaid Services

Mr. Todd Park
U.S. Chief Technology Officer
Office of Science and Technology Policy, The White House

Mr. Steve Van Roekel
U.S. Chief Information Officer and Administrator, Office of Electronic Government
Office of Management and Budget

Mr. David Powner
Director, Information Technology Management Issues
Government Accountability Office

Mr. Richard A. Spires
Former Chief Information Officer
U.S. Department of Homeland Security

Ms. Karen Evans
KE&T Partners, LLC

For more information, or to view the hearing, please visit: oversight.house.gov

Upcoming Oversight Subcommittee Hearing on Healthcare.gov

The Subcommittee on Oversight and Investigations will hold a hearing on Tuesday, Nov. 19, 2013, at 10:15 a.m. in Room 2123, Rayburn House Office Building. The hearing is entitled "Security of Healthcare.gov." Witnesses will be announced and are by invitation only. The hearing webcast will be available at: energycommerce.house.gov

Upcoming Health Subcommittee Hearing on Mobile Apps

Energy and Commerce Subcommittee on Health Chairman Pitts (R-PA) has announced his committee will hold a hearing entitled "Examining Federal Regulation of Mobile Medical Apps and Other Health Software." The hearing will take place on Tuesday, Nov. 19, 2013, at 10:00 a.m. in Room 2322, Rayburn House Office Building. This hearing will focus on the Food and Drug Administration's (FDA) final medical app guidance published in September 2013 and H.R. 3303, Sensible Oversight for Technology which Advances Regulatory Efficiency (SOFTWARE) Act of 2013.


Panel One
Jeffrey E. Shuren, M.D., J.D.
Center for Devices and Radiological Health
Food and Drug Administration

Panel Two
Mike Marchlik
Vice President, Quality Assurance and Regulatory Affairs
McKesson Technology Solutions

Jim Bialick
Executive Director
Newborn Coalition

The Honorable Zachary J. Lemnios
Vice President, Research Strategy
IBM Research

Robert Jarrin
Senior Director, Government Affairs
Qualcomm Incorporated

J. Leonard Lichtenfeld
Deputy Chief Medical Officer
American Cancer Society, Inc.

For more information, or to view the hearing, please visit: energycommerce.house.gov


Children's Hospital GME Reauthorization Clears Senate

On Nov. 12, the Senate passed by unanimous consent, a bill to reauthorize funding for graduate medical education programs in children's hospitals. Specifically, the bill, S. 1557, the Children's Hospital GME Support Reauthorization Act of 2013, would reauthorize funding for five years at up to $300 million each year. The program's existing authorization expired in 2011, but funding has continued to flow through annual appropriation measures. The House passed its own bill (H.R. 297) in February to reauthorize the program, and lawmakers are hopeful that a conference committee will convene to reconcile differences between the two chambers.

"Track and Trace," Compounding Legislation Clears Senate Hurdle

Last week, the Senate agreed, by a vote of 97-1, to invoke cloture on the motion to proceed on H.R. 3204, legislation that combines two smaller bills aimed at implementing a secure prescription drug supply chain, and adding clarity and additional regulation to the practice of pharmaceutical compounding. The Senate is expected to consider and pass the bill early in the week of Nov. 18. The lone vote in opposition to cloture was Sen. Vitter (R-LA).

2. Administration

Data Shows ACA Enrollment Falling Short of Expectations

Last week, the White House released much-awaited data on how many individuals have been able to successfully select a health insurance option through federally run health insurance exchanges. According to HHS Secretary Kathleen Sebelius, 106,185 people "selected" health plans from the Affordable Care Act health insurance marketplaces between Oct. 1 and Nov. 2, and another 975,407 applied for coverage and received an eligibility determination but have not yet selected a plan. Republicans seized on the numbers as an indication of the ACA's unworkable nature. In a statement, House Oversight and Government Reform Committee Chairman Darrell Issa (R-Calif.) said that the 27,000 enrollments through the federally facilitated marketplace "pale in comparison to the millions who have lost their health insurance under ObamaCare."

White House Policy Change to Address Plan Cancellations Due to ACA

In a press conference on the health care law implementation with President Obama on Nov. 14, the President announced an "administrative fix" to the Affordable Care Act that would allow insurers to renew current plans in the individual market through 2014 that do not meet the law's criteria for essential health benefits. The change is intended to reassure people who have been receiving plan cancellation notices, as it is aimed at allowing more people to keep their health plans. Moreover, the change was also clarified in a Nov. 14 Centers for Medicare and Medicaid Services (CMS) letter to state insurance commissioners and mandated that insurers alert consumers what protections their renewed plans do not include and offer alternative plan options that fall within ACA guidelines, including the opportunities for federal tax credits or Medicaid coverage. Policymakers are worried that the change may negatively impact insurer risk pools on the exchanges, given that healthier policyholders may choose to keep their older, usually less expensive, noncompliant policies.

3. State Activities

Alaska Rejects Medicaid Expansion

Last week, Alaska Gov. Parnell again rejected an expansion of his state's Medicaid program, as provided for by the ACA. Such an expansion would have potentially covered up to 40,000 low-income residents, though Parnell said he made the decision after reviewing state-commissioned study by The Lewin Group, which estimated it would cost the state just over $200 million over a seven-year period to expand Medicaid. "All those federal dollars are really enticing, but they're not free," said the Republican governor, who stressed the need to reform the program. The report was made public on Friday minutes before Parnell began talking to reporters.

4. Regulations Open for Comment

NEW -- CMS Requests Comments on Quality Measures for Plans on Exchanges

In a notice set to be published in the Nov. 19 Federal Register, the Centers for Medicare and Medicare Services is soliciting comments on quality measures for the health plans offered through the insurance exchange. The list of proposed quality rating system (QRS) quality measures has 42 measures for family/adult and 25 measures for child-only. CMS is also soliciting comments on the "hierarchical structure of the measure sets," the elements of the QRS methodology and the integrity of the QRS ratings. CMS also said it would provide "future technical guidance" for the quality health plan issuers and exchanges related to QRS measure specifications, detailed rating methodology guidelines and data reporting and procedures. CMS previously issued rules in the March 27, 2012, Federal Register directing the exchanges to oversee the ratings. Comments on the QRS quality measures are due Jan. 21, 2013.

Basic Health Plan Proposed Rule

On Sept. 20, CMS issued a proposed rule to guide the introduction of Basic Health Plans, as required by Section 1331 of the Affordable Care Act. The Basic Health Program provides states the flexibility to establish a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the state's Affordable Insurance Exchange (Exchange, also called a Health Insurance Marketplace). The Basic Health Program would complement and coordinate with enrollment in a Qualified Health Plan (QHP) through the Exchange, as well as with enrollment in Medicaid and the Children's Health Insurance Program (CHIP). This proposed rule sets forth a framework for Basic Health Program eligibility and enrollment, benefits, delivery of health care services, transfer of funds to participating states and federal oversight. Additionally, this rule would amend other rules issued by the Secretary of the Department of Health and Human Services (Secretary) in order to clarify the applicability of those rules to the Basic Health Program. Comments are due by Nov. 25, 2013.

CMS Proposed Rule for Federally Qualified Health Center Payments

On Sept. 18, CMS released a proposed rule that establishes a new Prospective Payment System (PPS) and increases Medicare reimbursement payments for federally qualified health centers (FQHC). In the rule, Medicare payments would increase 30 percent for FQHC services provided to beneficiaries in medically underserved areas. Under the PPS, Medicare would pay the FQHCs a single encounter-based rate per beneficiary per day for all services provided. The proposed rate would be calculated based on an average cost per encounter, which is estimated to be $155.90, adjusted for geographic variation, with additional consideration given to new Medicare beneficiaries.

"These health centers serve some of our most vulnerable populations," HRSA Administrator Mary Wakefield said in a Sept. 18 statement. "We are excited about our collaboration with CMS to create a payment system that enables these vital health centers to keep doing such important work." CMS estimates that during the first five years of implementation, the annual Medicare spending for the FQHCs would be $33 million in 2014, increasing to at least $200 million every year afterward until 2018. Comments on the proposed rule are due on Nov. 18, 2013.

IRS Proposed Rule -- ACA Employer Information Reporting Mandates

On Sept. 5, the IRS issued proposed regulations providing guidance to employers that are subject to the information reporting requirements under Section 6056 of the Internal Revenue Code (Code), enacted by the Affordable Care Act. Section 6056 requires those employers to report to the IRS information about their compliance with the employer shared responsibility provisions of Section 4980H of the Code and about the health care coverage they have offered employees. Section 6056 also requires those employers to furnish related statements to employees so that employees may use the statements to help determine whether, for each month of the calendar year, they can claim on their tax returns a premium tax credit under Section 36B of the Code (premium tax credit). In addition, that information will be used to administer and ensure compliance with the eligibility requirements for the employer shared responsibility provisions and the premium tax credit. The proposed regulations affect applicable large employers (generally meaning employers with 50 or more full-time employees, including full-time equivalent employees, in the prior year), employees and other individuals.

IRS will accept comments on specific aspects of the proposed rule, such as whether the proposed collection of information is necessary for the proper performance of the functions of the IRS, including whether the information will have practical utility, and how the quality, utility and clarity of the information to be collected may be enhanced. A public hearing will be held at 10 a.m. on Nov. 18.

IRS Proposed Rule -- Reporting On ACA Minimum Essential Coverage

On Sept. 5, the IRS issued proposed regulations providing guidance to providers of minimum essential health coverage that are subject to the information reporting requirements of Section 6055 of the Internal Revenue Code (Code), enacted by the Affordable Care Act. Health insurance issuers, certain employers and others that provide minimum essential coverage to individuals must report to the IRS information about the type and period of coverage and furnish related statements to covered individuals. These proposed regulations affect health insurance issuers, employers, governments and other persons that provide minimum essential coverage to individuals. Under the proposed rules, health insurance issuers are not required to submit Section 6055 information returns on minimum essential coverage they provide in the individual market through the ACA health insurance exchanges, or marketplaces; however, sponsors of self-insured group health plans are required to report minimum essential coverage under the proposed rule. In addition, self-insured group health plans or arrangements covering employees of related corporations are treated as sponsored by more than one employer and each employer must report for its employees.

IRS will accept comments on specific aspects of the proposed rule, such as whether the proposed collection of information is necessary for the proper performance of the functions of the IRS, whether the information will have practical utility, and how the quality, utility and clarity of the information to be collected may be enhanced. A public hearing will be held at 10 a.m. on Nov. 19.

IRS Proposed Rule -- ACA Small Business Tax Credit

The IRS has issued proposed rules on the ACA's small-business tax credit, available only to certain businesses with 25 or fewer full-time employees purchasing health coverage through a SHOP exchange. Under the proposed rule, for taxable years beginning during or after 2014, the maximum credit for an eligible small employer other than a tax-exempt eligible small employer is 50 percent of the eligible small employer's premium payments made on behalf of its employees under a qualifying arrangement for QHPs offered through a SHOP exchange. For a tax-exempt eligible small employer for those years, the maximum credit is 35 percent. The employer's tax credit is subject to several adjustments and limitations as set forth in this preamble.

In addition, all employees (determined under the common law standard) who perform services for the employer during the taxable year are taken into account in determining FTEs and average annual wages, including those who are not performing services in the employer's trade or business. An employee's hours of service for a year include hours for which the employee is paid, or entitled to payment, for the performance of duties for the employer during the employer's taxable year. Hours of service also include hours for which the employee is paid for vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty or leave of absence. Hours of service do not include the hours of seasonal employees who work for 120 or fewer days during the taxable year, nor do they include hours worked for a year in excess of 2,080 for a single employee.

Comments are due Nov. 21, 2013.

5. Reports


Advisory Opinion on Anesthesiology, Psychiatric Arrangement

According to an advisory opinion made public on Nov. 12 by the Department of Health and Human Services Office of the Inspector General (HHS-OIG), a proposed arrangement involving anesthesia services being provided to a psychiatric practice, as well as reassigning billing rights to the psychiatric practice, might violate federal statute prohibiting kickbacks. Specifically, between 1993 and the beginning of 2011, the anesthesia provider in question contracted with a hospital to provide all its anesthesia services with the exception of chronic pain management. However, in late 2010, a psychiatric practice that offered electroconvulsive therapy (ECT) began operating in the hospital, and when the anesthesia provider negotiated its 2011 contract with the hospital, the hospital inserted a provision that allowed the head of the psychiatric practice to provide anesthesia services to ECT patients, outside the anesthesia provider's relationship with the hospital. "The Proposed Arrangement therefore presents the significant risk that the remuneration Requestor would provide to the Psychiatry Group -- i.e., the opportunity to generate a fee equal to the difference between the amounts the Psychiatry Group would bill and collect for Requestor's anesthesia services, and the per diem amounts the Psychiatry Group would pay to Requestor -- would be in return for the Psychiatry Group's anesthesia referrals to Requestor," the opinion stated. 


MACPAC November Meeting

On Nov. 14-15, 2013, the Medicaid and CHIP Payment and Access Commission (MACPAC) held its regular monthly meeting to discuss issues in advance of the commission's annual report to Congress. The meeting consisted of six sessions: the Future of CHIP: Views from CHIP Directors; the Future of CHIP: Part II; the Long-Term Care Commission: Report from the Commission's Leadership; Short- and Long-Term Issues for CHIP; Medicaid Interactions with the ACA: Issues and Analyses for Further Consideration; and Medicaid Non-DSH Supplemental Payments.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

In association with
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.


Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.


Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.


A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.


This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.


If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.


From time to time Mondaq may send you emails promoting Mondaq services including new services. You may opt out of receiving such emails by clicking below.

*** If you do not wish to receive any future announcements of services offered by Mondaq you may opt out by clicking here .


This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at enquiries@mondaq.com.

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.