Last week, Congress and the White House managed to find enough common ground to protect most Americans from the tax increases they would have faced as a result of 'fiscal cliff' tax cut expirations. However, work remains to be done on additional items, such as finding a long-term solution to across-the-board spending cuts and preventing a government shutdown associated with the debt ceiling. In addition, the 113th Congress officially convened, with both House Speaker Boehner (R-OH) and Senate Majority Leader Reid (D-NV) retaining their respective positions at the helm of each chamber.
THIS WEEK:
1. Congress
House of Representatives
- Fiscal Cliff Deal
- Rep. Kingston Named Health Appropriations Chairman
- Oversight and Government Reform Establishes New Health Subcommittee
- Energy and Commerce Summarizes 112th Congress Accomplishments
Senate
- Senator Kirk Returns to Washington
2. Administration
Health and Human Services (HHS)
- More State Exchange Proposals Granted Conditional Approval...Even Utah
3. State Activities
- Colorado Opts to Expand Medicaid
- Massachusetts Governor Proposes Compounding Pharmacy Oversight Law
4. Regulations Open for Comment
- NEW – Food and Drug Administration (FDA) Proposes New Food Safety Rules
- Additional "Meaningful Use" Guidance Issued
- Additional Medicare Tax for Wealthy Beneficiaries
5. Reports
General Accountability Office (GAO)
- Medicare Physician Payment: Private-Sector Initiatives Can Help Inform CMS Quality and Efficiency Incentive Efforts
Congressional Budget Office (CBO)
- The "Fiscal Cliff" Deal
National Governors Association
- Suggestions to States Regarding Nurse Practitioner Scope of Practice Laws
Alliance for Health Reform
- Health Care System Cost Drivers and Remedies
Health Affairs
- ACA Helping Young Adults Acquire Health Insurance Coverage
National Institute on Drug Abuse
- Youth Smoking Down, Marijuana Use Steady
* * * * * * * * * *
1. CONGRESS
House of Representatives
Fiscal Cliff Deal
The drama surrounding the "fiscal cliff" of tax cut expirations and spending reductions came to a somewhat anticlimactic end last week as Congressional leaders and the White House reached agreement on a legislative package that will avert across-the-board "sequester" spending cuts for two months, and largely protect most Americans from net tax increases. The bill also included a one-year "doc fix," avoiding a scheduled 27 percent cut to Medicare physician payments. For a summary of all health-related provisions, please click here. For additional information on select long-term and post-acute care provisions, click here.
Rep. Kingston Named Health Appropriations Chairman
Though Republican leaders in the House have said their main focus regarding the Affordable Care Act (ACA) moving forward will be oversight, the law's reliance on annual appropriations guarantees that the Appropriations Subcommittee on Labor, Health and Human Services, and Education, and Related Agencies (Labor/HHS) will play a key role in negotiations over what aspects of the law will receive funding. To that end, Rep. Kingston (R-GA), the incoming chairman of this important subcommittee, will likely have to tread lightly when it comes to his view that the ACA is the law of the land, and though some provisions could be peeled off, all-out repeal has become extremely unlikely -- a position that could put him at odds with many Republicans who still favor nothing short of full repeal.
Oversight and Government Reform Establishes New Health Subcommittee
For the 113th Congress, Oversight and Government Reform Chairman Issa (R-CA) has announced the formation of a new subcommittee that will focus its oversight activities on health care and entitlement programs, in addition to energy policies. The panel, to be chaired by Rep. Lankford (R-OK), will take over some of the responsibilities previously covered by the Subcommittee on Health Care, District of Columbia, Census and the National Archives. That subcommittee, which was chaired by Rep. Gowdy (R-SC), was eliminated for the 113th Congress.
Energy and Commerce Summarizes 112th Congress Accomplishments
Last week, Energy and Commerce Chairman Upton (R-MI) circulated a report to committee Republicans and his party leadership in the chamber to highlight the work done by his committee over the course of the 112th Congress. Grouping activities under the themes of supporting job creation and economic growth; standing up for taxpayers by reducing the size and scope of the federal government; and protecting individuals, families and communities, the report describes specific actions taken by each of the six subcommittees, as well as full committee activities. Among the highlights: 188 total hearings, 69 markups leading to 88 bills subsequently receiving floor consideration and 40 bills being signed into law.
Senate
Senator Kirk Returns to Washington
After a year of physical therapy and rehabilitation following his stroke, Sen. Mark Kirk (R-IL) climbed the Capitol steps last week under his own power to kick off the 113th Congress. Kirk, a moderate currently serving his first term in the Senate, is a member of the powerful Senate HELP Committee.
2. ADMINISTRATION
Health and Human Services (HHS)
More State Exchange Proposals Granted Conditional Approval... Even Utah
Since our last update, HHS has granted "conditional approval" to four additional state health insurance exchange blueprints. The states -- Rhode Island, Minnesota, Delaware and Utah -- may now proceed with implementation of their exchange plans. Rhode Island, Minnesota and Utah have opted to run their own state-based exchanges while Delaware will partner with the federal government. Though Utah's blueprint still must progress in order to meet HHS's requirement of providing "affordable, quality coverage to individuals and small businesses," many experts were surprised that it was given any measure of approval, as it currently represents a more conservative vision of how an exchange should operate. To date, CMS has granted conditional approval to exchange plans submitted by 19 states and the District of Columbia. Of the 19, only two (Arkansas and Delaware) intend to pursue a "State Partnership Exchange," in which the federal government will act as a partner in operating the exchange. The other 17 and DC will run their own state-based exchanges. For those states that do not select either a partnership or solely state-run exchange, the federal government will establish an exchange for them.
3. STATE ACTIVITIES
Colorado Opts to Expand Medicaid
Last week, Colorado Gov. John Hickenlooper formally announced that, through a combination of an amendment to the state's Medicaid plan with HHS and a change in state law, Colorado will be able to expand its Medicaid program to an additional 160,000 residents. According to Hickenlooper, the plan will not increase expenditures from the state. "Not one dollar from the state's general fund will be used for this expansion, even in 2017 when the federal government begins to reduce its share," the governor said.
Massachusetts Governor Proposes Compounding Pharmacy Oversight Law
In the aftermath of a fungal meningitis outbreak that claimed the lives of 39 individuals and sickened hundreds more, Massachusetts Governor Deval Patrick has come forward with a proposal to increase the oversight of compounding pharmacies, which often operate in a gray area between pharmaceutical manufacturing and distribution. Specifically, the proposal would require compounding pharmacies to seek a special license to ensure compliance with safety standards, and would require Massachusetts to license out-of-state pharmacies that distribute medication within the state. The proposal would also alter the state's board of pharmacy to address concerns of undue pharmaceutical industry influence.
4. REGULATIONS OPEN FOR COMMENT
NEW -- Food and Drug Administration (FDA) Proposes New Food Safety Rules
The FDA has proposed new rules on food safety, including regulations on good manufacturing practices standards for growing, handling and packaging produce. Specifically, to minimize the risk of serious adverse health consequences or death from consumption of contaminated produce, the FDA is proposing to establish science-based minimum standards for the safe growing, harvesting, packing and holding of produce, meaning fruits and vegetables grown for human consumption. FDA is proposing these standards as part of its implementation of the FDA Food Safety Modernization Act (FSMA). These standards would not apply to produce that is rarely consumed raw, produce for personal or on-farm consumption, or produce that is not a raw agricultural commodity. The proposed rule would also set forth procedures, processes and practices that minimize the risk of serious adverse health consequences or death, including those reasonably necessary to prevent the introduction of known or reasonably foreseeable biological hazards into or onto produce and to provide reasonable assurances that the produce is not adulterated on account of such hazards.
Another proposed rule would amend FDA's current regulation for Current Good Manufacturing Practice In Manufacturing, Packing, or Holding Human Food (CGMPs), which requires domestic and foreign facilities that are required to register under the Federal Food, Drug, and Cosmetic Act (FD&C Act) to establish and implement hazard analysis and risk-based preventive controls for human food. FDA also is proposing to revise certain definitions in FDA's current regulation for Registration of Food Facilities to clarify the scope of the exemption from registration requirements provided by the FD&C Act for "farms."
Comments on both proposed rules are due by May 16, 2013.
Additional "Meaningful Use" Guidance Issued
HHS has issued an interim final rule with comment period revising the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, updating a few technical specifications for EHR systems participating in the meaningful use program, in addition to adjusting some elements for hospital Stage 2 reporting requirements. The rule also provides notice of CMS's intention to issue technical corrections to the electronic specifications for clinical quality measures (CQMs) released on Oct. 25, 2012. A 60-day public comment period will expire Feb. 4, 2013.
Additional Medicare Tax for Wealthy Beneficiaries
This proposed regulation addresses issues relating to Additional Hospital Insurance Tax on income above threshold amounts ("Additional Medicare Tax"), as added by the Affordable Care Act. Specifically, the proposed regulation provides guidance for employers and individuals relating to the implementation of Additional Medicare Tax. This document also contains proposed regulations relating to the requirement to file a return reporting Additional Medicare Tax, the employer process for making adjustments of underpayments and overpayments of Additional Medicare Tax, and the employer and employee processes for filing a claim for refund for an overpayment of Additional Medicare Tax. The document also provides notice of a public hearing scheduled for April 4, 2013, on these proposed rules. The deadline for submitting comments on the proposed regulation is March 1, 2013.
5. REPORTS
General Accountability Office (GAO)
Medicare Physician Payment: Private-Sector Initiatives Can Help Inform CMS Quality and Efficiency Incentive Efforts
Last week, GAO released a report identifying activities currently being conducted by private-sector entities to provide incentives for high-quality, efficient care that the agency believes could potentially benefit the Centers for Medicare and Medicaid Services (CMS) in its quest to achieve the same goals. Among the activities, GAO noted that private entities often target incentive payments to physician groups as opposed to individual physicians, and tie incentive payments to absolute physician performance targets instead of physician performance relative to their peers. According to the report:
CMS should consider whether certain private-sector practices could broaden and strengthen the Value Modifier program's incentives. Specifically, the agency should consider rewarding physicians for performance improvement as well as for meeting absolute benchmarks, and making more timely payment adjustments to better reflect recent physician performance. Furthermore, the agency should develop a strategy to reliably measure the performance of solo or small physician practices. HHS concurred with all of GAO's recommendations for CMS.
Congressional Budget Office (CBO)
The "Fiscal Cliff" Deal
Though the deal was largely finalized and primed for the president's desk, CBO released an assessment of the fiscal cliff package last week concluding that the deal would increase government spending by approximately $4 billion, relative to the then-current law provisions it replaced. However, the report noted that relative to a simple extension of existing 2012 policies, the package would actually reduce overall government spending. And in the context of GDP, CBO believes "the legislation will probably increase GDP growth in 2013 by about 1 1/2 to 1 3/4 percentage points relative to what would have happened under prior law."
National Governors Association
Suggestions to States Regarding Nurse Practitioner Scope of Practice Laws
In a recent report, the National Governors Association examined the practice laws governing nurse practitioners. The report concluded that nurse practitioners can help meet the growing demand of primary care physicians and suggested states consider "easing their scope of practice restrictions and modifying their reimbursement policies." Currently, 16 states and Washington, D.C., allow nurse practitioners to practice without the oversight of a physician. The report suggested the 34 remaining states follow suit or otherwise ease regulations in order to meet demand.
Alliance for Health Reform
Health Care System Cost Drivers and Remedies
The Alliance for Health Reform has released a report on the cost-drivers of our nation's health care system. According to the report, which describes the role of not only overall health spending but also the rate of growth in such spending, there is plenty of blame to go around when it comes to skyrocketing costs. The report's authors outline a comprehensive list of major cost drivers, from a lack of patient engagement, to misguided reimbursements to providers that incentivize volume over quality, and expensive medical technology. In addition, the report lays out ways, such as payment model reforms, that encourage quality and coordination among providers, in which both overall spending and the rate of growth in spending can be addressed.
Health Affairs
ACA Helping Young Adults Acquire Health Insurance Coverage
Citing a provision in the ACA requiring insurance plans to cover dependent children up to age 26, a recent report in Health Affairs finds that a significant number of young adults are acquiring health insurance, without any evidence that the policy is harming patient access to care. According to the report, "[u]sing data from two nationally representative surveys, comparing young adults who gained access to dependent coverage to a control group (adults ages 26-34) who were not affected by the new policy, we found sizable coverage gains for adults ages 19-25." Full report (subscription required).
National Institute on Drug Abuse
Youth Smoking Down, Marijuana Use Steady
The National Institute on Drug Abuse released the results of a national survey conducted by Monitoring the Future that shows a drop in cigarette use among teenagers. The survey asked 45,000-50,000 teenagers if they had smoked a cigarette in the last 30 days. According to the results, 10.6 percent of teenagers had in 2012, compared to 11.7 percent in 2011. The survey found that one reason for the drop in cigarette use was a result of the decrease in students who have tried smoking. Researchers note that there was not a decline in marijuana use from 2011 to 2012.
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