Legislative Activity

Following a bad week for the Affordable Care Act (ACA) roll-out, with criticism of the deficiencies from Republicans and Democrats alike, this week will bring renewed calls for legislative action to delay implementation. Provisions that would extend the open enrollment period and a delayed tax enforcement of the individual mandate are getting the most attention, with the budget conference legislation providing a potential vehicle.

This Week’s Hearings:

  • Tuesday, October 29: The House Committee on Ways and Means will hold a hearing on the status of ACA implementation. Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services (CMS) is scheduled to testify.
  • Wednesday, October 30: The Budget Conference Committee will hold its first official meeting to reconcile House- and Senate-passed budgets. The House Committee on Energy and Commerce will hold a hearing entitled PPACA Implementation Failures: Answers from HHS. The Senate Committee on Health, Education, Labor and Pensions will meet in executive session to consider the following bills:
  • S._, the Childrens Hospital GME Support Reauthorization Act of 2013;
  • S._, the CHIMP Act Amendments of 2013;
  • H.R. 2094, the School Access to Emergency Epinephrine Act; and
  • S._, the Older Americans Act Reauthorization Act of 2013.

Regulatory ACTIVITY

CMS Program Integrity Final Rule

CMS issued the final rule, “Patient Protection and Affordable Care Act; Program Integrity: Exchange, PremiumStabilization Programs, and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014.” According to the notice, the “final rule outlines financial integrity and oversight standards with respect to Affordable Insurance Exchanges, qualified health plan (QHP) issuers in Federally-facilitated Exchanges (FFEs), and States with regard to the operation of risk adjustment and reinsurance programs. It also establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFE, and makes certain amendments to definitions and standards related to the market reform rules. These standards, which include financial integrity provisions and protections against fraud and abuse, are consistent with Title I of the Affordable Care Act. This final rule also amends and adopts as final interim provisions set forth in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule, published in the Federal Register on March 11, 2013, related to risk corridors and cost-sharing reduction reconciliation.”

Regs on Schedule

CMS issued a brief update that the agency intends to complete the calendar year 2014 Medicare fee for service payment regulations, despite the interruption of the government shutdown. These regulations include:

  • Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (CMS-1526-F);
  • CY 2014 Changes to the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (CMS-1601-FC);
  • CY 2014 Home Health Prospective Payment System Final Rule (CMS-1450-F); and
  • Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2014 Final Rule with Comment Period (CMS-1600-FC).