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Thomas Dowdell (US)

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US Senate Republican leadership releases new draft of health care reform legislation

Earlier this afternoon U.S. Senate Republican leadership released a new discussion draft of the Better Care Reconciliation Act of 2017. Senate Republican leadership released the first version of the draft legislation last Thursday, June 22. This new discussion draft includes a provision to encourage individuals to maintain continuous health care coverage. This provision, which would … Continue reading

U.S. Senate health care reform legislation if enacted into law will make significant changes to the Affordable Care Act

U.S. Senate Republican leadership yesterday released its draft health care reform legislation entitled the “Better Care Reconciliation Act of 2017.” The Senate legislation would retain two key provisions of the Affordable Care Act (ACA):  (i) insurers are prohibited from denying coverage or increasing an individual’s premiums based on a preexisting medical condition; and (ii) young … Continue reading

U.S. Senate Republican leadership releases draft text of health care reform legislation entitled “Better Care Reconciliation Act of 2017”

This morning U.S. Senate Republican leadership released a 142-page “Discussion Draft” of the Senate health care reform legislation entitled “Better Care Reconciliation Act of 2017.” Senate Majority Leader Mitch McConnell reportedly is pushing for a vote as soon as next Thursday, June 29. The Congressional Budget Office is considering the projected financial effects of this … Continue reading

Republican Senators continue work on health care reform legislation while another insurer withdraws from a state ACA marketplace; U.S. Senate and House of Representatives committees hold hearings this week on the cost of prescription drugs and funding for safety net health programs

Last Tuesday, Senior Republican leadership in the Senate held a closed-door briefing for Republican Senate members regarding Senate health care reform legislation.  Senior Republican leadership reportedly indicated that they favor the retention of guaranteed protections for individuals with preexisting conditions, a more gradual roll back of the expansion of Medicaid, and may opt to keep … Continue reading

US Senate returns from recess with Senate Republicans hoping to draft their version of health care reform legislation; members urge HHS to allow charitable assistance programs to provide financial assistance to patients

The US Senate resumes business this week after a week-long recess with Senate Republicans hoping to begin to draft their version of health care reform legislation. Senate Majority Leader Mitch McConnell (R-Ky.) has expressed doubt whether Republicans will have the minimum 50 votes necessary in the Senate to pass the bill. The most significant issues … Continue reading

Congressional Budget Office releases score of American Health Care Act of 2017 as passed by the U.S. House of Representatives; Senate Republicans continue work on their version of health care reform legislation

On May 24th, the Congressional Budget Office (CBO) released its score of H.R. 1628, the American Health Care Act of 2017 (AHCA), as passed by the U.S. House of Representatives.  The CBO estimates that the AHCA would reduce the federal deficit by $119 billion over 10 years.  The CBO also estimates that if enacted, in … Continue reading

U.S. Senate begins considering health care legislation; CBO to release score of American Health Care Act next week

Congressional work on health care legislation took a back seat last week to President Trump’s firing of FBI Director James Comey.  Nonetheless, there was some health care activity. As previously reported, on May 4 the U.S. House of Representatives passed the American Health Care Act of 2017 (H.R. 1628) (AHCA) by a vote of 217-213.  … Continue reading

House narrowly passes American Health Care Act; Republican Senators signal they will draft a health care bill from scratch

Following a series of thwarted efforts and delays, on May 4, 2017, the U.S. House of Representatives passed by a narrow margin of 217-213 the American Health Care Act of 2017 (H.R. 1628) (AHCA), a plan to repeal and replace the Affordable Care Act. The Congressional Budget Office and Joint Committee on Taxation first estimated … Continue reading

Vote on MacArthur Amendment delayed; Trump Administration will continue to pay subsidies to insurers for low-income individuals; CMS issues three new payment rules for FY 2018 proposing increased payments to skilled-nursing facilities, inpatient rehabilitation facilities, and hospice care

Vote on MacArthur Amendment delayed: Last week, the House delayed voting on a revised bill to repeal and replace the 2010 Affordable Care Act, thwarting White House plans to hold a vote before President Donald Trump’s 100th day in office. The revised American Health Care Act (AHCA) would include the amendment drafted by Representative Tom … Continue reading

CMS issues FY 2018 IPPS proposed rule and final rule intended to stabilize insurance marketplaces; Trump Administration threatens to end cost-sharing subsidies and vows to pass the AHCA

Despite Congress being on Easter recess, last week was a busy week in Washington.  The Centers for Medicare & Medicaid Services (CMS) released its fiscal year (FY) 2018 inpatient prospective payment system (IPPS) proposed rule.   The rule provides that the proposed increase in operating payment rates for general acute care hospitals paid under the IPPS … Continue reading

Trump Administration and Republican Congressional leadership shift focus following non-vote on ACA repeal and replace legislation; States push for Medicaid expansion

Republican Congressional leadership quickly reprioritized and refocused their efforts following the Trump Administration and House Republican leadership’s failure to secure enough votes for full House passage of the American Health Care Act (“AHCA”), the bill intended to repeal and replace the Affordable Care Act (“ACA”). As previously covered, Republican House Speaker Paul Ryan pulled the … Continue reading

Republicans advance ACA repeal and replace legislation through 2 House Committees; House Budget Committee will take up Bill this week

On Thursday, March 9, the U.S. House of Representatives’ Ways and Means Committee approved by a party-line vote the tax provisions in the American Health Care Act (AHCA). The AHCA is the Republican legislation to repeal and replace the Patient Protection & Affordable Care Act (ACA). On the same day the House Energy and Commerce Committee … Continue reading

House Republicans release Affordable Care Act replacement legislation

On Monday evening, March 6, House Republicans released proposed legislation that would replace the Affordable Care Act (ACA).  The proposed legislation would: Eliminate the individual and large employer mandates Permit insurers to impose a surcharge up to 30 percent on individuals who go uninsured for more than two months and then purchase coverage Provide tax … Continue reading

News from DC – President Trump addresses a Joint Session of Congress and House Republicans revise ACA replacement legislation and schedule hearings

On Tuesday, February 28, President Trump addressed a Joint Session of Congress and outlined his Affordable Care Act (ACA) replacement legislation principles.  The President endorsed a tax credit and expanded Health Savings Accounts to help people purchase health care insurance.  He reiterated that individuals should be able to purchase health insurance across state lines.  The President … Continue reading

President signs into law 21st Century Cures Act

On December 13th, President Obama signed into law the 21st Century Cures Act.  The legislation authorizes $4.8 billion for the National Institutes of Health to fund new initiatives in precision medicine, cancer, neuroscience, and regenerative medicine.  The bill also provides $500 million over ten years for the Food and Drug Administration for the development of … Continue reading

A first look at the healthcare industry under President Trump

The “100 Day Action Plan” of President-elect Donald Trump promised to bring broad and sweeping change to the current laws governing the healthcare industry in the US Specifically, Trump’s 100 Day Action Plan called for the full repeal of the Patient Protection and Affordable Care Act (“ACA”) and its replacement with health savings accounts, cross-states … Continue reading

CMS Issues CY 2017 Final Rule

On November 1, 2016, CMS issued its Calendar Year (CY) 2017 Outpatient Prospective Payment System (OPPS) final rule with comment period. CMS also issued an interim final rule with comment period that establishes Medicare Physician Fee Schedule (MPFS) rates for certain items and services furnished by certain hospital off-campus outpatient departments. Significant provisions of the … Continue reading

CY 2017 OPPS Final Rule and Hospital Off-Campus Outpatient Department Payment Implications

On Tuesday, November 1, CMS published its Calendar Year 2017 Outpatient Prospective Payment System (OPPS) final rule with comment period.  The final rule includes provisions implementing the Bipartisan Budget Act of 2015, Section 603.  On the same date CMS also issued an interim final rule with comment period that establishes Medicare Physician Fee Schedule (MPFS) … Continue reading

MACRA: Advanced APMs and MIPS Replace SGR Effective January 2017

On October 14, 2016, CMS issued the “Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models” final rule with comment period. MIPS and Advanced APMs are the two ways for health care providers to participate in the CMS Quality Payment Program that … Continue reading

Administrative dispute resolution process is proposed to resolve 340B drug pricing program disputes

On August 11 the Health Resources and Services Administration (HRSA) issued a notice of proposed rulemaking (RIN 0906-AA90) that would implement an administrative dispute resolution (ADR) process that would apply to all drug manufacturers and covered entities that participate in the 340B drug pricing program. The rule if implemented as proposed will establish and implement … Continue reading

CMS 2017 OPPS Proposed Rule includes Medicare payment provisions for hospital off-campus outpatient departments

On July 6, 2016, the Centers for Medicare & Medicaid Services (CMS) published its Calendar Year (CY) 2017 Outpatient Prospective Payment System Proposed Rule.  We will be providing an in-depth analysis of all significant proposals shortly.  In the interim, we note that significant provisions of the rule would implement Bipartisan Budget Act of 2015 Section … Continue reading

CMS publishes final rule to update medicare clinical diagnostic laboratory tests payment system for program savings

On June 17, 2016, CMS published the “Medicare Clinical Diagnostic Laboratory Tests Payment System” final rule. Among the key changes in this final rule, CMS has revised the Medicare Clinical Laboratory Fee Schedule (CLFS) such that payment for clinical diagnostic laboratory tests (CDLTs) beginning January 1, 2018 will reflect the weighted median of private payor … Continue reading

OIG finds CMS deficient in monitoring compliance by hospitals with provider-based status requirements

On June 17, 2016, the Department of Health and Human Services’ Office of Inspector General (OIG) released a report entitled “CMS Is Taking Steps to Improve Oversight of Provider-Based Facilities, But Vulnerabilities Remain” (OEI-04-12-00380). The OIG reviewed oversight by the Centers for Medicare & Medicaid Services (CMS) of compliance by hospitals with the Medicare provider-based … Continue reading
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