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CHIP Program funding remains in limbo; Senators advocate reversal of 340B Drug Discount Program cuts; CMS reports on 2016 U.S. health expenditures

Payments under the Children’s Health Insurance Program (CHIP) remain uncertain in many states without an extension of federal funding to the program. CHIP provides insurance coverage for children whose parents earn too much for Medicaid but cannot afford other health insurance coverage. While the short-term spending bill signed into law on December 8 allows for … Continue reading

U.S. Senate passes tax bill eliminating penalties for failure to comply with ACA individual health insurance mandate

On December 2, the U.S. Senate passed a tax bill by a 51-49 vote.  The legislation would not repeal the Affordable Care Act (ACA) individual health insurance mandate but instead would eliminate tax penalties for con-compliance with the mandate.  Senator Susan Collins (R-ME) announced her support for the bill in a press release in which … Continue reading

Senate tax bill would effectively repeal ACA individual mandate; House legislation to reverse 340B Drug Discount Program cuts; CMS addresses prescription drug costs and the opioid crisis

On November 14, Senate Finance Committee Chairman Orrin Hatch (R-UT) released the Chairman’s Mark to the Senate version of the Tax Cuts and Jobs Act. Hatch’s version of the tax plan effectively repeals the Affordable Care Act (ACA) individual mandate by reducing the associated penalty to $0. The ACA individual mandate requires individuals to buy … Continue reading

340B drug discount program payment reductions challenged; Alex Azar nominated as next HHS Secretary

On November 13, the American Hospital Association, Association of American Medical Colleges, America’s Essential Hospitals, Eastern Maine Healthcare Systems, Henry Ford Health System, and Fletcher Hospital filed a lawsuit in United States District Court for the District of Columbia seeking declaratory and injunctive relief, including a preliminary injunction preventing the reduction in payments for 340B … Continue reading

CMS issues 2018 Medicare physician fee schedule final rule and MACRA physician QPP final rule

On November 2, 2017, the Centers for Medicare & Medicaid (CMS) Services issued its Calendar Year (CY) 2018 Medicare Physician Fee Schedule (MPFS) final rule.  The overall update to payments under the MPFS in 2018 will be +0.41 percent.  The 2018 MPFS conversion factor will be $35.99, an increase from $35.89 in 2017.  MPFS payment … Continue reading

CMS issues 2018 hospital OPPS and home health PPS final rules

On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued its final hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system final rule for Calendar Year (CY) 2018.  On the same day CMS also issued its home health prospective payment system 2018 final rule.      OPPS payment rates will … Continue reading

Federal judge rejects preliminary injunction mandating ACA cost-sharing reduction payments; CBO estimates $3.8 billion deficit reduction from bipartisan ACA bill

On Wednesday, October 25, Judge Vince Chhabria, federal district court in San Francisco, rejected a request for a  preliminary injunction by 18 states and the District of Columbia to compel the Trump Administration to continue to pay cost-sharing reduction (CSR) payments to health insurance companies.  Judge Chhabria concluded:  (i) States have been preparing for months … Continue reading

Senators Alexander and Murray release draft bill intended to stabilize the ACA marketplaces

On October 17, Senate Committee on Health, Education, Labor, and Pensions Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) announced a bipartisan proposal intended to stabilize Affordable Care Act (ACA) marketplaces and relax ACA State Innovation Waiver restrictions. On October 19, Chairman Alexander released the proposed health care bill known as the Bipartisan … Continue reading

President Trump announces end of cost-sharing reduction payments to insurers; President signs executive order promoting association health plans

On October 12, President Trump announced in a filing by the Department of Justice in the ongoing litigation challenging the cost-sharing reduction (CSR) payments that such payments will no longer be made to insurers. CSR payments help offset deductibles and other out-of-pocket expenses for Affordable Health Care Act (ACA) exchange health insurance coverage for approximately … Continue reading

U.S. Senate Republican leadership decides against full Senate vote on Graham-Cassidy ACA repeal and replace legislation; HHS Secretary Tom Price resigns under pressure from the White House

On Tuesday, September 26, Senate Republican leadership decided not to hold a full Senate vote on the Graham-Cassidy Affordable Care Act (ACA) repeal and replace legislation. The previous day, Monday, September 25, the Senate Finance Committee held a hearing on the Graham-Cassidy bill. Following the hearing, Senator Susan Collins (R-ME) announced her opposition to the … Continue reading

US Senators Graham and Cassidy revise Affordable Care Act repeal legislation prior to Finance Committee hearing; AHA requests CMS guidance on hospital co-location and shared space arrangements

On Sunday evening, September 24, U.S. Senators Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana) released a revised version of their Affordable Care Act (ACA) repeal legislation in advance of the Senate Finance Committee hearing scheduled for Monday, September 25, at 2 PM EST. The amended bill is similar to the legislation previously released in … Continue reading

CMS clarifies when hospitals are primarily engaged in inpatient care; U.S. Republican Senators introduce ACA repeal legislation while Democrats promote Medicare for all

The Centers for Medicare and Medicaid Services (CMS) recently issued Survey and Certification Letter 17-44, clarifying what it means for a facility to be “primarily engaged” in inpatient care for purposes of meeting the definition of a hospital and qualifying for reimbursement as a hospital under Medicare and Medicaid. A facility is primarily engaged in … Continue reading

U.S. Senators continue ACA stabilization and repeal efforts

The Senate Health, Education, Labor and Pensions (HELP) Committee has held three hearings in the past few days attempting to reach a bipartisan agreement on stabilizing the Affordable Care Act (ACA) insurance markets and will hold a fourth hearing later this week.  HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Minority Member Patty Murry (D-WA) … Continue reading

CMS issues blanket waivers as a result of Hurricane Harvey; health care reform efforts continue

The Centers for Medicare & Medicaid Services (CMS) has issued several blanket waivers of Medicare requirements as a result of Hurricane Harvey.  Examples of requirements that CMS may waive include those relating to conditions of Medicare participation or certification, preapproval requirements, EMTALA requirements, Stark Law self-referral sanctions, and performance deadlines.  Providers do not need to … Continue reading

CBO releases report on effects of terminating ACA cost-sharing reduction payments; CMS proposes to end two incentive payment models

On August 15, the Congressional Budget Office (“CBO”) released a report on the effects of terminating payments to insurers for cost-sharing reductions under the Affordable Care Act (“ACA”) in 2017. The CBO estimated that by 2018, insurance premiums for silver plans would increase by 20 percent and leave 5 percent of Americans living in areas … Continue reading

Health care reform discussions continue in U.S. Senate; CMS issues multiple rules relevant to payments to and policies for hospitals, hospices, and skilled nursing facilities

On August 1, Chairman Lamar Alexander (R-Tenn.) and Ranking Minority Member Patty Murray (D-Wash.) of the U.S. Senate Committee on Health, Education, Labor and Pensions announced that the committee will hold hearings the week of September 4th on actions that Congress could take in an attempt to stabilize and strengthen the individual insurance markets in … Continue reading

U.S. Senate rejects health care reform legislation; CMS releases home health proposed rule for CY 2018

Last week the U.S. Senate rejected three health care reform proposals intended to repeal all or parts of the Affordable Care Act (ACA).  On Tuesday, Vice President Mike Pence cast the deciding vote 51-50 for the Senate to begin debate on legislation to repeal significant parts of the ACA.  Later Tuesday evening, however, the Senate … Continue reading

Senate Republican leadership plans vote to begin debate on health care reform legislation; House Budget Committee approves budget resolution; 340B program hearing held

Without enough votes to begin debate on the July 13th version of the “Better Care Reconciliation Act of 2017” on Monday, July 17, Republican leaders in the Senate called for the repeal of the Affordable Care Act (ACA) without an immediate plan to replace the ACA. According to a report issued by the Congressional Budget … Continue reading

Senate delays vote on health care bill; CMS issues OPPS and physician fee schedule proposed rules; House subcommittee to hold hearing on 340B drug pricing program

As reported last week , on Thursday U.S. Senate Republican leadership released their latest version of the “Better Care Reconciliation Act of 2017.” The Congressional Budget Office score of the revised bill was expected today, with Senator Majority Leader Mitch McConnell intending for the full Senate to debate and vote on the legislation this week. However, last … Continue reading

US Senate Republican leadership releases latest version of health care reform legislation

On Thursday, Senate Republican leadership released their latest version of health care reform legislation entitled the “Better Care Reconciliation Act of 2017.” The revised bill includes Senator Cruz’s proposal (in brackets) to allow insurers under certain conditions to offer health plans that do not comply with the Affordable Care Act (ACA), provided they also offer … Continue reading

Senate Majority Leader Mitch McConnell continues work on Senate health care reform legislation; CMS delays changes to home health agency conditions of participation.

The U.S. Congress was not in session last week, but Senate Majority Leader Mitch McConnell (R-Kentucky) continued to work on the Senate Republican health care reform legislation.  Senator McConnell proposed:  (i) adding $45 billion to the bill to combat the opioid epidemic, up from $2 billion in the original legislation; and (ii) expanding Health Savings … Continue reading

Senate Republicans unveil health care reform bill; CMS proposes updates to the Quality Payment Program

On June 22, U.S. Senate Majority Leader Mitch McConnell unveiled the draft Senate health care reform bill, the Better Care Reconciliation Act of 2017. Earlier today, Senate Republican leadership released a new discussion draft. As of this afternoon, Republican leadership reportedly has firm commitments from less than the 50 Senators needed to approve the legislation … Continue reading

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
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