Noteworthy - 12/10/2012

Noteworthy

12/10/2012

 

·     States cannot partially expand their Medicaid programs and get full federal funding says HHS in an FAQ provided by Health and Human Service’s Secretary Kathleen Sebelius in a letter sent to governors.

o   PPACA does not provide for a phased-in or partial expansion and HHS will not consider a partial expansions for populations eligible for the 100 percent matching rate in 2014 through 2016.

o   A state may propose a demonstration that includes a partial expansion and HHS would consider it if it furthers the purposes of the program, subject to the regular federal matching rate.

·     The administration no longer supports a Medicaid blended FMAP, says the HHS FAQ which was released today. 

o   As the Medicaid expansion is now-voluntary, HHS notes, “[t]he Supreme Court decision has made the higher matching rates available in the Affordable Care Act for the new groups covered even more important to incentivize states to expand Medicaid coverage.”

·     Conditional approval has been provided to six State-based Exchange plans submitted by Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington.

·     The U.S. Chamber of Commerce requested an extension of the comment period for the three exchange-related rules released in late November.

o   The Chamber has asked for an extension of the 30-day comment period of three rules, “especially in light of their length and complexity”:

§  Standards Relating to Essential Health Benefits, Actuarial Value, and Accreditation;

§  Health Insurance Market Rules; Rate Review; and

§  HHS Notice of Benefit and Payment Parameters for 2014,

which have comment period deadlines currently of December 26th, December 26th and December 31st respectively.

o   The Chamber notes that CMS signed off on these proposed rules much earlier than their post-election release, “raise[s] specific questions about the abnormal process the administration has been using throughout the implementation of the Patient Protection and Affordable Care Act (PPACA).”

Medicare Part D Competition Continues to Hold Down Premiums

2013 Premiums Are 48 Percent Below CBO’s Initial Estimate

      by Christina Sochacki R.N., J.D.

[PDF]

Washington, D.C., August 8, 2012 – Secretary Sibelius reported Monday that, for the third consecutive year, average basic premiums for Medicare prescription drug plans are projected to remain constant.[1] According to calculations by the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary, the average 2013 monthly premium for basic prescription drug coverage is expected to be $30 - 50 percent less than originally projected in 2004.

CY 2013 Medicare Physician Fee Schedule (PFS)

Proposed Rule Released by CMS        
   by Christina Sochacki R.N., J.D. & The Council for Affordable Health Coverage

[PDF]

Tracking Health Care Reform

Week of July 9th on Capitol Hill      
      by Christina Sochacki R.N., J.D.

[PDF]

ACA On Trial Part V: Severability and to What Extent

Day Three of Supreme Court Arguments
      by Christina Sochacki R.N., J.D.

[As published on CAHC.net, here]

This morning’s arguments centered around the question: If the Court strikes down the mandate, what happens to the rest of the law? With hundreds of pages of text, including sections concerning the Indian Act, black lung disease, wellness programs, and others, which, arguably, have no relation to the individual mandate, the court must decide if one part of the law is invalidated, is it severable and to what extent, from the rest of the law.

ACA On Trial Part IV: The Individual Mandate

Day Two of Supreme Court Arguments
       by Christina Sochacki R.N., J.D.

[As published at CAHC.net, here]

And now, for the main event. For two hours today, oral arguments were heard on the most anticipated question – Is the “minimum coverage” provision of the act a valid regulation of the health insurance market, or an unconstitutional burden on a person’s choice to not buy insurance.

ACO on Trial Part III: Tax or Penalty?

Day One of Supreme Court Arguments
   by Christina Sochacki R.N., J.D.

[As published at CAHC.net, here]

Tax or Penalty? The First Issue before the Supreme Court Today marks the beginning of the Supreme Court’s debate about the fate of the Patient Protection and Affordable Care Act (ACA). This morning, 90 minutes are dedicated to the first issue: standing. This is a question about whether the Supreme Court is even allowed to rule on the arguments regarding the individual mandate, the meat of the challenge before the Court.

ACA on Trial Part II: Possible Outcomes

As published on the CAHC website here.

In Part I of our multi-part piece on the Affordable Care Act (“ACA”) in the Supreme Court, CAHC took a brief look at the issues before the Court. In this Part II, CAHC presents a diagram demonstrating the possible outcomes when the high court hands down its decision at the end of its term in June.

But note, while the ACA sits before the Supreme Court, the justices might not be the only threat to its provisions. The Court is expected to hand down its decision at the end of their term, just months before the 2012 election. While implementation of the law has already begun, the largest part, the individual mandate, does not take effect until after the election, in 2014. Defund and delay tactics through a Republican President or control in the Senate or House could pose a bigger threat to implementation than the Supreme Court. Yet, until a decision is reached, we wait with bated breath.

ACA on Trial - Part I: Lower Court Cases and Rulings

Health Law and Policy presents a summary of the lower court rulings on the ACA leading up to the Supreme Court's grant of certiorari. [as published on the CAHC website here.]

The Affordable Care Act (ACA) on Trial - Part I: An Overview

Part I: Overview of the ACA in the Supreme Court

[As published on the CAHC website here.]

On November 14, 2011, the Supreme Court decided to hear a combined case from 26 states[1] the National Federation of Independent Business[2], and the Federal Government[3] addressing four challenges to the Patient Protection and Affordable Care Act (ACA)[4]. 

There are four questions before the Supreme Court: