Health Care Reform Implementation Update – December 12, 2012


As the year’s end approaches, the Hill is a flurry of activity with representatives from various health groups trying to ensure that whatever solution Congress finds to the fiscal cliff problems does not negatively affect them and those they represent.  More proposed rules were published this week – among them, one on reducing incentives for insurers to avoid enrolling unhealthy people and another on establishing a multistate insurance plan program for exchanges.



The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordination for Health Information Technology (ONC) issued a proposed rule that tweaks the meaningful use criteria health care providers need to meet to qualify for payment under the federal Electronic Health Record (EHR) incentive program.  It adds an alternative meaningful use criterion for the electronic transmission of structured lab results from hospitals to ambulatory care providers who ordered the lab test.  Another change is to the ONC’s 2014 EHR certification criteria – the change calls for an update to the data element catalogue, which is what identifies which data is needed to calculate the clinical quality measures included in the EHR incentive payment program’s meaningful use requirements.

A CMS proposed rule, published on Friday (12/7), details a risk adjustment methodology to reduce incentives for health insurers to avoid enrolling people with pre-existing conditions.

A proposed rule, published on Wednesday (12/5), by the Office of Personnel Management provides guidance on establishing a multistate insurance exchange program.  The proposed rule highlights five main objectives: ensuring a choice of a least two high-quality products to consumers, promoting competition in the health insurance market, offering plans from the same issuer to families or small businesses residing/operating in more than one state, providing effective contractual oversight of the multistate plans, and working cooperatively with states and HHS to ensure a “level-playing field” for qualified health plans and multistate plans.

The Internal Revenue Service released new proposed regulations and a set of frequently asked questions regarding some of the new taxes intended to help pay for the Affordable Care Act.  The regulations address the Net Investment Income Tax, which applies at a rate of 3.8 percent to some net investment income for individuals, estates and trusts that are above certain statutory thresholds.  The IRS also released proposed regulations on the additional Medicare tax, which also applies to individuals and couples that fall above certain thresholds.



Negotiations to avert the fiscal cliff continue on the Hill.  Around Washington, people are expecting to see large cuts in spending on Medicare and Medicaid.  Other items flagged as potential negotiating tools are the Medicaid provider tax and graduate medical education.

The House Small Business Committee will be releasing documents with guidance to small businesses to assist them in complying with the law.  This past week, on Thursday (12/6), the committee released a list of provisions that will go into effect in the next two years.

Rep. Phil Roe (R-Tenn) and Rep. Phil Gingrey (R-Ga.) will serve as co-chairs of the House’s GOP Doctors Caucus for the 113th Congress.  The Caucus’ stated goal is “to play an effective role in protesting the largest overhaul of our nation’s health system in history.”  Rep. Gingrey is currently a co-chair of the caucus, and Rep. Roe will be replacing current co-chair Rep. Murphy.



On Monday (12/3), 11 Republican governors sent a letter to President Obama requesting a meeting to discuss the impact of the Affordable Care Act.  Among the signees of the letter were Florida Gov. Rick Scott, Louisiana Gov. Bobby Jindal, Ohio Gov. John Kasich, Virginia Gov. Bob McDonnell and Arizona Gov. Jan Brewer.

On Thursday (12/6), New Jersey Gov. Chris Christie vetoed state legislation to set up a health care exchange.

In an address to the South Dakota state legislature on Tuesday (12/4), Gov. Dennis Daugaard strongly expressed his opposition to expanding the state’s Medicaid program.

Ohio Gov. John Kasich notified HHS that Ohio would not run a health exchange.  Though high level officials had already suggested this was the route Ohio would take, the state had not yet reported the decision to the federal department.

To view our compilation of recent health care reform implementation news, click here.


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