NAHU Washington Update - 07/16/2010 (Plain Text Version)

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Preventive Care Regulation Released

On Wednesday, the Departments of Health and Human Services, Labor and Treasury released an interim final regulation outlining the details of the preventive care coverage requirement for health plans established by the Patient Protection and Affordable Care Act (PPACA).

PPACA requires that all plans provide first-dollar coverage of specific preventive care services recommended by the United States Preventive Services Task Force beginning on the first day of the first plan year following September 23, 2010. The requirements apply to all individual and group health plans, including self-funded plans, but grandfathered plans are exempt as long as they retain their grandfathered status. The complete list of preventive care services that are required to be covered can be found here.

The new rules not only outline what screenings and preventive care services must be covered without being subject to cost-sharing, but they also establish how cost-sharing will work under a number of more complicated coverage scenarios. For example, when the preventive care is administered during an office visit, and that office visit would normally be subject to a deductible or co-payment, generally the preventive care will need to be billed separately for other cost-sharing to apply. Also, if a preventive care screening or service results in the patient needing additional care or medication, cost-sharing can apply to the patient’s treatment.

If the plan has a network, out-of-network cost-sharing rules will apply to any recommended preventive services a beneficiary receives from an out-of-network provider. And, if the federal recommendation or guideline for a preventive service does not specify the frequency, method, treatment or setting for the provision of that service, the plan or issuer can use reasonable medical management techniques to determine any coverage limitations. If a plan covers any preventive care services above and beyond the new federal requirements, then the plan can impose cost-sharing requirements on those services. 

Finally, the rules make it clear that if a federal preventive care service recommendation changes, the health plan is no longer required to provide first-dollar coverage of that particular service. Additional guidelines are being developed regarding preventive benefits and the utilization of value-based insurance designs by group health plans. 

“Meaningful Use” Rules Will Dictate How Providers Implement Health IT Requirements

On Monday, the Centers for Medicare and Medicaid Services released its final regulation establishing what criteria hospitals and medical providers need to meet to be considered “meaningful users” of electronic medical records and health care quality reporting guidelines, thereby qualifying for federal incentives to reimburse them for the cost of implementing the health information technology.  

The new rules became final after a 90-day comment period, during which more than 2,000 formal comment letters were considered by CMS. The new rules are widely considered to be much more flexible for providers than the original version, however, one aspect of the health IT requirements where there is no flexibility is the implementation deadline. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 requires providers to implement electronic medical records by 2015 or face monetary penalties in the form of Medicare reimbursement funds. The House Ways and Means Committee’s Health Subcommittee has scheduled a hearing next week on the implementation of the new regulation.   [return to top]

Despite Recess Appointment, Berwick Could Still Face Congressional Hearings and Scrutiny

Dr. Donald Berwick was sworn in this week as the new CMS administrator, finalizing his recess appointment by President Obama. Although the politically controversial Berwick escaped the Senate confirmation process, that does not mean he will necessarily be able to avoid a congressional grilling about his qualification for the post and political views. 

Republican members of both the House Ways and Means Committee and the Senate Finance Committee (the two committees with jurisdiction over CMS) have asked their respective chairmen to call Berwick to Capitol Hill to testify. While it is unclear whether or not Ways and Means Committee Chairman Sander Levin (D-MI) will respond to the minority’s request and agree to a hearing, the GOP letter to Senate Finance Committee Chairman Max Baucus (D-MT) puts him in a tight spot. It was only last week that Baucus released a statement saying that he was troubled by President Obama bypassing his committee’s oversight through the recess appointment, so to ignore a call for hearings would be incongruous. Baucus stated Thursday that he would call Berwick before his committee at “an appropriate time” to discuss health reform.

Public calls for a Berwick hearing and other hearings on PPACA provisions and implementation are all part of the GOP’s strategy to keep public discontent over health care reform in the news through the November congressional elections. And while there may not be too many hearings held by Democratic committee chairmen this summer, if the makeup of either the House or Senate (or both) changes in November, you can count on Berwick and other administration officials with health care reform oversight responsibility being up on Capitol Hill much more often! [return to top]

NAHU Sends Support Letter to the Hill

NAHU sent Senate Finance Committee Chairman Max Baucus and Senate Small Business Committee Chairwoman Mary Landrieu (D-LA) a letter this week in support of the provision in their Small Business Jobs Act that would allow self-employed individuals a one-year tax break on their health insurance coverage costs. A letter on the same issue was also sent to the Senate on behalf of our entire Coalition for Affordable Health Care, and many individual coalition partners have sent their own letters to Baucus and Landrieu as well.

This legislation may be considered soon and the provision we support is based on a recommendation NAHU has made to Congress for many, many years: allow self-employed individuals who are sole proprietors or who have Sub-S corporations tax equity regarding the deductibility of health insurance premiums with businesses organized as “C” corporations by establishing that their health insurance premium costs are a fully deductible business expense.

Under current law, business owners are not permitted to deduct the cost of health insurance for themselves and their family members for purposes of calculating self-employment tax. The Baucus/Landrieu legislation would allow business owners to deduct the cost of health insurance incurred in 2010 for themselves and their family members in the calculation of their 2010 self-employment tax.

More information on the bill can be accessed here and here. [return to top]

Financial Services Bills Clears Senate and Heads to President Obama for Signature

The Senate voted 60-39 to pass comprehensive financial reform legislation yesterday, giving President Obama his second major legislative victory this year. Three Republican senators, Scott Brown (R-MA), Susan Collins (R-ME) and Olympia Snowe (R-ME), voted for the legislation, and Democrat Russ Feingold (D-WI) opposed it, stating the bill would do little to prevent another future national financial system crisis.  

The 2,300+ page measure will create a new national financial services consumer protection agency and establish a new federal regulatory framework that will impact virtually every segment of the financial services industry. Specifically regarding the broker-dealer provisions of the bill, the measure establishes a “best interest” fiduciary standard of customer care that broker-dealers and investment advisors may be held to when they provide clients with advice. It also requires the Securities and Exchange Commission to conduct a study on how current obligations of broker-dealers are applied and enforced relative to investment advisers, and report back to Congress within six months.   [return to top]

Please Consider a GRIP Contribution

We know many of you have been extremely active and generous with your time and resources with legislative issues leading up to the new health reform law, and we want to thank you for your hard work! Please know it has certainly made a difference and has helped in preserving and protecting the role of professional benefit specialists.

The next few months of implementation of PPACA will be among the most intensive and demanding of times for our association's government affairs efforts. In order to help provide the best possible information, strategy and direction in this all-important and complex implementation stage, we are reinstating our Grass Roots Initiative Program. GRIP is a voluntary donation program for our legislative and regulatory expenses at the national level that was created some years ago.

We are now soliciting both individual and chapter contributions to GRIP, and would greatly appreciate any additional help as there is still much to be done on the legislative and regulatory front.

How to donate:

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