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NOTEWORTHY
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Vic Campbell Receives Lifetime Achievement Award from FAH
Vic Campbell, Sr Vice President, HCA, (pictured here with wife, Tawnie, and son Wirth) received the Lifetime Achievement Award from the Federation of American Hospitals (FAH) during the FAH Policy meeting on February 29. Mr. Campbell has participated in the FAH for 38 years and served as Chairman three times.
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HCA Receives 2016 FedPAC Leadership Award
Accepting the 2016 FedPAC Leadership Award is Jon Grayson (L) and Frazer Rolen (C) with HCA Government Relations. Presenting the award is Keith Pitts (R), 2015 FAH Chairman and Vice-Chairman of Tenet Healthcare Corp.
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South Carolina Presidential Primary Results
| Democrats Only |
Clinton 73%; Sanders 26% |
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Super Tuesday Presidential Primary Results
The real quest is for delegates and the first to reach 2,383 in the Democratic Party and 1,237 in the Republican Party will secure the nomination for his/her party. The tally for delegates is as follows:
Democrats: Clinton, 1052; Sanders, 427
Republicans: Trump, 319; Cruz, 226; Rubio, 110; Kasich, 25; Carson, 8; Bush, 4
Super Tuesday state results are as follows:
Democrats: Clinton - 6 states; Sanders, 4 states.
Republicans: Trump, 7 states; Cruz, 3 states; Rubio, 1 state.
Alabama
| Democrats |
Clinton, 77%; Sanders, 19% |
| Republicans |
Trump, 43%; Cruz, 21%; Rubio, 18%; Carson, 10%, Kasich, 4% |
Alaska
| Republicans Only |
Cruz, 36%; Trump, 33%; Rubio, 15%; Carson, 11%; Kasich 4% |
Arkansas
| Democrats |
Clinton, 66%; Sanders, 29% |
| Republicans |
Trump, 32%; Cruz, 30%; Rubio, 25%; Carson, 5%; Kasich, 3% |
Colorado Caucus
| Democrats Only |
Sanders, 59%; Clinton, 40% |
Georgia
| Democrats |
Clinton, 71%; Sanders, 28% |
| Republicans |
Trump, 38%; Rubio, 24%; Cruz, 23%; Carson, 6%; Kasich, 5% |
Massachusetts
| Democrats |
Clinton, 50%; Sanders, 48% |
| Republicans |
Trump, 49%; Kasich, 18.11%; Rubio, 17.94%; Cruz, 9%, Carson, 2% |
Minnesota Caucus
| Democrats |
Sanders, 61%; Clinton 38% |
| Republicans |
Rubio, 36%; Cruz, 28%; Trump, 21%; Carson, 7%; Kasich, 5% |
Oklahoma
| Democrats |
Sanders, 51%; Clinton, 41%; others, 6% |
| Republicans |
Cruz, 34%; Trump, 28%; Rubio, 26%; Carson, 6%; Kasich, 3% |
Tennessee
| Democrats |
Clinton, 66%; Sanders, 32% |
| Republicans |
Trump, 39%; Cruz, 24%; Rubio, 21%; Carson, 7%; Kasich, 5%; |
Texas
| Democrats |
Clinton, 65%; Sanders, 33% |
| Republicans |
Cruz, 43%; Trump, 26%; Rubio, 17%; Kasich, 4%; Carson, 4% |
Vermont
| Democrats |
Sanders, 86%; Clinton, 13% |
| Republicans |
Trump, 32%; Kasich, 30%; Rubio, 19%; Cruz, 9%; Carson, 4% |
Virginia
| Democrats |
Clinton, 64%; Sanders, 35% |
| Republicans |
Trump, 34%; Rubio, 32%; Cruz, 17%; Kasich, 9%; Carson, 5% |
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FEDERAL
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States File Lawsuit Challenging ACA's Health Insurer Fee
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On February 24, six states filed a lawsuit challenging the Affordable Care Act's (ACA's) health insurance provider fee. The lawsuit was filed in the Northern District of Texas by: Indiana; Kansas; Louisiana; Nebraska; Texas; and Wisconsin, in which the states allege that ACA's language did not clarify that states would be required to help pay the fee.
Under the law, insurers are required to pay an annual fee to help fund federal subsidies intended to offset the cost to low-income individuals for purchasing coverage through the ACA's exchanges. States also are on the hook for a portion of the fee via their Medicaid managed care organizations (MCOs), which are responsible for paying the federal government. The federal government reimburses states for part of their share, but, ultimately, states lose about 54 cents for every dollar paid toward the fee.
According to the lawsuit, states under the provision are projected to pay the federal government between $13 billion and $15 billion over the next 10 years. The lawsuit seeks an injunction against the provision requiring states to pay the fee and requests that states be refunded for fees they already have paid.
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CMS Issues Final Rule on Notice of Benefit and Payment Parameters for 2017, Issuer Call Letter
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The Centers for Medicare & Medicaid Services (CMS) has issued a final rule on the notice of benefit and payment parameters standards for health insurance issuers and the Health Insurance Marketplaces in 2017. The final rule sets forth provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for federally-facilitated exchanges. Through the rule, CMS finalized changes to the network adequacy requirements to facilitate continuity of care when a provider leaves a plan's network and confirmed its intentions to develop ratings of each Qualified Health Plan's (QHP) network coverage that will be available to the public through HealthCare.gov. It also directs plans to count the cost sharing charged to enrollees for certain out-of-network services provided at in-network facilities by an ancillary provider towards the enrollee's annual limitation on cost sharing beginning in 2018, which is intended to help limit "surprise coverage" to consumers. The agency also finalizes policy changes to the premium stabilization programs by recalibrating the risk-adjustment formula using more recent data. CMS also expanded current regulations related to patient safety standards for hospitals, but the agency allows flexibility.
The final rule requires QHP issuers that contract with hospitals with more than 50 beds to verify that the hospitals either participate with a federally-listed patient safety organization or implement "an evidence-based initiative to improve health care quality through the collection, management and analysis of patient safety events that reduces all cause preventable harm, prevents hospital readmission, or improves care coordination." Those hospitals choosing to work with a PSO must also demonstrate implementation of a mechanism for comprehensive, person-centered discharge, which CMS believes can be achieved by sharing its CMS Certification Number with QHP issuers. The rule establishes the annual open enrollment period for 2017 as November 1, 2016 to January 31, 2017.
CMS also issued the final 2017 Letter to Issuers in the Federally- facilitated Marketplaces and an FAQ on the moratorium on the health insurance provider fee for 2017. The letter provides issuers seeking to offer QHPs in the marketplaces or the Federally-facilitated Small Business Health Options Programs with operational and technical guidance to help them successfully participate in any such marketplace in 2017. |
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Appropriators Wary of Mandatory Funding for Medical Research
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The bulk of federal spending for medical services is handled through mandatory funding. House appropriators are investigating the concept of introducing mandatory spending for medical research. The administration has proposed a special funding stream for a portion of its push for enhanced cancer research, and a House-passed bill (HR 6) that seeks to spur medical research advances also includes a mandatory funding element.
The Administration's annual budget plan pushed the issue onto appropriators' agenda by including the mandatory spending as a pivotal source for increased fiscal 2017 research funding. The budget plan calls for $30.3 billion in discretionary funding for NIH, plus $1.83 billion in mandatory spending. Mandatory funding for opioid abuse programs, which skips discretionary spending caps, is also part of the White House budget proposal.
Appropriators, at the budget hearing with Health and Human Services (HHS) Secretary Sylvia Mathews Burwell, became concerned at the prospects of what happens when the special funding expires, or does not materialize in separate legislation. The committee would then have to scramble to find discretionary funds to maintain medical research spending. |
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STATE
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Alaska
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Judge Dismisses Legislature's Suit Over Medicaid Expansion
Superior Court Judge Frank Pfiffner dismissed the Legislature's lawsuit to halt Governor Bill Walker's Medicaid expansion on March 1. In his decision and order, Judge Pfiffner concluded that the state acted within the bounds of the law when it expanded Medicaid.
Legal arguments from both sides had focused on what was required under federal law, because state law says that Alaska must comply with federal requirements. Judge Pfiffner sided with Governor Walker, and wrote, "Because the Social Security Act requires expansion, state law makes the expansion group eligible for Medicaid services. Because existing law required the Governor to provide Medicaid to the expansion group, the Governor did not violate the Alaska Constitution by doing so." In his decision, Judge Pfiffner said his role was limited to interpreting what statutes meant, not in creating new programs.
Senate Majority spokeswoman, Michaela Goertzen, said that the Legislature has stated in the past that they would appeal to the Supreme Court; however they are still taking things under advisement.
The Legislative Council, on behalf of the Legislature, sued Governor Walker's administration in mid-August to stop him from unilaterally expanding the health care program. Medicaid expansion took effect August 31, opening the program to childless adults whose income falls beneath 138 percent of the federal poverty level, or an annual salary of about $20,000. |
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California
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Governor Signs New Tax Plan for Managed Care Organizations (MCO)
Governor Jerry Brown (D) signed a legislative package that includes a plan to replace the state's expiring tax on Managed Care Organizations (MCOs). The state Legislature passed the package Monday by a 28-11 vote in the state Senate and a 61-16 vote in the General Assembly. The plan is expected to generate about $1.3 billion annually to help fund the state's Medicaid program.
The package includes:
- $306.5 million in funding for individuals with developmental disabilities;
- $240 million to cover the health care costs of future retirees; and
- $123 million in debt relief funds for skilled-nursing facilities.
Currently, only MCOs participating in the state's Medicaid program, called Medi-Cal, are taxed. California receives about $1.1 billion in federal matching funds for revenue generated through the tax, which helps fund Medi-Cal. The current MCO tax expires in June, and federal officials have said they would not reauthorize the agreement unless California extends the tax to all MCOs in the state.
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Colorado
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Colorado's Hospital Provider Fee Gains Favorable AG's Opinion
Colorado's Republican Attorney General (AG), Cynthia Coffman, released a formal legal opinion on the constitutionality of changing the current Hospital Provider Fee (HPF) into a government-owned enterprise and affirms that an HPF enterprise would legally qualify under Colorado's constitution. Importantly, it also removes the provider fee revenue from the state's Taxpayer Bill of Rights (TABOR) calculation, which will allow the legislature to focus on funding critical issues such as transportation, education, and healthcare.
The AG opinion aligns with the bipartisan legal memo released earlier in February by Jon Anderson and Trey Rogers, legal counsels to former Governors Owens and Ritter respectively. Current Colorado Springs Mayor and former Colorado Attorney General John Suthers also supported the analysis and conclusion of the Anderson-Rogers memo.
The Colorado House is expected to move forward immediately with a bill transforming the fee into an enterprise but opposition is expected in the Republican controlled Senate.
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Oklahoma
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Additional 4% Across-the-Board Government Budget Cut Ordered March 3
The budget crisis affecting the state deepened on March 3, with the announcement that another round of immediate budget cuts would be necessary. There is not enough revenue coming in to cover costs in the current spending plan, forcing four percent (4%) reductions to all agencies, including the Department of Education, the Oklahoma Health Care Authority, and the Regents for Higher Education. These 4 percent (4%) cuts amount to an overall cut of almost $236 million.
This is the second round of budget cuts ordered amid an oil bust that has greatly reduced state tax revenue. In December, three percent (3%) cuts were ordered to make up a projected $157 million shortfall. Since these cuts are to yearly appropriations, but are coming in the closing months of a fiscal year that ends June 30, the reductions constitute a severe drop in funding for state agencies.
With an across-the-board cut, the agencies that receive the most state funding will see the biggest monetary decline. Education will receive an additional cut of $62.4 million. Its earlier cut was $46.8 million. The total reduction for Higher Education is $56.2 million. With both cuts taken into consideration, the total reduction for the Health Care Authority is $63.8 million.
Oklahoma House Passes Bill That Would Reduce Medicaid Benefits - Awaits Senate Action
The Oklahoma Health Care Authority seeks to remove 111,000 people from the rolls of the Medicaid program under a bill approved by the House on March 2. Representatives voted 65-34 to pass the bill, which is aimed at saving the state $130 million annually and help with the budget crisis.
The bill would affect low-income people who receive Medicaid benefits but are considered able-bodied, are not pregnant, and are under 65 years of age. Many in this group are single mothers. Representative Doug Cox, R-Grove, said he introduced the bill as a way to deal with a $1.3 billion budget hole and with the understanding that if these people are not removed from Medicaid, medical services for people in greater need could be endangered. He said the system has grown to the point where it serves more than a million Oklahomans.
"It was designed to help low-income children, low-income pregnant women, the blind and disabled and low-income aged people who need help caring for themselves," he said. "This bill does not affect a single one of those people." Representative Cox said there is only a slim chance that the Centers for Medicare and Medicaid Services (CMS) would approve the change, but that he would argue it is needed in order to protect the overall program in the state. Opponents suggest 80,000 of those who would be affected are women who cannot work full time because they cannot afford child care. |
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Tennessee
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Legislative Update
Balanced Billing Legislation
Legislation has been filed that is supported by the insurance industry, which would require hospitals and out-of-network hospital-based physicians to provide cost estimates to patients for services provided by these out-of-network providers.
With the amendment, SB 1782 by Senator John Stevens (R-Huntingdon) and HB 1861 by Representative Ron Travis (R-Dayton) would require out-of-network hospital-based providers or the in-network facility where these services are provided, to disclose to a consumer, prior to the non-emergency admission of the enrollee to a facility, the anticipated amount to be billed for these out-of-network physician services. The bill's provisions are placed under the Consumer Protection Act with a potential award of triple damages for violations, as well as injunctive relief and civil penalties.
The bill will be in the House Consumer and Human Resources Subcommittee, and the Senate Commerce Committee.
Tele-Health Bill
The Telehealth legislation (SB 2373 by Senator Mike Bell (R-Riceville) and HB 2331 by Representative Cameron Sexton (R-Crossville) is on the Council on Pensions and Insurance calendar.
The legislation would require reimbursement for Telehealth services to be on the same basis that a payer provides for the same service through in-person encounters. Payers would be prohibited from reimbursing based on the geographic area, or any federal, state, or local designation or classification of the geographic area where the patient is located. The bill also eliminates the requirement that a patient be at a hospital or other qualified site for the service to be considered Telehealth services for insurance purposes and broadens the definition of Telehealth to include audio-only conversations, electronic mail messages, and facsimile transmissions.
Payers have voiced opposition to broadening the definition of Telehealth services to include services provided at locations beyond just those provided at hospitals, physician offices, and federally qualified health centers, but have not yet proposed any specific language to address their concerns. They also have questioned the provision prohibiting payers from determining whether reimbursement will occur based on the geographic location of the patient.
Certificate of Need
Representative Cameron Sexton's (R-Crossville) HB 1730 Certificate of Need (CON) modernization legislation remains off notice, awaiting an amendment. Once the amendment is filed, the bill is expected to be put back on notice for consideration by the House Health Committee. |
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Utah
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Medicaid "Ultra-Light" Medicaid Expansion
House Majority Leader Jim Dunnigan's version of ultra-light Medicaid expansion has passed out of committee on a 9-4 vote. It will now move to the House floor for consideration.
Representative Dunnigan's bill would provide Medicaid health coverage to an estimated 16,300 of the poorest Utahns, 12,500 of which are either chronically homeless, recently released from the prison system, or diagnosed with behavioral health needs, and another 3,800 who have children.
The plan would cost $30 million in state dollars and utilize $70 million in federal funds. Utah hospitals have agreed to pay up to $13.6 million of the state's share. |
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