Health Reform Weekly Digest

June 14-June 18 | 2010

FEDERAL REGISTER NOTICES

Interim Final Rule on Grandfathered Plans
http://edocket.access.gpo.gov/2010/pdf/2010-14488.pdf
Indoor Tanning Services
http://edocket.access.gpo.gov/2010/pdf/2010-14396.pdf
http://edocket.access.gpo.gov/2010/pdf/2010-14398.pdf
Establishment of the Personal Care Attendants Workforce Advisory Panel
http://edocket.access.gpo.gov/2010/pdf/2010-14447.pdf
Medicare Program; Supplemental Proposed Changes to the Hospital Inpatient Prospective Payment
Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and
Supplemental Proposed Fiscal Year 2011 Rates; Corrections
http://edocket.access.gpo.gov/2010/pdf/2010-14808.pdf
Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal
Year2010 Rates and to the Long-Term Care Hospital Prospective Payment System and Rate Year 2010
Rates: Final Fiscal Year 2010 Wage Indices and Payment Rates Implementing the Affordable Care Act;
Corrections
http://edocket.access.gpo.gov/2010/pdf/2010-14810.pdf

IRS NOTICE:
Tax Benefit to Health Professionals Working in Underserved Areas:
The Internal Revenue Service announced that under the Affordable Care Act health care professionals who
received student loan relief under state programs that reward those who work in underserved communities
may qualify for refunds on their 2009 federal income tax returns as well as an annual tax cut going forward.

COBRA:
On Thursday, the Department of the Treasury issued the Interim Report to the Congress on COBRA Premium
Assistance, as required by ARRA. The report found that as many as two million households received COBRA
premium assistance in 2009 at a cost of $2.1 billion. For state by state data, including number of households
with premium assistance and total dollar amount allocated to each state, see report attached to this email.

BRIEFINGS
TODAY Friday, June 18 at 1pm: HIT Conference Call with HHS on the Certification Final Rule
Monday, June 21: National Health Policy Forum briefing on the Massachusetts Attorney Generals report
1:30pm at the Reserve Officers Association, 1 Constitution Avenue, NE, 5th Floor
Thursday, June 24: MedPAC briefing for Finance Committee LAs on the June Report to Congress.
4pm in SD-211
Friday, June 25: CRS briefing on nursing home transparency and the Elder Justice Act. 3pm in SD-215
Friday, June 25: National Health Policy Forum briefing titled, Focus on Reform: Public Health Provisions.
9am at the Reserve Officers Association, 1 Constitution Avenue, NE, 5th Floor

UPDATED CRS REPORTS

PPACA Requirements for Offering Health Insurance Inside Versus Outside an Exchange (Updated 6/10)
Public Health, Workforce, Quality, and Related Provisions in the Patient Protection and Affordable Care Act
(PPACA) (Updated 6/7)
Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA) ( Updated 5/27)

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Prepared by HELP and Finance Republican Committee Staff
 Community Living Assistance Services and Supports (CLASS) Provisions in the Patient Protection and
Affordable Care Act (PPACA) (Updated 6/4)
Health-Related Revenue Provisions in the Patient Protection and Affordable Care Act (PPACA) (Updated
5/3)
Grandfathered Health Plans Under the Patient Protection and Affordable Care Act (PPACA) (has not as of
yet been updated with new regulations- last time Updated 6/7)

BE ON THE LOOK OUT:

High Risk Pools: Section 1101 of PPACA requires that the Secretary establish the high risk pool
program and start providing health insurance coverage for eligible individuals by June 21, 2010.
The Early Retiree Reinsurance Program: Section 1102 of PPACA requires the Secretary to establish
an early retiree reinsurance program by June 21st. Comments for this provision were due by June 4
and can be viewed at regulations.gov
Medicare Program; Medicare Coverage Gap Discount Program Model Manufacturer Agreement:
Comments are due by June 21st.
Public Health Service Act, Rural Physician Training Grant Program, Definition of Underserved
Rural Community: Becomes effective on June 25th
Web Portal: July 1st the website is supposed to be established.

MISSED DEADLINES:
June 11: Secretary Sebelius failed to respond to a May 27 letter sent by Senators McConnell, Kyl,
Alexander, Thune, Grassley, Enzi, Coburn and Barrasso requesting information regarding the CMS
Medicare brochure.
April 19: HHS failed to respond to an April 5 letter from Senator Grassley regarding phantom
pharmacies.
May 6: CDC failed to respond to an April 22 letter regarding COI Federal Advisory Boards

ADMINISTRATION MATERIALS
$250 Million Investment to Strengthen Primary Health Care Workforce
Press Release, fact sheet,
Grandfathered plans
Press Release, blog post, White House blog post
$25 Million in Patient Safety and Medical Liability Demonstration Projects
Blog post, Press Release, website

RESOURCES
The National Association of Insurance Commissioners (NAIC) website has a special section dedicated
to PPACA where they share reports, articles and implementation updates. Pay special attention to the
column on the right side of the website where they provide documents, updated frequently, to reflect
the latest information on implementation.
The latest issue of Health Affairs titled, Moving Forward on Health Reform (June 2010 Volume 29,
Number 6), is dedicated entirely to health reform. Sections include: Bending the Cost Curve, Coverage
& Insurance Reforms, Medicaid Expansion & State Roles, Delivery & Payment Reforms, Large
Employers, Individual Mandate Controversy, Update on Massachusetts

REPORTS
PricewaterhouseCoopers study on Medical Cost Trends for 2011
(the White House has a blog post on this study)

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Prepared by HELP and Finance Republican Committee Staff
PERTINENT LEGISLATION INTRODUCED:
S. 3491 and H.R. 5527: Registered Nurse Safe Staffing Act of 2010
To amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse
staffing levels at certain Medicare providers. Senator Daniel K. Inouye [D-HI] and Rep Lois Capps [D-CA-
23]
H.R. 5546
To provide for the establishment of a fraud, waste, and abuse detection and mitigation program for the
Medicare program under title XVIII of the Social Security Act. Rep Peter J. Roskam [R-IL-6]
S. 3502
A bill to restore Americans' individual liberty by striking the Federal mandate to purchase
insurance. Senator Hatch [R-UT]
S. 3501
A bill to protect American job creation by striking the job-killing Federal employer mandate.
Senator Hatch [R-UT]

IN THE NEWS
Grandfathering Provisions (OR, If you like what you have you cant keep it):
HHS released the new interim final rules on grandfathering. NFIB released a statement. Kaiser health news
reports, Business groups gave mixed reviews Monday to new Obama administration rules limiting how much
employers and insurers can change their health insurance plans. According to the report, The administration
estimates that half of all employers, including two-thirds of small employers, could lose their
grandfathered status by 2013. Also reporting on the new grandfathering provisions is Politico.

Implementation:
The Inside Health Policy blog speculates that insurers are concerned about the role Secretary Sebelius is
playing in regulatory oversight and that there are, concerns that Sebelius has been using political as opposed
to strictly regulatory tools to oversee insurers.

Drug Rebates:
Secretary Sebelius reached out to Vermont Governor Douglas, to reconsider plans to reduce state benefits to
seniors who are enrolled in the states VPharm supplemental prescription assistance program, in response to
the new Medicare Part D rebate checks. On Monday, Vermont Officials said they would not try to collect $250
federal rebates going to some Medicare beneficiaries for prescription drug costs, according to the AP.

Early Retiree Reinsurance Program :

The 10 page application for the ERRP is available on the HHS website. Employers are now concerned that
the $5 Billion set aside for the early retiree fund looks set to run out more quickly than expected.

MLRs:
The New York Times reports that, State insurance officials say they fear that health insurance companies will
cancel policies and leave the individual insurance market in some states because of a provision of the new
health care law that requires insurers to spend more of each premium dollar for the benefit of consumers.

On Monday, according to Inside Health Reform NAIC, gave preliminary approval to a resolution
recommending that the HHS secretary consult with each state's insurance commissioner to determine if she
should adjust the MLR in that state during a transition period in order to prevent market destabilization.

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Prepared by HELP and Finance Republican Committee Staff
High Risk Pools:
Kaiser Health News reports that, Federal officialshave told states that they must provide more information
by the end of next week on how they intend to run the high-risk health insurance pools According to
guidance according to guidance that Jay Angoff, director of the Office of Consumer Information and Insurance
Oversight, It will start enrollment on July 1 and begin coverage on Aug. 1. However, the pools are to be up
and running by Monday, June 21st. Politico Pulse states that the President, guarantees the American Nursing
Association that in just two weeks, Americans denied coverage because of preexisting conditions will be able
to enroll in a new national insurance pool. It is still unclear how the Administration will cover the residents in
the 20 states that declined to participate in the new program.

Wellness:
CQ examines portions of the health care law that will, allow employers to vary health insurance premiums
based on employees success in meeting health standards.

Dependent Coverage:
The New York Times examines how people are growing up slower and reaching traditional adult milestones
later, citing the new health reforms dependent coverage provisions through the age of 26 as proof positive.

Medicaid:
The recapture provision for Medicaid rebates is causing states concern and State Medicaid directors have
warned the Obama administration that it might violate the new health reform law if it follows through with plans
to capture revenue associated with certain Medicaid rebates independently negotiated by states. More on this
at Inside Health Policy.

Medicare:
Found on Inside Health Policy CMS spent nearly $1 Million in the, Obama administration's latest bid to
counter Republican opposition to health reform [it] consists of a nationwide radio buy to remind seniors of the
$250 checks they will be receiving if they're in the Medicare Part D doughnut hole and to warn beneficiaries
not to give out personal Medicare information.

Medicare Fraud:
HHS and the Office of the Inspector General ramp up penalties for Medicare fraud by, asking Congress for
broad new authority to boot offending corporate executives from the insurance program. See more from The
Hill.

Berwick Nomination:
On Wednsday, the Boston Globe published an article titled, Dangerous to Our Health, outlining objections to
Donald Berwicks nomination as CMS Administrator.
NPR reports on Secretary Sebelius statement, that, Republicans are raising roadblocks to Berwick's
appointment less because of what they think he actually represents and more in an effort to keep the debate
on the new health law alive.

Lawsuit:
A motion to dismiss the Florida AG and NFIB law suit has been filed by the Department of Justice according to
a number of sources including Politico Pulse and Birmingham Business Journal

Repeal:
On Tuesday (6/15) the House voted, 187-230, with 21 Democrats voting to roll back the individual mandate.
Politico, Roll Call and The Hill report on this vote.

Politics of Reform:
NPR looks at how the rising cost of health care could be a challenge for Democrats because now, everything
that happens in health care, whether due to the Patient Protection and Affordable Care Act or not, is their
responsibility. The story also looks at the grandfathering provisions.

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Prepared by HELP and Finance Republican Committee Staff
An AP-GfK poll shows a higher support for health reform than in the past. The AP reports.

Editorials:
Karl Rove in the Wall Street Journal on how, The Bad News About Obama Care Keeps Piling Up
Grace Marie Turner (Galen Institute) on how Market-based reforms are key to health law success

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Prepared by HELP and Finance Republican Committee Staff