Health Care on the Hill: Week of October 21, 2013

This week the House is in session but the Senate is in recess.

Also of note, President Obama will be delivering remarks at 11:25 a.m. today on the rollout of, the federal health insurance exchange website.

Thursday, October 24, 2013

9:00 a.m.
“PPACA Implementation Failures: Didn’t Know or Didn’t Disclose?”
House Energy and Commerce Committee Hearing
2123 Rayburn House Office Building

Drinker Biddle Webinar on 2013 Regulatory and Economic Outlook

It’s not too late to RSVP for tomorrow’s “2013 Regulatory and Economic Outlook” webinar featuring Drinker Biddle’s Lobbying and Advocacy Team Senior Government Relations Director Jodie Curtis, Drinker Biddle Counsel Heather B. Abrigo, and Drinker Biddle Director of Growth Strategies Nick Araco.

The webinar, to be held at 10:00 a.m. on Wednesday, October 9, 2013, will touch upon implementation of the Affordable Care Act (ACA, or health reform) and in particular what employers need to be thinking about, the debt ceiling debate, sequestration, and the current legislative and regulatory environments. For more information or to register, see

Health Care on the Hill – Week of October 7, 2013

With the ongoing government shutdown, the Congressional calendar has been up in the air. A number of hearings scheduled for last week were postponed, and we recommend that you reconfirm that the following hearings are still scheduled to happen the day prior.

Tuesday, October 8, 2013

10:00 a.m.
“Transforming Medicare Post-Acute Care: Issues and Options”
Senate Finance Committee Hearing
219 Dirksen Senate Office Building

Wednesday, October 9, 2013

1:00 p.m.
“The Effects of the Health Law’s Definitions of Full-Time Employee on Small Businesses”
House Small Business Subcommittee on Health and Technology Hearing
2360 Rayburn House Office Building

Thursday, October 10, 2013

10:00 a.m.
“Between Peril and Promise: Facing the Dangers of VA’s Skyrocketing Use of Prescription Painkillers to Treat Veterans”
House Veterans’ Affairs Subcommittee on Health Hearing
334 Cannon House Office Building

October 1st – Huge Day for Healthcare

The first day of the federal government shutdown occurred on October 1, 2013, the same day as the start of the open enrollment period for the health insurance exchanges.  This blog post focuses on some of the top issues impacting health care policy on this date.

HHS Operating Status

Like most other federal agencies, the Department of Health and Human Services (HHS) has implemented a contingency plan, which calls for 52% of HHS employees to be placed on furlough.

Medicare Reimbursement

Despite the government shutdown, most Medicare fee-for-service reimbursement will continue as scheduled.

On October 1, 2013, the Medicare Administrative Contractors (MACs) indicated they would “continue to perform all functions related to Medicare fee-for-service claims processing and payment.”  However, according to the HHS contingency plan, health care fraud and abuse efforts will cease during the government shutdown.  In addition, CMS will be curtailing the number of recertification and initial surveys for Medicare and Medicaid providers.

ACA Implementation

Despite the HHS furlough, October 1st marked the first day of open enrollment for the health insurance exchanges.  Initially individuals were reporting that many of the individual state-based health insurance exchange sites were not working properly and the website and toll-free number were experiencing problems or longer than average wait times.  However, as of yesterday afternoon, HHS informed reporters that more than 2.8 million individuals had visited the website since it launched earlier that morning, the call centers received more than 81,000 calls, and there were more than 61,000 live chat requests.  HHS did not announce how many individuals had successfully enrolled in a health insurance plan offered through the exchange on this first day.

Medicare and Medicaid Provider Policies

In addition to the establishment of the new health insurance exchanges, the ACA also mandated certain Medicare and Medicaid cuts to begin on October 1, 2013, including:

  • Medicare readmissions reductions:  Under the Hospital Readmissions Reduction Program (HARP) hospitals are assessed a penalty for patients with certain conditions who return to the hospital within 30 days of discharge.  When the program began on October 1, 2012, hospitals were assessed a maximum penalty of one percent of total revenue.  As of October 1, 2013, the penalty increases to two percent of total revenue.  CMS data suggests that more than 2,200 hospitals will have their Medicare payments reduced under this program.  (More information on the program is available here.)
  • Medicaid Disproportionate Share Hospital (DSH) payments:  The Medicaid program provides additional payments—DSH payments—to hospitals that see a higher than average share of low-income beneficiaries.  The ACA reduced the overall level of Medicaid DSH payments beginning October 1, 2013 when cumulatively states will receive a $500 million cut in DSH payments.

Medicaid Expansion

Under the ACA, states who choose to do so may expand their Medicaid programs to cover uninsured individuals up to 133 percent of the federal poverty level (2013 federal poverty level figures are available here).  More than half the states have chosen to expand their Medicaid programs, as seen in this map.  Expanded Medicaid coverage begins in most states on January 1, 2014.

Drinker Biddle Webinar on 2013 Regulatory and Economic Outlook

Drinker Biddle’s Lobbying and Advocacy Team Senior Government Relations Director Jodie Curtis will be joining Heather B. Abrigo, Counsel, Drinker Biddle, and Nick Araco, Director of Growth Strategies, Drinker Biddle, to present a webinar on “2013 Regulatory and Economic Outlook.” The webinar, to be held at 10:00 a.m. on Wednesday, October 9, 2013, will touch upon implementation of the Affordable Care Act (ACA, or health reform), the debt ceiling debate, sequestration, and the current legislative and regulatory environments. For more information or to register, see

Health Care on the Hill: Week of September 9, 2013

This week Congress returns to Washington, DC following their August recess and are jumping right back into legislative matters. Listed below are a few health-related hearings scheduled for this week.

Each Monday Capitol Health Record will be providing health-related highlights for the coming week.

Tuesday, September 10, 2013

10:15 a.m.
PPACA Pulse Check: Part Two
House Energy and Commerce Subcommittee on Health Hearing
2322 Rayburn House Office Building

Wednesday, September 11, 2013

2:00 p.m.
The Threat to Americans’ Personal Information: A Look into the Security and Reliability of the Health Exchange Data Hub
House Homeland Security Subcommittee on Cybersecurity, Infrastructure Protection, and Security Technologies Hearing
311 Cannon House Office Building

Thursday, September 12, 2013

10:00 a.m.
Dental Crisis in America: The Need to Address Cost
Senate Health, Education, Labor, and Pensions Subcommittee on Primary Health and Aging Hearing
430 Dirksen Senate Office Building

Thursday, September 12, 2013 and Friday, September 13, 2013

In addition to the above Congressional hearings, the Medicare Payment Advisory Commission (MedPAC) will be meeting in Washington, DC on Thursday and Friday to discuss recommendations regarding Medicare payment policies. MedPAC will meet at the Ronald Reagan Building and International Trade Center (1300 Pennsylvania Avenue, NW) from 9:30 a.m. to 5:15 p.m. on Thursday and 9:00 a.m. to 12:00 p.m. on Friday (agenda).


Dewonkify – Health Insurance Exchanges

The Word:  Health Insurance Exchanges

Definition:  Health insurance exchanges (often referred to as “exchanges”) will be marketplaces where individuals and employers can purchase comprehensive health insurance.  Health insurance exchanges will be available in every state beginning January 1, 2014.

Used in a sentence:  “Aetna cut its rates by 5 percent for its small group plans on the D.C. exchange, the D.C. Health Benefit Exchange Authority said on Tuesday.” – Politico Pulse, Jason Millman, July 3, 2013.

Background:  The Affordable Care Act (ACA) created new health insurance exchanges.  Each state must decide whether to operate their own state-based exchange (where the state maintains control over the entire exchange), a federal-state partnership exchange (where the state and federal government work together to operate the exchange), or a federal exchange (where the state relies almost entirely on the federal government to operate the exchange).  Approximately one half of states have decided to operate their own state-based health insurance exchanges.  Here is a list of states and the status of state health insurance exchanges.  Individuals with limited incomes can apply for tax credits to help offset the costs of their premiums and/or cost-sharing requirements.

Health insurance plans that are operating in the health insurance exchanges must cover items and services with at least the following ten essential health benefit categories: prescription drug coverage , preventive care, emergency services and hospitalizations, maternity and newborn care, mental health and substance abuse services, ambulatory patient services, rehabilitation and habilitation services, laboratory services, preventive and wellness services and chronic disease management, and pediatric services (dental and vision).

IRS Delays Penalties Under ACA Employer Mandate Until 2015

Last night the Internal Revenue Service (IRS) announced that the enforcement of penalties under the Affordable Care Act’s (ACA’s) employer mandate will be delayed one year, and will go into effect in 2015 rather than 2014. Drinker Biddle Partner Sarah Bassler Millar and Counsel Dawn E. Sellstrom prepared the following client alert on the IRS’s decision.

Drinker Biddle Client Alert: IRS Announces Penalties Under the Employer Mandate Will Not Apply Until 2015

HHS Finalizes Exchange Rules

On Wednesday, June 26, 2013, the Department of Health and Human Services (HHS) released its long-awaited final rules related to the health insurance exchanges, (also referred to as health insurance marketplaces).  The open enrollment period for the health insurance exchanges begins in less than 100 days.  A copy of the final rule is available here.

Under the Affordable Care Act (ACA), beginning on January 1, 2014, most individuals will have to maintain a minimum level of health insurance coverage or face a penalty.  The ACA provides that individuals who are members of an organized religion and those with limited incomes may be exempt from the individual mandate requirement.  Today’s rule provides additional information on the standards and processes by which the health insurance exchanges will use to determine whether an individual is exempt from the individual mandate requirement.

The final rule also provides additional clarification on the ACA requirements on the standards that will be used to determine whether the health insurance coverage being offered by plans qualifies as minimum essential health coverage, as outlined under the ACA.

Final Workplace Wellness Rule Released

Today the Department of Health and Human Services (HHS) released the final rules implementing the Affordable Care Act (ACA) provisions on workplace wellness.  The ACA created incentives for employers to offer workplace wellness programs and support healthier workplaces.  These new rules apply to group health plans beginning on or after January 1, 2014.

Here is a link to the HHS fact sheet on the issue.  Here is a link to the 123-page final rule.