Negotiators from the House, Senate and White House reached an agreement to continue funding the Federal government late Friday evening, just ninety minutes before funding was set to expire and force a government shutdown. The final spending agreement will cut $38.5B from current spending levels through September 30th, 2011. Reports indicated that the total amount of cuts had previously been agreed to, but negotiators were squabbling over so-called “policy riders”, efforts to defund Planned Parenthood and several Affordable Care Act provisions favored by the White House, that were included in the House-passed spending bill last month. In the end, the vast majority of these riders were removed from the bill, creating momentum to move forward with the compromise. The House and Senate both passed a week-long continuing resolution late Friday evening to give them enough time to translate the larger agreement into legislative language and pass it through both houses by the end this week. So, those of us heading to DC for the AOPA Policy Forum this week actually will have a government to meet with!
With the 2011 budget squared away, the focus turns to increasing the debt ceiling and proposed plans for the 2012 budget. Representative Paul Ryan (R-WI), Chair of the House Budget Committee, last week introduced his committee’s version of a 2012 budget that seeks to cut more than $6T from the Federal debt over the next decade by making substantial changes to entitlement programs and the tax code. The plan would turn Medicaid into a block grant program in which the Federal government provides states with a fixed amount for Medicaid expenditures each year and allows individual states to disperse the funds. Ryan’s budget plan would also end the current Medicare system for those under 55 and provide funds to aid in purchasing a private insurance plan. These changes are seen as both heroic and extraordinarily controversial; as both would likely result in fewer overall insured Americans but also provide substantial savings over the next several decades.
In spite of the budget uncertainty blanketing the news, there were several key policy developments related to the Affordable Care Act (ACA) this past week. The Senate voted to repeal the 1099 Tax Reporting provision of the ACA, which would have required small businesses to report any purchase of $600 or more to a single vendor to the IRS beginning in 2012. Small business owners and policy makers alike lined up to repeal the policy and, after some legislative back and forth, the final bill will be signed by the President in the near future. Also this week, the FDA released proposed menu labeling rules for chain restaurants of more than 20 locations. Section 4205 of the Affordable Care Act requires restaurants of more than 20 locations to publish calorie counts and nutritional information on menus beginning in 2012. The FDA will accept public comment until June 6th and plans to finalize the rules by the end of the year.
CMS Releases Rules for Accountable Care Organizations
The Centers for Medicare and Medicaid Services (CMS) was also busy this week releasing initial rules on the setup of Accountable Care Organizations that are widely seen as a key component of the Affordable Care Act’s attempt to reform the current health care delivery system nationwide. Under the proposed rules hospitals, physicians, skilled-nursing facilities and other health care providers will receive incentives for combining their services and reducing their overall costs in treating Medicare patients. Initially, these Accountable Care Organizations can receive up to 60% of the savings generated by combining services, sharing data and providing healthier outcomes for Medicare beneficiaries. More
CMS Delays Round 2 of Competitive Bidding, Looks at Off-the-Shelf O&P
CMS also decided to delay Round 2 of the controversial “competitive bidding” program for durable medical equipment to the summer of 2013. Round 1, currently operating in nine metropolitan areas was to be expanded to an additional 91 large cities at the end of 2012. In addition to new geographic areas, Round 2 will also likely expand the list of competitively bid products. Products being identified for possible inclusion in Round 2 include manual wheel chairs, infusion pumps and off-the-shelf orthotics and prosthetics; these three product categories each fall into the top 10 most commonly billed products not already included in the program. More
Iowa House Committee Kills O&P State Licensure for 2011
Last week the Iowa House State Government Committee met to discuss pending legislation for the final time before their self-imposed “funnel deadline”. The “funnel deadline” is an arbitrary date by which individual pieces of legislation must have met certain benchmarks in order to remain eligible for debate moving forward. In this case, SF364′s (O&P State Licensure) benchmarks were passage out of one chamber and at least one committee in another chamber by the end of this week. As I’ve written previously, SF364 passed out of the Senate with a strong bipartisan vote of 37-12 earlier this month and was on track for another bipartisan vote this week in the House State Government Committee, but a final committee vote was blocked yesterday. More
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