Health care was a hot topic in Washington DC last week, and not just both sides impatiently awaiting the Supreme Court ruling on the constitutionality of the Affordable Care Act. The Department of Health and Human Services released a proposed rule on reporting requirements for states on the essential health benefits package as part of the Affordable Care Act and the United States House of Representatives Ways and Means Committee voted to repeal the medical device excise tax, sending the bill to the full House later this month. The FDA User Fee bill also passed both the House and Senate in recent weeks and now heads to an official conference committee in hopes of finding concensus.
HHS Releases Proposed Rule on Data Collection on EHBP -U.S. Department of Health and Human Services (HHS) released a proposed rule last week to establish data collection standards for essential health benefits health plans and the process for accrediting entities to certify qualified health plans. The rule proposes that issuers of the three largest small group market products in each state be required to report information on covered benefits. Initially, the National Committee for Quality Assurance (NCQA) and URAC, an independent nonprofit organization, would be recognized as accrediting entities on an interim basis. HHS will accept comments on the proposed rule until July 5, 2012. The ACA lists both the categories of goods and services that must be include in the EHBs, benchmark plans to be sold on state-based health exchanges beginning in 2014, and “required elements for consideration” to ensure balanced and nondiscriminatory benefit packages are sold on the exchanges. Orthotics and prosthetics are believed to be included under the “rehabilitative and habilitative services and devices” category, but the specific interpretations of the broad categories of coverage have not yet been announced by HHS.
Each state is supposed to identify a “benchmark plan,” chosen from one of four categories: the largest plan of one of the three largest small-group “products” in the state; one of the three largest state employee plans; one of the three largest Federal Employee Health Benefit Plans; or the state’s largest non-Medicaid HMO. The benefits offered by the benchmark plan chosen by the state will become the EHBs for that state and all plans offered in the individual and small group market must offer equivalent benefits. It is imperative that orthotics and prosthetics are included in essential health benefit packages in all 50 states. The proposed rule and information on how to submit comments can be found here.
House Ways & Means Committee Repeals Device Excise Tax — Also last week the House Ways and Means Committee voted to repeal the medical device excise tax. Created as part of the Affordable Care Act, the medical device excise tax is a 2.3% tax on medical device manufacturers scheduled to take effect on January 1, 2013 unless legislative action is taken to stop it. The Protect Medical Innovation Act of 2011 (HR 436) was introduced by Representative Erik Paulsen (R-MN) last year and carries a ten-year cost of $29 billion, the bill passed out of committee 23-11 does not include specific pay-for’s, but it is expected that the pay-for’s will be included before the bill is brought before the full House sometime next week. The bill is likely to win approval from the Republican-led House, but it’s fate is uncertain in the Senate, which has taken to defending the Affordable Care Act since Republicans took control of the House following the 2010 midterm elections. National O&P organizations like AOPA and NAAOP have worked with the IRS to help O&P patient facilities potentially be exempt from the excise tax under the “retail” exemption, but a full repeal of the bill is the preferred route for the industry as many providers would see the impact of the tax from their manufacturers. MORE