SAMHSA222s Weekly Financing News Pulse: National Edition April 30, 2010 4/30/10 1 SAMHSA222s Weekly Financing News Pulse: National Edition National News IBC Offers Dependent Coverage Ahead of Deadline, FEHB does not; AHIP Announces End of Rescissions; Republicans Call for Hearings with CMS Actuary; State High-Risk Pool Implementation Begins AstraZeneca Settles Illegal Marketing and Kickbacks Case over Antipsychotic Update: Senate Gives Final Approval to Veterans Legislation with Mental Health Components Pentagon Data Shows TRICARE Costs Rising Rapidly Polls Find Concern over Health Care Costs SAMHSA Announces Availability of Project LAUNCH Grants Studies Released KFF Releases Updated Medicare Primer, Report on CHIP Enrollment, Updated Fact Sheet on 223Extenders224 Bill, Brief on Exchanges CBPP Releases Analysis Finding Federal Government Will Cover Majority of Medicaid Expansion WSJ Analysis Finds Abuse of Previous Medicare Reimbursements for Home Health Care Avalere Health Study Finds Most Seniors in Medicare Advantage Plans Not in Quality Plans, Will Affect Funding Under Reform Around the Hill: Hearings on Health Financing To Subscribe to SAMHSA222s Weekly Financing News Pulse, please go to the following link and choose 223Health Care Financing224: https://service.govdelivery.com/service/multi_subscribe.html?code=USSAMHSA&origin=http://www.samhsa.go v/enetwork/success.aspx For questions or comments, please contact Kevin Hennessy ( kevin.hennessy@samhsa.hhs.gov ). SAMHSA222s Weekly Financing News Pulse: National Edition April 30, 2010 4/30/10 2 National News IBC Offers Dependent Coverage Ahead of Deadline , FEHB does not; AHIP Announces End of Rescission s; Republicans Call for Hearings with CMS Actuary ; State High - Risk Pool Implementation Begins: On April 23, Independence Blue Cross (IBC) announced that starting June 1, it would join UnitedHealthcare , Humana, WellPoint , and Kaiser Permanente in offering coverage to dependents up to 26 years old on their parents222 health insurance, prior to the health care reform law222s September 23 deadline. Blue Cross will extend coverage to dependents on both its individual and employer-sponsored plans. Also on April 23, the U.S. Office of Personnel Management (OPM) announced that the Federal Employee Health Benefits (FEHB) Program will not extend dependent coverage until its new plan year begins on January 1 because it may not do so u ntil then , under federal law. Dependents of employees covered under FEHB are covered for an additional 31 days after they turn 22, and they may extend coverage for up to 36 months under their parents222 plan through the Temporary Continuation of Coverage (TCC), which they must pay for out-of -pocket. On April 27, the Internal Revenue Service (IRS) released a notice stating that extra coverage offered through the extension to dependents is tax-free ( Kaiser Health News, 4/27 ; Office of Personnel Management, 4/23 ; PR Newswire, 4/23 ; Los Angeles Times, 4/27 ; Internal Revenue Service, 4/27 ). On April 28, America222s Health Insurance Plan222s (AHIP) President Karen Ignani sent a letter to top U.S. House Democrats informing them that industry executives had agreed to end the practice of resci ssion, except for cases of fraud and intentional misrepresentation, in May, ahead of the September deadline outlined in the health care reform law ( Kaiser Health News, 4/29 ). On April 28, U.S. House Republicans sent a letter to House Energy and Commerce Committee Chairman Henry Waxman (D -CA) demanding an investigation into whether the health care reform law will increase national spending. House Republica ns requested the testimony of Chief Actuary of the Centers for Medicare and Medicaid Services (CMS), Richard Foster, in light of his April 22 report which projected that reform would cost $828 billion and save $577 billion over the next decade, and increas e national spending one percent over that period ( Kaiser Health News, 4/29 ; Kaiser Health News, 4/24 ). In other health care reform news, the U.S. Department of Health and Human Services (HHS) met its obligation under the health care reform law to publicly post a full list of the decision making authority tha t HHS Secretary Kathleen Sebelius has under the health care reform law ( Kaiser Health News, 4/23 ; Healthreform.gov, 4/23 ). Finally, April 30 is the deadline for states to notify HHS of their intentions to establish and operate their own high - risk insurance pools or to let HHS do it for them. ( Kaiser Health News, 4/30 ; The New York Times, 4/29 ). AstraZeneca Settles Illegal Marketing and Kickbacks Case over Antipsychotic: On April 27, Attorney General Eric Holder announced that AstraZeneca agreed to pay a $520 million settlement to end DOJ222s investigation of AstraZeneca222s alleged illegal marketing of its anti psychotic drug, Seroquel. DOJ officials say these actions resulted in millions of dollars in false Medicaid and Medicare claims. DOJ alleges that AstraZeneca marketed the drug to physicians for uses not approved by the U.S. Food and Drug Administration (FDA) and paid physicians kickbacks to encourage them to prescribe the drug for unapproved uses. By law, doctors are allowed to prescribe drugs for purposes other than their FDA approved uses, however drug manufacturers are not allowed to market drugs for unapproved uses. U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius said AstraZeneca encouraged prescriptions of Seroquel for unapproved uses by children, the elderly, veterans, and prisoners. AstraZeneca still faces over 25,0 00 lawsuits on behalf of patients who allege that the company did not properly disclose the drug222s risks. AstraZeneca reported $4.9 billion in Seroquel sales in 2009 ( Kaiser Health News, 4/28 ; New York Times, 4/27 ; The Washington Post, 4/28 ; The Wall Street Journal, 4/27 ). SAMHSA222s Weekly Financing News Pulse: National Edition April 30, 2010 4/30/10 3 Update: Senate Gives Final Approval to Veterans Legislation with Mental Health Components : On April 22, the U.S. Senate gave final approval to the Caregiver and Veterans Omnibus Health Services Act (S. 1963 ). The bill expands access to care for members of the military, including for mental health counseling. The legislation also creates a sup port program for caregivers of disabled veterans from the Afghanistan and Iraq wars, which law makers project will cost $1.7 billion over the next five years. On April 27, the bill was presented to President Barack Obama , and it awaits his signature ( PR Newswire, 4/23 ). P entagon Data Shows TRICARE Costs Rising Rapidly: The U.S. Department of Defense (DOD) announced that spending on health care by TRICARE, the U.S. military health care program, will rise from $19 billion in 2001 to a projected $50.7 billion in 2011, an increase of 167 percent. Total U.S. spending on health care during that pe riod is projected to increase 84 percent. Officials attribute the rapid increase to the mental health and physical problems of veterans serving multiple tours of duty, the mental health burden of war on military families222 children, and the health needs of career military retirees. DOD reported that behavioral health counseling sessions for troops and their family members rose 65 percent since 2004, and that children, often suffering from anxiety or depression caused by a parent222s deployment, had 42 percent more c ounseling sessions last year than in 2005. Active duty members of the military and their families receive free health care except for copayments of $3 or $9 per prescription. R etirees receive the same care for $230 annually for an individual or $460 annually for a family along with copayments for services. Out-of -pocket fees for TRICARE have not risen since 1995. Lawmakers and military officials suggested an increase may be necessary ( USA Today, 4/25 ; Kaiser Health News, 4/23 ). Polls Find Concern over Health Care Costs: On April 28, Thomson Reuters released its Consumer Healthcare Sentiment Index , a metric based on Thomson Reuters222 monthly PULSE Healthcare Survey, w hich found that consumers 222 confidence in affor dability and access to health care has declined from a baseline of 100 in December to 97 in March. The Index examines both consumers222 experiences during the past three months and their expectations for the next three months. In February, the Index reached 98, and a statistically significant number of respondents reported that in the prior three months they had delayed filling a prescription or had failed to fill one, and that they expected to delay or cancel a diagnostic test in the next three months. In March, the Index reached 97, and an increasing number of respondents reported that they lost or reduced their insurance coverage in the prior three months, and that they expected to delay or cancel an elective surgery, diagnostic test, doctors222 visit, or therapy in the next three months. A survey conducted by Harris Interactive for the American Institute of Certified Public Accountants on American222s financial concerns found the second largest concern to be uninsured medical expenses, at 11 percent. The survey found that 86 percent of Americans have some form of health insurance, but 58 percent of those with coverage have experienced premium increases in the past year. The most common explanation for not having health insurance was that it is unaffordable, at 47 percent ( Yahoo! Health, 4/27 ; Thomson Reuters, 4/28 ; Health Leaders Media, 4/29 ; Kaiser Health News, 4/28 ). SAMHSA Announces Availability of Project LAUNCH Grants: On April 28, SAMHSA announced that it is offering six grants of up to $650,000 each as part of i ts project Linking Actions for Unmet Needs in Children222s Health (LAUNCH) grant program which is targeted at children from birth to eight years old. The grants will fund projects that support the integration of early childhood service systems and improved collaboration, policy -making, and planning at the state, territorial, tribal, and community SAMHSA222s Weekly Financing News Pulse: National Edition April 30, 2010 4/30/10 5 reduce beneficiary cost sharing ( Avalere Health, 4/29 ; AP, 4/29 ; The Wall Street Journal, 4/29 ; Kaiser Health News, 4/29 ). Around the Hill: Hearings on Health Financing House Ways and Means Subcommittee on Income Security and Family Support : Social Security Disability Claims Backlogs April 27, 2:00 p.m., 1100 Longworth Senate Health Homeland Security and Governmental Affairs Subcommittee on Contracting Oversight : Medicare and Medicaid Services Contract Management April 28, 2:30 p.m., 342 Dirksen House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies : Fiscal 2011 Appropriations: Labor, HHS, Education April 28, 10:00 a.m., 2359 Rayburn House Veterans222 Affairs Subcommittee on Health : Veterans222 Health Bills April 29, 10:00 a.m., 334 Cannon Senate Veterans222 Affairs Committee : VA Disability Compensation May 5, 9:30 a.m., 418 Russell Senate Veterans222 Affairs Committee : Veterans222 Issues May 19, 9:30 a.m., 418 Russell