WeeklyFinancingNewsPulseNationalEditionfinal20100716.pdf (PDF | 217.73 kb)
SAMHSA222s Weekly Financing News Pulse: National Edition July 16, 2010 7/16/10 1 SAMHSA222s Weekly Financing News Pulse: National Edition National News Obama Administration Releases New Rules on Preventive Services, Including Behavioral Health Screenings; HHS Mails Second Round of Medicare 223Doughnut Hole224 Rebate Checks CBS News Poll Finds Declining Support for National Health Care Reform House - App roved War Supplemental Bill Includes 223Pay - for- Delay224 Restriction That Would Save $2.4 Billion Over 10 Years Bazelon Center for Mental Health Law Begins Initiative to Reduce Interaction Between Mentally Ill Individuals and Law Enfor cement Update: VA222s New Rules on Disability Compensation for PTSD Take Effect WellCare Reaches Preliminary Settlement Over Fraud Allegations Studies Released AHRQ Finds 12.5 Percent of ER Visits in 2007 due to MH/SUD Issues, Medicare and Medicaid Fund 50 Percent Health Affairs Releases Issue On the Impact of the National Health Care Reform Law Mercer Estimates Dependent Coverage Extension Could Increase Employer - Sponsored Health Plan Costs Up to 2 Percent Commonwealth Fund Brief Examines CER for Prescription Drugs 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 July 16, 2010 7/16/10 2 National News Obama Administration Releases New Rules on Preventive Services, Including Behavioral Health Screenings; HHS Mails Second Round of Medicare 223Doughnut Hole224 Rebate Checks: On July 14, President Obama222s Administration released new rules outlining the preventive services that the national health care reform law requires insurers to cover without out - of - pocket costs. The rules affect insurance plans that renew on or after September 23. U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius estimates that the new rules will affect coverage for 41 million individuals next year. In addition, HHS officials project that the rules will affec t 88 million people by 2013, as more insurance plans lose grandfathered status and must comply with the new requirements. The rules cover four sets of preventive services, including certain screenings strongly recommended by the U.S. Preventive Services Task Force , routine vaccinations, select preventive screenings for children, and women222s health screenings. In addition, some behavioral health screenings are among those covered under the law. The law affects alcohol misuse screening and counseling; depression screening; tobacco use screening and cessation intervention; alcohol and drug use assessments for adolescents; and behavioral assessments for children. Federal officials estimate the law will increase insurance premiums 1.5 percent ( Kaiser Health News, 6/15 ; The New York Times, 7/14 ; AP, 7/15 ). In other health reform news, HHS mailed 300,000 more $250 rebate checks to seniors that reached the Medicare Prescription Drug Program (Part D) 223doughnut hole224 coverage gap. This is the second round of rebate checks, the first of which went to approximately 80,000 seniors in June. HHS sent rebates to seniors that entered the coverage gap between April and June and are ineligible for Medicare low - income subsidies ( Kaiser Health News, 7/9 ; The New York Times, 7/8 ; HHS, 7/8 ). CBS News Poll Finds Declining Support for National Health Care Reform: A CBS News poll found that the percentage of Americans that approve of the national health care reform law has dropped from 43 percent in May to 36 percent in July. In addition, the percentage of Americans that disapprov e of the law has increased from 47 percent to 49 percent over the same period. Support for the law is still higher than after its passage in March, when 32 percent of Americans approved of the law. CBS also found that 48 percent of Americans expect the l aw to not personally affect them, while 33 percent believe it will 223hurt224 them and 13 percent believe it will 223help224 them ( CBS News, 7/13 ; Kaiser Health News, 7/14 ). House -Approved War Supplemental Bill Includes 223Pay -for-Delay224 Restriction That Would Save $2.4 Billion Over 10 Years: The supplemental war spending bill ( H.R. 4899) approved by the U.S. House on July 1 includes a provision strengthening the Federal Trade Commission222s (FTC) power to restrict the practice known as 223pay - for - delay.224 Under 223pay for delay224 , drug makers pay competitors to delay the introduction of generic versions of their drugs. The Congressional Budget Office (CBO) estimates that the restriction would save the federal government $2.4 billion over 10 years through lower drug costs for Medicare, Medicaid, the military, and veterans. Additionally, the bill would require drug makers that participate in Medicaid to provide higher prescription drug rebates, which lawmakers estimate would save the federal government an additional $2.1 billion over 10 years. The bill now goes before the U.S. Senate ( The Hill, 7/12 ; Kaiser Health News, 7/13 ). B azelon Center for Mental Health Law Begins Initiative to Reduce Interaction Between Mentally Ill Individuals and Law Enforcement: The Bazelon Center for Mental Health Law is providing grants for a five - county initiative to reduce the reliance on local law enforcement in psychiatric emergencies and further empower community mental health systems. The initiative will examine interactions between mentally ill individuals and law enforcement, seeking patterns and trends SAMHSA222s Weekly Financing News Pulse: National Edition July 16, 2010 7/16/10 3 that may be averted through policy changes and better community - based care. The goal of the program is to improve care while reducing both treatment and law enforcement costs. Bazelon will also use the data to determine whether to advocate for national policy, such as changes to Medicaid covered services. The five participating counties are Wayne County, Michigan; Westchester County, New York; Multnomah County, Oregon; Allegheny County, Pennsylvania; and Trav is County, Texas ( Bazelon, 7/6 ; The Oregonian, 7/ 8 ). U pdate: VA222s New Rules on Disability Compensation for PTSD Take Effect: The U.S. Department of Veterans Affairs222 (VA) new rules designed to increase access to disability compensation for veterans with post - traumatic stress disorder (PTSD) took effect on July 13. The rules eliminate the current requirement that veterans document specific events that caused their PTSD. Instead, th e VA will grant disability compensation to veterans proving that they served in a war zone working a job consistent with the events that they say triggered their condition. Veterans who did not experience traumatic events but had good reason to fear them are also eligible for disability compensation. Congressional analysts estimate the rules will cost $5 billion ( The New York Times, 7/12 ; Kaiser Health News, 7/13 ). WellCare Reaches Preliminary Settlement Over Fraud Allegations: WellCare Health Plans , Inc. reached a preliminary settlement for alleged failure to repay overpayments made by Florida and New York222s Medicaid programs. In total, WellCare is accused of defrauding several states of $400 to $600 million and using rescission to eliminate unprofitable beneficiaries. Under the preliminary settlement outlined in a June 24 Securities a nd Exchange Commission (SEC) filing, WellCare will avoid prosecution by paying $137.5 million over 36 months to the U.S. Department of Justice (DOJ) and the U.S. Attorney222s Offices for Connecticut and Florida222s Middle District. In addition, WellCare must pay $23 million to the Florida Agency for Health Care Administration, Florida222s Medicaid program, for overcharging the agency from August to October 2005. The settlement still requires judicial approval ( American Medical News, 7/12 ; AP via Business Week, 6/25 ). Studies Released AHRQ Finds 12.5 Percent of ER Visits in 2007 D ue to MH/SUD Issues, Medicare and Medicaid Fund 50 Percent : The U.S. Agency for Healthcare Research and Quality (AHRQ) released a study finding that 12 million of 95 million emergency room (ER) visits in 2007, or 12.5 pe rcent, were for MH/SUD related issues. Of those 12 million visits, 66 percent were for mental health issues, 25 percent were for substance abuse issues, and 9 percent were for co - occurring conditions. AHRQ also found that, of the ER visits related to MH/SUD issues, Medicare paid for 30 percent, private insurance paid 26 percent, Medicaid paid 20 percent, and 21 percent of the individuals were uninsured ( AHRQ, 7/8 ; Los Angeles Times, 7/9 ). Health Affairs Releases Issue On the Impact of the National Health Care Reform Law: The Ju ly issue of Health Affairs features the theme, 223Weighing the Impact of Health Reform224. The issue projects the impact of various provisions of the law and explores potential methods to maximize quality and efficiency through implementation. Articles in the issue examine possible methods to improve health care payment and delivery, maximize the impact of health information technology (HIT) on patient outcomes, and reduce drug costs under Medicaid. The issue also highlights the law222s impact on children222s health coverage ( Kaiser Health News, 7/9 ). SAMHSA222s Weekly Financing News Pulse: National Edition July 16, 2010 7/16/10 4 Mercer Estimates Dependent Coverage Extension Could Increase Employer -Spo nsored Health Plan Costs Up to 2 Percent: A new study by Mercer estimates that the national health care reform law222s extension of dependent coverage will increase the cost of employer - sponsored health plans by 0.25 to 2 percent. The law requires insurance plans to offer coverage for dependent children up to age 26. Mercer recommends that employers conduct dependent eligibility audits before the measure takes effect on September 23 to ensure that they do not inflate their plan costs by offering coverage to ineligible dependents ( Chicago Tribune, 7/14 ). C ommonwealth Fund Brief Examines CER for Prescription Drugs: A brief released by the Commonwealth Fund examines the role of comparative effectiveness research (CER) in prescription drug coverage. The brief outlines the use of CER in six European countries and derives U.S. policy im plications from those findings. The author finds that CER identifies drugs that offer the most value for their cost and notes that the U.S. lacks robust and publicly available comparative effectiveness information on prescription drugs. The brief recomme nds that the U.S. invest in CER to lower costs and improve quality ( Commonwealth Fund, 7/2 ). Around th e Hill: Hearings on Health Financing Senate Veterans222 Affairs Committee : Veterans222 Claims Processing July 14, 9:30 a.m., 418 Russell House Veterans222 Affairs Subcommittee on Oversight and Investigations : Veterans222 Suicide Prevention Outreach Efforts July 14, 10:00 a.m., 334 Cannon House Veterans222 Affairs Subcommittee on Health: Serving Rural Vets in Virginia July 19, 10:00 a.m., Bedford County Board of Supervisors Meeting Room, County Administration Bldg., 122 East Main St., Bedford, Va. House Veterans222 Affairs Committee : Treatments for TBI and PTSD July 21, 10:00 a.m., 334 Cannon House Veterans222 Affairs Subcommittee on Oversight and Investigations : Gulf War Illness July 27, 10:00 a.m., 334 Cannon
