WeeklyFinancingNewsPulseNationalEditionfinal20100730.pdf (PDF | 205.94 kb)
SAMHSA222s Weekly Financing News Pulse: National Edition July 30, 2010 7/30/10 1 SAMHSA222s Weekly Financing News Pulse: National Edition National News Sen. Cornyn Introduces Bill to Repeal IPAB; Senators Challenge HHS Secretary222s Premium Increase Claims; Obama Administration Clarifies Regulations on Coverage for Sick Children KFF Tracking Poll Finds Steady Support for Health Reform, Opposition Declines Senate Appropriations Committee Approves $74.6 Billion for HHS, Includes Pay - For - Delay Restrictions Senator Baucus Unveils Adjustments to Small Business Bill Including Program to Combat Medicare Fraud Senator Gillibrand Introduces Bill to Combat Medicare and Medicaid Fraud BP Oil Spill Victim Compensation Fund Administrator Says Funds for Mental Health Compensation Unlikely Studies Released Commonwealth Fund Examines State222s Early Identification and Intervention Models for Children with Mental Illness, Offers Suggestions to Improve Financing GPhA Finds Greater Utilization of Generics May Yield $1 Billion Medicaid Savings Urban Institute Briefs Examine Impact of Health Reform on Physicians and Hospitals KFF Report Examines Lessons From States222 M edicaid Expansions 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 Rasheda Parks ( Rasheda.Parks@samhsa.hhs.go v ). SAMHSA222s Weekly Financing News Pulse: National Edition July 30, 2010 7/30/10 2 National News Sen. Cornyn Introduces Bill to Repeal IPAB; Senators Challenge HHS Secretary222s Premium Increase Claims; Obama Administration Clarifies Regulations on Coverage for Sick Children: On July 27, Senator John Cornyn (R - TX) introduced legislation ( S. 3653) to eliminate the Independent Payment Advisory Board (IPAB). Established under the national health care reform law, the 15 - me mber IPAB is designed to contain Medicare costs by issuing cost - cutting recommendations when per - capita Medicare spending exceeds pre - determined levels. In addition, if Congress elects not to implement the IPAB222s recommendations, the health care reform law requires Congress to implement cost - saving changes equal to those proposed under the IPAB222s plans. As currently constituted, the IPAB is the first mandatory spending limit placed on Medicare ( The Hill, 7/28 ; Kaiser Health News, 7/29 ). In other health care reform news, on July 22, S enators Chuck Grassley (R - IA) and Mike Enzi (R - WY) sent a letter to U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius requesting all actuarial studies conducted on the national health care reform law. The senators are challenging the secretary222s claim that the law will increase insurance premiums by less than 1 percent ( The Hill, 7/22 ; AP, 7/22 ; Kaiser Health News, 7/23 ). Finally, on July 27, HHS issued clarifications on regulations governing the law222s mandate that insurers cover all sick children. Addressing insurers222 co ncerns that parents would not purchase coverage for children until they became ill, HHS clarified that insurers may establish specific enrollment periods for individual and small group plans ( The Hill, 7/29 ; Kaiser Health News, 7/29 ). KFF Tracking Poll Finds Steady Support for Health Reform, Opposition Declin es: The July Kaiser Family Foundation (KFF) Kaiser Health Tracking Poll found that the percentage of Americans that hold a favorable view of the national health care reform law rose from 48 per cent in June to 50 percent in July. In addition, the percentage of Americans holding an unfavorable view of the law decreased from 41 percent to 35 percent over the same period. The poll also found that that 46 percent of seniors have an unfavorable view of the law while 38 percent view it favorably. KFF found that 20 percent of seniors believe they will be 223better off224 under the law, 35 percent believe they will be 223worse off,224 and 37 percent believe they will be largely unaffected. However, the poll f ound that seniors222 understandings of the law222s provisions are mixed. While 50 percent understand that it will gradually close the Medicare Prescription Drug Program (Part D) 223doughnut hole224 coverage gap and 33 percent know that it will eliminate Medicare 222s copayments and deductibles for certain preventive services, 50 percent mistakenly believe that it will eliminate previously universal Medicare benefits ( KFF, 7/29 ). Senate Appropriations Committee Approves $74.6 Billion for HHS, Includes Pay -For-Delay Restrictions: On July 29, the U.S. Senate Appropriations Committee approved the FY2011 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill . The bill includes $74.6 b illion for the U.S. Department of Health and Human Services (HHS), $300 million more than President Barack Obama222s Administration requested. To save $371 million, the bill would eliminate 23 HHS programs, including a $75 million State Health Access grants program. Additionally, the spending bill contains $561 million for health care fraud and abuse control at the Centers for Medica re & Medicaid Services (CMS) and includes a provision to strengthen the Federal Trade Commission222s (FTC) power to restrict the practice known as 223pay - for - delay.224 Under 223pay - for- delay,224 drug makers pay competitors to delay the introduction of generic versions of their drugs. The U.S. House included a similar pay for delay measure in the supplemental war spending bill ( H.R. 4899) but it was removed in the U.S. Senate . The Congressional Budget Office (CBO) estimates that the pay for delay restriction would save the federal government $2.4 billion over 10 years through lower drug costs for Medicare, SAMHSA222s Weekly Financing News Pulse: National Edition July 30, 2010 7/30/10 3 Medicaid, the military, and veterans. The measure would also require drug makers participating in Medicaid to provide higher prescription drug rebates, saving the federal government an additional $2.1 billion over 10 years The bill now goes before the full Senate ( Medical News Today, 7/29 ; Kaiser Health News, 7/28 ; The Wall Street Journal, 7/29 ; Senate Appropriations Committee, 7/29 ; CQ, 7/29 ). Se nator Baucus Unveils Adjustments to Small Business Bill Including Program to Combat Medicare Fraud: On July 27, Senator Max Baucus (D - MT) released alterations to the Small Business Jobs and Credit Act of 2010 ( H.R. 5297 ) that include a program to reduce Medicare fraud. Under the measure, HHS would hire contractors to conduct yearlong predictive modeling analyses to identify and prevent illegitimate claims in Medicare Parts A and B. The program would begin in the 10 states with the most Medicare waste, fraud, and abuse and expand to an additional 10 states if it achieves 223more than nominal savings.224 If savings continue after the expansion to 20 stat es, the program would expand nation - wide the following year. Furthermore, if the national Medicare program continues to realize savings, the program would expand to include Medicaid and the Children222s Health Insurance Program (CHIP). The bill is currently under consideration in the U.S. Senate and has stalled in the face of a GOP filibuster ( The Hill, 7/27 ; The Boston Globe, 7/30 ). Senator Gillibrand Introduces Bill to Combat Medicare and Medicaid Fraud: On July 22, Senator Kirsten Gillibrand (D - NY) introduced legisla tion ( S. 3632) to combat Medicare and Medicaid fraud through increased enforcement and detection measures. The bill would increase the financial penalties for Medicare and Medicaid fraud and allow greater access to Medicare claims data for fraud detection . Additionally, the legislation would establish a five - year pilot program to determine whether Medicare beneficiaries receive the benefits for which Medicare has been billed. Similar legislation ( H.R. 5044) is currently before the U.S. House ( The Hill, 7/27 ). BP Oil Spill Victim Compensation Fund Administrator Says Funds for Mental Health Compensation Unlikely: At the U.S. House Judiciary Committee o n July 21 , BP PLC Oil Spill Victim Compensation Fund Administrator Kenneth Feinberg said that it is 223highly unlikely224 that the fund will provide compensation for mental health conditions unless the conditions are related to physical injuries. The compensation fund has jurisdiction over individual and business claims, while BP will handl e claims by state and local governments directly. In a related development, BP officials have requested that states seeking funds for mental health programming submit uniform applications to expedite the review process. The Substance Abuse and Mental Hea lth Services Administration (SAMHSA) is providing states with template applications and SAMHSA Administrator Pamela Hyde222s office has added an appeal to the package, seeking to increase the likelihood that states receive the funding. State officials in Al abama, Florida, Louisiana, and Mississippi have requested a combined minimum of $27 million from BP PLC for mental health services and outreach related to the spill ( Pro Publica, 7/27 ; Times - Picayune, 7/22 ). Studies Released Commonwealth Fund Examines State222s Early Identification and Intervent ion Models for Children with Mental Illness, Offers Suggestions to Improve Financing: On July 16, the Commonwealth Fund released a report examining efforts to develop systems for early identification and intervention of children with mental i llness. The report examines systems in Colorado, Indiana, Massachusetts, and Rhode Island and identifies common strategies for innovation that may be applicable to other states. Additionally, the report suggests that states develop resources clearly deli neating their early identification and intervention systems222 funding sources to reduce duplication of SAMHSA222s Weekly Financing News Pulse: National Edition July 30, 2010 7/30/10 4 effort and increase cost - sharing and cost - effectiveness ( The Commonwealth Fund, 7/16 ; Kaiser Health News, 7/23 ). GPhA Finds Greater Utilization of Generics May Yield $1 Billion Medicaid Savings : A report released by the Generic Pharmaceutical Associ ation (GPhA) found that a 2 percent increase in the substitution of generic drugs for identical brand name products would yield a $1 billion savings for Medicaid. Because Medicaid222s 64 percent generic drug utilization rate is more than 10 percent lower th an that of the general population, GPhA suggests that there is a significant potential for generic savings within the program. The study also found that, from 2000 to 2009, the use of generic drugs saved the U.S. health care system $824 billion ( The Wall Street Journal, 7/26 ; Kaiser Health News, 7/27 ). Urban Institute Briefs Examine Impact of Health Reform on Physicians and Hospitals: On July 15, the Urban Institute released two briefs exa mining the impact of the national health care reform law on physicians and hospitals. The brief examining the law222s impact on physicians found that the combination of increased coverage and higher fees for primary care services will likely increase physician practice revenue. The authors note that the effects of the law222s efforts to reduce health care costs remain unclear but suggest that they will likely benefit physi cians more than other health care providers. The brief examining the law222s impact on hospitals projects that hospitals will generate $40 billion in new revenue by 2019 because of the larger pool of insured individuals. The authors also suggest that the payment reform policies and pilot programs within the law will reward hospitals that emphasize value of care over volume of patients ( Urban Institute, 7/15 ; Urban Institute, 7/15 ; Kaiser Health News, 7/15 ). KFF Report Examines Lessons From States222 Medicaid Expansions: Drawing for the experiences of seven states and the District of Columba, KFF released a report examini ng lessons for the national health care reform law222s expansion of Medicaid eligibility. The report examines Medicaid eligibility expansions in Arizona, the District of Columbia, Indiana, New York, Pennsylvania, Vermont, Washington, and Wisconsin. KFF sug gests that enrollment practices drawn from these states will be effective but notes that new outreach and communication strategies are necessary to target the newly eligible population ( KFF, 7/28 ). Aroun d the Hill: Hearings on Health Financing House Veterans222 Affairs Subcommittee on Oversight and Investigations : Gulf War Illness July 27, 10:00 a.m., 334 Cannon House Veterans222 Affairs Committee : Inadequate Cost Controls at VA July 28, 10:00 a.m., 334 Cannon Senate Appropriations Labor, Health and Human Services, Education, and Related Agencies : Fiscal 2011 Appropriations: Labor, HHS, And Education July 29, 2:15 p.m., 138 Dirksen Senate Veterans222 Affairs Committee : VA Disability Compensation September 23, 9:30 a.m., 418 Russell
