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Weekly Healthcare Reform Update
House
prepares for floor vote, Senate awaits CBO score
Late
last week, the House leadership introduced H.R. 3962, the "Affordable
Health Care for America Act." The legislation merges earlier versions
of healthcare reform passed by the three House committees of jurisdiction
before the congressional recess in August. The 1,990 page bill includes
provisions which would expand coverage to 96 percent of non-elderly
residents at a net cost of $894 billion, according to a preliminary
analysis produced by the Congressional Budget Office. The bill would be
financed through a surtax on high-income individuals and policy changes
that produced savings in the Medicare and Medicaid programs. See
specific details regarding overall reforms in the legislation and an
implementation timeline.
The legislation
as introduced contains many provisions of interest to medical groups, such
as the public health insurance option, available within a health insurance
exchange in 2013. MGMA and other physician organizations strongly opposed
the creation of any new plan that included reimbursement linked to
Medicare. This opposition was successful, resulting in the inclusion of new
legislation that the public option's provider reimbursement rates be
negotiated between the Secretary of Health and Human Services and
providers.
The bill
does include substantive administrative simplification reforms long-sought
by MGMA. These important reforms include:
- Utilization
of a machine-readable health plan beneficiary identification card
- Creation of
a unique health plan identifier
- Standardized
HIPAA transaction "companion guides" and "operating
rules"
- Near
real-time adjudication of claims
- Standardized
electronic health claims attachments
In
addition, the legislation requires timely and transparent claim and denial
management processes, including uniform claim edits, uniform reason and
remark denial codes, tracking, adjudication and appeals processing.
Simultaneous with introduction of the merged healthcare reform legislation,
the Democratic leadership introduced H.R.
3961, the "Medicare Physician Payment Reform Act." This
parliamentary tactic reduces the cost of the broader healthcare reform bill
and keeps it in line with the president's recommended target of $900
billion. H.R. 3961 would eliminate the current sustainable growth rate
(SGR) formula and replace it with a new formula that reimburses physicians
for primary and preventive services at the rate of Gross Domestic Product
(GDP) plus 2 percent, and all other services at GDP plus one percent. This
bill is expected to be considered either shortly before or after the
broader healthcare bill on the House floor. House leaders have tentatively
scheduled consideration of H.R. 3962 to begin later this week.
The
Senate continues to wait for CBO scoring of the bill that Democratic leader
Sen. Harry Reid, D-Nev., submitted after merging the two bills produced by
the Senate committees of jurisdiction. The legislation that Sen. Reid
submitted to CBO contained a public option plan with negotiated rates which
allowed states to opt out by 2014. Subsequent to receiving an official
budget score, Senate rules dictate that Sen. Reid obtain 60 votes before
the Senate can even begin discussing their version of healthcare reform
legislation. Most observers do not believe there are 60 votes to support
legislation which includes a public option provision as currently
drafted.
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Nov. 2, 2009
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