Washington insiders say lawmakers were still hashing out a solution to the impending 27 percent Medicare physician payment cut just hours before the Senate voted on a year-end tax deal early Jan. 1 that included a one-year physician payment patch.732 words

Now that Medicare provider pay cuts have been delayed for a year, and lower tax rates are permanent for some 99 percent of Americans, physicians are scrambling to ensure lawmakers remain focused on enacting a permanent repeal of the embattled Sustainable Growth Rate formula, but they face new hurdles. The decision by Congress and the White House to tackle fiscal issues in a piecemeal fashion instead of pursuing a "grand bargain," which could have masked the near $250 billion cost of a permanent SGR repeal, may make it more difficult for physicians to push for a permanent SGR replacement, sources say.571 words

Congress extended a long list of Medicare payment provisions in the fiscal cliff deal, including a few that had expired, which comes as a relief to lobbyists who had worried that some of the payment "extenders" would not be included in the fiscal cliff package. The cliff deal buys at least one more year for many health care sectors because if Congress this year permanently fixes the biggest of all extenders -- the Sustainable Growth Rate (SGR) formula that determines doctor pay -- the other extenders are not expected to survive yearly extensions on their own, lobbyists say.1072 words

Bad debt reductions were removed from the table during the year-end fiscal cliff negotiations as hospital advocates argued there was no public policy reason for negotiators to reduce Medicare bad debt payments to glean health care savings, even though the HHS Office of the Inspector General recently pegged the reductions a priority. But the issue could reemerge in upcoming deficit talks and was cited by analysts as a possible health care offset in President Obama's earlier fiscal cliff solution, sources say.483 words

Rep. James Lankford (R-OK) will chair a reconfigured energy, health care and entitlements subcommittee within the House Oversight Committee, the committee announced Wednesday (Jan. 2). Previously, the Oversight health subcommittee did not have "entitlements" in its title, and the change could suggest that the issue will be a high-profile subject in 2013.216 words

The Medicare Rights Center on Wednesday (Dec. 18) urged the president and congressional leaders to embrace Part D rebates, drug price negotiation and expanded competitive bidding for medical equipment instead of proposals that would result in higher costs for beneficiaries. The move comes as House Democrats and other seniors groups also push back against proposals to raise the Medicare eligibility age to 67, which House Republicans failed to get from the president during deficit talks, and as insurers and seniors' advocates object to Medigap reform proposals that would limit or prohibit first-dollar coverage.337 words

CMS says state exchanges can permit Medicaid managed care organizations to offer limited-enrollment plans to certain populations that would serve as a "bridge" between public programs such as Medicaid and CHIP and private health insurance, an option that's similar to the health reform law's Basic Health Program in terms of its goals but that seems more appealing to states, sources tell Inside Health Policy.1000 words

The Medicare Identity Theft Prevention Act, passed by the House prior to the holidays, not only asks CMS to phase out Social Security numbers on Medicare cards for beneficiaries, but also calls on the Government Accountability Office to look into the feasibility of replacing the current cards with "smart" identification cards.581 words

Hospital, pharmacy and medical imaging stakeholders are protesting the payment offsets settled on by senators to cover the around $30 billion cost of avoiding a 27 percent Medicare physician pay cut and extending several expiring CMS payment policies for one year. Legislation passed by the Senate early Tuesday gleans $10.5 billion from hospitals for coding and documentation adjustments and another $4.2 billion by rebasing Medicaid Disproportionate Share Hospital (DSH) payments, in addition to requiring competitive bidding for diabetic supplies, rebasing end-stage renal disease (ESRD) payments, adjusting coding intensity for Medicare Advantage plans, cutting back certain imaging payments and eliminating all unobligated funds from the health law's Consumer Operated and Oriented Plans.844 words

Several well-placed sources tell Inside Health Policy that Senate Finance Chair Max Baucus' office recently convened a small group of hospital and other stakeholders, including health plans, and asked them to generate a letter in support of paying for the $243.7 billion cost of full repeal of SGR with the so-called "war savings," or money saved from the Overseas Contingency Operations fund due to early draw down of troops in Afghanistan. The meeting took place at a time when the White House reportedly was seriously considering including a full repeal of the physician pay formula as part of a larger deal, which did not happen.568 words

Seventeen House Democrats on Friday (Dec. 21) pushed HHS to adopt an open drug formulary as a part of the health reform law's essential health benefit requirements, outlining their concerns in a letter that followed one by 151 patient groups which likewise urged HHS to require broader drug coverage.198 words

The Internal Revenue Service on Friday (Dec. 28) unveiled a key proposed regulation that outlines the administration's stance on several key issues surrounding the health law's employer mandate, including the determination of applicable large employers, rules for determining full-time employees, and rules for determining whether an employer is subject to the health law's penalties.149 words

Several health care lobbyists believe that Pennsylvania Sen. Bob Casey (D) might replace outgoing Sen. John Kerry (D-MA) on the powerful Senate Finance Committee now that Kerry has been nominated as Secretary of State. Casey, who as a member of the Senate health committee has been involved in drug shortage issues as well as advocated for a delay of the health reform law's medical device tax, could replace Kerry at a time when the Senate Finance Committee's role becomes even more crucial because of anticipated discussions for next year on entitlement and tax reform.520 words

Sen. Bob Corker (R-TN) is touting a "dollar-for-dollar" plan that would raise the debt ceiling by nearly $1 trillion while reducing spending the same amount through reforms to Social Security and the federal health programs, including calling for further means-testing, raising the Medicare eligibility age, prohibiting Medigap coverage after 2017 and transforming Medicare Advantage into a uncapped competitively bid program - dubbed Medicare Total Health Plan -- that would operate alongside traditional Medicare. The legislation would grant states the authority to establish a global spending cap under an enhanced Medicaid waiver that also allows shared savings and phases out provider taxes over 10 years, saving an estimated $50 billion.889 words

HHS is facing pressure from 151 patient advocacy groups to further broaden the number of drugs that plans with essential health benefits must cover, with the groups saying in a recent letter that the administration's recent proposal doesn't go far enough for patients with complex medical needs. Instead of allowing drug formularies to vary highly by state due to HHS' essential benefits benchmark plan approach, the groups argue that plans should be required to cover all or close to all drugs in each class.727 words

Maryland Gov. Martin O'Malley (D) urged the president and congressional leaders to maintain the current threshold for Medicaid provider taxes that most states use to help fund their programs but is a tool that has long been eyed for change by both parties as a way to cut federal Medicaid spending. O'Malley said maintaining the provider tax threshold is crucial to ensuring adequate compensation for nursing homes, which along with other health care groups also lobbied lawmakers to avoid cutting the threshold.592 words

The medical device industry is resuming its lobby for Congress to scrap the health reform-created medical device tax, now hoping that a repeal of the law's $30 billion excise tax will be taken up as lawmakers deal with broader tax and budget issues in the coming months. The device industry, having failed to get Congress to address the issue as part of its New Year's fiscal cliff deal, continues to play up the impact of the 2.3 percent device tax on jobs and patient care and touts bipartisan support in both chambers to repeal the fee, which went into effect Jan. 1.501 words

CMS Actuary Rick Foster Retiring1675 words

A bill creating a pediatric research network at the National Institutes of Health sailed through the House on Wednesday (Dec. 19) as part of a three-bill package, but it is unclear how the measure, despite being scaled back and modified to appease Senate lawmakers, will move in the upper chamber, according to a stakeholder backing the bill.395 words