President Obama's allusion during his State of the Union address that he will push to extend Medicaid drug rebates to Part D pleased supporters of the controversial deficit-cutting policy, but sparked immediate strong protests from the pharmaceutical lobby, which criticized the proposal as "radical" price controls that would destroy Part D's success. In a move that would build on the president's call, sources tell Inside Health Policy that Sen. Jay Rockefeller (D-WV) plans to introduce a Part D rebates bill after lawmakers return from Presidents Day recess.910 words

Insurance giant Humana told investors it is rethinking its exchange strategy due to a surprise provision in recent HHS guidance that requires plans aiming to participate in a federally facilitated insurance exchange to also join small group market (SHOP) exchanges if those plans currently offer products in the state, yet Humana still expects to participate in 10 exchange markets. Humana's uneasiness about the SHOP link comes as the insurance lobby urges HHS to scrap the idea and instead reassess the situation in later years.743 words

House Republicans working on a replacement to the Medicare physician pay formula are open to replacing CMS' quality reporting programs, such as PQRS, with registries developed by physician societies, physician lobbyists say, and the administration already is seeking public input on ways to allow doctors to participate in registries developed by their own societies instead of reporting to the Physician Quality Reporting System. A registry provision in the fiscal cliff deal could lay the foundation for a system that lets CMS pay physicians based on their performance and which would be measured against quality-reporting systems that physician groups develop.547 words

Ohio is proposing to enroll childless adults up to 138 percent of the federal poverty level into Medicaid as a part of its health reform expansion plans but sources tell Inside Health Policy that Republican Gov. John Kasich is exploring a premium assistance initiative for beneficiaries between 100 and 138 percent of poverty so that they could enroll in private plans on the exchange. If Ohio gets the go-ahead to move forward with its premium assistance plan, many other states might also be more receptive to expanding Medicaid if they could do the same, a Medicaid source says.1109 words

House Energy and Commerce Chairman Fred Upton (R-MI) told the American Medical Association Wednesday (Feb. 13) he hopes to have a "doc fix" bill on the floor by the end of July or the first week of August, adding that instituting a new Medicare physician payment system is one of Congress' top priorities for 2013.431 words

DALLAS -- CMS insurance oversight chief Gary Cohen shot down rumors that HHS will have to delay implementation of the health insurance exchanges, pledging the markets will be ready to enroll people by the Oct. 1 open enrollment date. That message will be coming out loud and clear from the administration in coming weeks, Cohen said, adding that he intends to stress the point when he testifies before the Senate Finance Committee this week.562 words

The insurance lobby urged White House officials in a private meeting this week to dramatically scale back CMS' plan to collect premium rate setting data, telling the officials that CMS has gone "far beyond the statutory language" by proposing that plans submit data for all rates in the individual and small group markets, instead of only data for rate increases as called for by the ACA. The insurers hope the final version of CMS' rate-review rule, undergoing White House Office of Management and Budget review, will limit the rate-setting data collection to rate increases.617 words

The president Tuesday night repeated his call for Medicare prescription drug rebates, Medicare means testing and a focus on heath care payment and delivery reforms as central tenets of his plan to reduce entitlement spending under a broad deficit reduction deal, while adding he is open to additional reforms from both parties so long as they "don't violate the guarantee of a secure retirement." President Obama's State of the Union address opened with an appeal to complete the goal of $4 trillion in deficit reduction with a bipartisan solution that couples "modest" entitlement programs with revenue-raising measures.1126 words

Key House panels are seeking advice from providers on how a new Medicare physician payment system that bases payment on quality performance would take into account differences among specialties and whether they think some form of risk and reward should be tied to performance on quality care measures, according to documents obtained by Inside Health Policy. The questionnaire, which seeks to fill out the House Ways & Means and Energy & Commerce committees' joint proposal to repeal and replace the Sustainable Growth Rate, was distributed to stakeholders during Friday meetings held by staff from the two committees.484 words

Republicans on two key House health care committees made it clear Thursday (Feb. 7) they plan to work collaboratively on a new Medicare physician payment system after jointly floating a multi-tiered SGR repeal proposal, and Inside Health Policy, which obtained the proposal last week, has learned that Energy and Commerce and Ways and Means staff will meet with several provider stakeholders Friday (Feb. 8) to discuss their straw-man plan.705 words

HHS Secretary Kathleen Sebelius and Medicare Director Jonathan Blum told stakeholders this week that the success of delivery system reforms are responsible for the recent slowdown in the growth of health care spending -- though the spending is often credited to the economy. Sebelius said more efforts to accelerate the transformation of care are needed to prevent blunt budget cuts in the future that could hit providers, beneficiaries or private payors.633 words

CMS denied the Mississippi insurance commissioner's application to run a state exchange and is urging the state to instead pursue a partnership model, stating in a letter Friday (Feb. 8) that conditional approval could not be given because Gov. Phil Bryant (R) has said he will oppose implementation of a state-run exchange. Stakeholders have closely watched the Mississippi case because a CMS decision in favor of the commissioner could have signaled Obama administration support for exchange-friendly state commissioners to run their own exchanges without the backing of their respective governors.495 words

A group of key GOP lawmakers - including Senate Finance ranking member Orrin Hatch (UT) and Finance members Charles Grassley (IA) and Mike Enzi (WY) -- has asked the Health Resources and Services Administration to detail its audits of hospitals covered by the 340B drug discount program as well as the 2012 certification process, including a description of any entities decertified by the agency. The group representing 340B hospitals applauds the congressional interest in HRSA's work, but adds that several other program integrity provisions supported by Congress -- including price transparency, establishment of a meaningful dispute resolution process and drug manufacturer audits -- have never been implemented.859 words

Proposed regulations implementing new health reform provisions on employer wellness programs under which employees can receive rewards for achieving better health outcomes -- health-contingent wellness programs -- are taking heat from employers as well as from top Democrats on key congressional health committees, the latter pushing the administration to limit those wellness programs and related premium variations to ones aimed at reducing tobacco use.851 words

Hospital readmissions changed very little up to 2010, with any progress coming slowly and inconsistently to hospitals whose readmissions rates varied drastically, according to a new report from the Robert Wood Johnson Foundation. While hospitals, facing CMS penalties for high rates, have become actively engaged in efforts to reduce avoidable readmissions, the success of their efforts and the effects on patient outcomes and overall health care costs are unknown, the report says.670 words

CMS confirmed that the health reform law's voluntary Basic Health Program would be operational in 2015 at the earliest because the agency will not finalize rules on the program until next year. In a FAQ document published Wednesday (Feb. 6), CMS says that it expects to issue proposed rules on the program this year and finalize guidance in 2014 so that states could pursue the option in 2015, a year after the 2014 implementation date of the ACA's major market reforms.413 words

HHS Secretary Kathleen Sebelius brushed off GOP senators' call for the department to give stakeholders at least 60 days to comment on health care reform rules, writing to them Tuesday (Feb. 12) that a shorter comment period is sufficient given the more-than-a year of guidance, bulletins and other forms of stakeholder engagement and feedback on ACA-related issues.337 words

Health care experts say the health care sector lacks adequate models to estimate the country's increased workforce needs -- a growing concern accompanying the ACA's Medicaid expansion -- due partly to the likelihood that a cross-section of professions will be involved. There is currently no accurate way of measuring supply or demand for health professionals on a national or cross-professional basis, the experts say, as lawmakers float legislation aimed at the beefing up the primary care workforce and as CMS implements ACA provisions that aim to do the same.842 words

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California's latest duals demo plan does not require participating private plans to pay for certain home and community based services that are now mandatory, spurring concerns among advocates for the disabled that plans lacking experience with dually eligible beneficiaries may not realize that in the long term it may be cheaper to cover those services.434 words