DCMedical News: December 14, 2017
DCMedical News
Washington, D.C.
Healthcare, Medical Education
December 14, 2017
Schedule for the Tax Bill
Senate plan to be filed by week’s end, sent to the Pres. then. Senate action early next week, House action mid next week, action needed by Friday the 22nd..
Reports yesterday of House-Senate agreement included more of the Senate bill (Amendments to H.R. 1), such as elimination of the individual mandate, continuation of the deduction for high out-of-pocket medical expenses, no taxing of graduate student tuition stipends, and various bows in the direction of individuals who drove the market to another record of 24,586.
Related tax matters: The Academy of Actuaries checked in to say that, no, Alexander-Murray (restoration of Cost-Sharing Reduction reimbursement payments, C-SRs) would not compensate for loss of the individual mandate. They project deterioration in the riskpool profile, insurer losses and insolvency, an increase in insurer withdrawals from the market, exacerbated by association health plans and short term duration policies. (Whatever happened to the December 12 deadline called for in the Executive Order of October 12, here, by which time the various Secretaries were to “consider” moves to boost AHPs and STDLIs? You might want to take a look at the STDLI rules, published by the about-to-be-previous administration on October 31, 2016, here.)
Spending Follows Taxes
The pell-mell rush to the tax bill is accompanied by the parallel quest to develop a two-year spending cap deal as TSA lines up to rush through travelers leaving Washington on the 22nd. The problem is that there are “a lot of different pieces” (hurricanes, fires and, oh, CHIP and all of those health bills) hitching a ride on “must-pass” vehicles. Holiday memories flood back, an echo of author Grace Paley’s delightfully titled “Enormous Changes at the Last Minute.” For example, the National Health Planning and Resources Development Act (HSAs, SHCCs, SHPDAs), a “national CoN law” cleverly hastened by Mr. Rogers of Florida in December of 1974, not expunged from the books until 1982. Even the Continuing Resolution (CR) strategy is controversial, however, dubbed by Mr. Schumer (and 43 other Dem Senators) the “CRomnibus” with a planned $70B increase for defense, but not a new penny for the rest. Here is the vehicle, HJR 124, including CHIP funding for a year.
MACPAC Meets Today
MACPAC (Medicaid and CHIP advisory body to Congress) meets today, the agenda here. Next meeting: January 25-26.
We’ll Have to Implement It to Find Out What Is In It
On November 1 CMS offered up 1133 pages of the Hospital Outpatient Prospective Payment and Ambulatory Surgical Payment Systems and Quality Reporting Programs, memorialized in the Federal Register on November 13 (42 CFR Parts 414, 416, 419, FR pgs. 52356-52637, here). Apparently something was left out. So yesterday the “Final Rule” was republished, now at 1135 pages, here, to be officially republished in the FR today. Did you notice the printing error? Well, it doesn’t matter, because publication—on which comments can be submitted right up until 5:00 p.m. on 12-31—is a “Final Rule.” But if you are affected by OPPS, ASC payments, OQR or ASCQR (and who isn’t) you’ll find out in CY 2018.
Still, worth reading. For example, pgs. 4-7 of the 1135 pager has an excellent list of names, e-mail addresses and phone numbers.
Who is responsible for those ASCQR (Ambulatory Surgical Center Quality Reporting) Program Measures, anyway? And what about OPPS brachytherapy? Contact info for insiders!
And this: ten pages of acronyms (pgs. 9-18) for entities appearing in this document alone. And this: plain language explanations of why this and why that, responses to comments received after these regulations were proposed (FR July 20, when there were only 664 pages, here).
There is an excellent letter September 11 from HFMA, comments on the proposed rule, here, and another HFMA document, a 65 page summary of the final rule, here, or even a 3 page summary, here. This last is an exercise in concision.
Meanwhile, folks still sign up, as shown in this CMS report yesterday, here, based, however, on results through September 15, two months ago.
Prices, prices: Next week (we publish Monday through Thursday) a summary of price control movement in drugs, health generally. A NEJM study today lays out the rationale for paying no more than Medicare, here.
Oh, and “Health United States Spotlight” is here, more at https://www.cdc.gov/nchs/hus/spotlight/HUSSpotlight_Dec2017_p2_lg.png.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com