Obama Administration Announces Health Insurance Mandate Delay and Reduction of Percentage of Workers Covered Requirements

The Obama Administration announced changes in the implementation of the Affordable Care Act provisions related to the employer mandate for "medium-sized" businesses.  The provisions were originally drafted to go into effect this year. 

The changes in implementation deadlines do not affect most businesses. Companies with fewer than 50 workers remain exempt from the mandate. 

First, the deadline to meet the coverage requirements under the mandate for medium-sized businesses, companies that employ between 50 and 99 workers, has been delayed until January 1, 2016. The delay is conditional and requires companies to promise that the employer will neither cut an employees' hours nor let go of employees for the purpose of making their business qualify as a "medium-sized" business with 50-99 workers. Officials describe the verification process of this promise as "self-attestation" and the IRS has not provided information on how it will determine the companies' veracity. 

White House advisor Phil Schiliro explained the reasoning behind the change, "For the two-percent of American businesses that have between 50 and 99 employees, the Treasury Department concluded that a phase-in was the most common-sense way to implement the law." 

The employer provisions will go into effect for companies that do fall into categories covered by the employer mandate that do not have 50-99 workers. However, the requirement that the employers offer coverage to 95% of their full-time employees by January 1, 2015 has been reduced by 25%. The employers will now be required to offer coverage to 70% of their full-time employees by January 1, 2015. The Treasury Department's final rules state that the requirement for employers to offer coverage to 95% of their full-time employees has been delayed until 2016. 

Other changes affect seasonal workforces, adjunct faculty and volunteer firefighters and paramedics. Seasonal workers that work less than six months will not be considered full-time employees. The changes include a method for estimating the hours of adjunct faculty that accounts for hours spent working outside the classroom. The Administration's promise that volunteer firefighters and paramedics would not be considered full-time employees was formally implemented in the most recent changes. 

Many commentators are suggesting that the adjustments in implementation deadlines and requirements for businesses will increase pressure on the Obama Administration to extend deadlines for individuals so that they are not subject to the $95 or 1% of income fine for failing to purchase health insurance this year. Other experts counter that extending the deadline for individuals would result in fewer healthy individuals signing up now which could drastically shift the ratio of sick-to-healthy individuals enrolled. If too many individuals with significant health problems enroll without the balance of healthy individuals it could make the price of coverage more expensive. 

Final Health IT Innovators Win Funding for Cancer Treatment Apps

Innovative winners of a U.S. Department of Health and Human Services (HHS) public data and cancer challenge have created health IT applications that use public data and existing technology to help patients and health care professionals prevent, detect, diagnose and treat cancer. The two winners presented their submissions during a special symposium at the Hawaii International Conference on Systems Sciences and were each awarded $20,000 by the Office for the National Coordinator for Health Information Technology (ONC).

The two winning applications include:
- Ask Dory! – submitted by Chintan Patel, Ph.D.; Sharib Khan, M.D., M.A., M.P.H.; and Aamir Hussain of Applied Informatics LLC – helps patients find information about clinical trials for cancer and other diseases, integrating data from www.ClinicalTrials.gov and making use of an entropy-based, decision-tree algorithm. A functional demonstration of the application is available at http://Dory.trialx.com .

- My Cancer Genome – submitted by Mia Levy, Ph.D., M.D., of the Vanderbilt University Medical Center – provides therapeutic options based on the individual patient’s tumor gene mutations, making use of the NCI’s physician data query clinical trial registry data set and information on genes being evaluated in therapeutic clinical trials. The app is in operation at www.MyCancerGenome.org .

Information on the four semifinalist teams can be found at http://go.USA.gov/5DA.

With the support of the National Cancer Institute, part of the National Institutes of Health, ONC launched the “Using Public Data for Cancer Prevention and Control: From Innovation to Impact” challenge during the summer of 2011 in support of ONC’s Investing in Innovation (i2) program. The i2 program utilizes prizes and challenges to facilitate innovation and obtain solutions to intractable health IT problems. Aligned with the Obama administration’s innovation agenda, i2 is the first federal program to operate under the authority of the America COMPETES Reauthorization Act.

“What makes these health IT challenges so powerful is their ability to catalyze the expertise and creativity of innovators both in and out of health care,” said Wil Yu, ONC’s special assistant for innovations. “We seek breakthrough solutions to nuanced issues; some are ready for the marketplace and some are prototypes, but all will have a great potential to benefit Americans. Ask Dory and My Cancer Genome are examples of results that innovation challenges can incentivize and deliver – we’re really excited to see their impact.”

For additional details on the “Using Public Data for Cancer Prevention and Control” challenge, visit www.Health2Challenge.org/using-public-data-for-cancer-prevention-and-control-from-innovation-to-impact-2.

For additional information about ONC or on the Investing in Innovation (i2) program, visit http://HealthIT.HHS.gov.

Source: HHS News Release

Health Care Fraud Crackdown Recovers $2.9b

Vice President Joe Biden, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ) are teaming up to crack down on fraud. HHS and DOJ recovered $2.9 billion in health care fraud in 2011. HHS also announced it was taking more steps to prevent Medicare prescription drug fraud.

Source: HHS News Release

Obama Administration Takes New Steps to Encourage Doctors, Hospitals to Adopt HIT

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius released a report showing that doctors’ adoption of health information technology (IT) doubled in two years. HHS also announced new actions to speed the use of health IT in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.

While protecting confidential personal information, health IT can improve access to care, help coordinate treatments, measure outcomes and reduce costs. The new administrative actions announced today, which were made possible by the HITECH Act, will make it easier for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.

“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius. “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”

In addition to improving the health care system, data indicate that the national transition to health IT is creating jobs. Over 50,000 health IT-related jobs have been created since the enactment of the HITECH Ac. According to the Bureau of Labor Statistics, the number of health IT jobs across the country is expected to increase by 20 percent from 2008 to 2018, much faster than the average for all occupations through 2018.

HHS also announced its intent to make it easier to adopt health IT. Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.

These policy changes are accompanied by greater outreach efforts that will provide more information to doctors and hospitals about best practices and to vendors whose products allow health care providers to meaningfully use EHRs. For example, in communities across the country HHS will target outreach, education and training to Medicare eligible professionals that have registered in the EHR incentive program but have not yet met the requirements for meaningful use. Meaningful use is the necessary foundation for all impending payment changes involving patient-centered medical homes, accountable care organizations, bundled payments, and value-based purchasing.

These efforts will complement existing outreach efforts to doctors and hospitals including the Obama Administration’s work to create a nationwide network of 62 Regional Extension Centers. The extension centers are comprised of local nonprofits that provide guidance and resources to help eligible health care providers participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.

Also released, a new Centers for Disease Control and Prevention (CDC) survey found 52 percent of office-based physicians in the U.S. now intend to take advantage of the incentive payments available for doctors and hospitals through the Medicare and Medicaid EHR Incentive Programs. EHR incentive payments for eligible health care professionals can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program. The CDC data also show the percentage of physicians who have adopted basic electronic health records in their practice has doubled from 17 to 34 percent between 2008 and 2011 (with the percent of primary care doctors using this technology nearly doubling from 20 to 39 percent).

To meet the demand for workers with health IT experience and training, the Obama Administration has launched four workforce development programs that help train the new health IT workforce. The training is provided through 82 community colleges and nine universities nationwide. As of October 2011, community colleges have had 5,717 professionals successfully complete their training in health information technology. Currently there are 10,065 students enrolled in the training programs across the nation. As of November 2011, universities have graduated over 500 post-graduate and masters-level health IT professionals, with over 1700 expected to graduate by July 2013.

While improving the health care system, health IT can help keep information private and secure. Federal laws require key persons and organizations that handle health information to have policies and security safeguards in place to protect health information—whether it is stored on paper or electronically.

For more information on how health IT can lead to safer, better, and more efficient care, and for a fact sheet about today’s announcement, visit http://www.healthit.gov/

For more information about the Medicare and Medicaid EHR Incentive Programs, see http://www.cms.gov/EHRIncentivePrograms

For more information on the 2011 CDC survey data referenced above, seehttp://www.cdc.gov/nchs/surveys.htm

For more information about the HHS Recovery Act health IT programs, see http://www.hhs.gov/recovery/announcements/by_topic.html#hit

Source: HHS News Release

CMS Announces New Demonstrations to Help Curb Improper Medicare, Medicaid Payments

The Office of Management and Budget (OMB) announced that the Administration cut wasteful improper payments by $17.6 billion dollars in 2011 as part of the Obama Administration’s Campaign to Cut Waste, fueled by decreases in payment errors in Medicare, Medicaid, Pell Grants, and Food Stamps. Combined with the avoided improper payments in 2010, agencies have avoided making over $20 billion in improper payments in the two years since President Obama issued an Executive Order initiating an aggressive campaign against the wasteful payment errors.

To help cut improper payments, the Centers for Medicare & Medicaid Services (CMS) has announced it will launch demonstration programs beginning in January 2012 targeting some of the most common factors that lead to improper payments. The demonstration programs will help strengthen Medicare by aiming at eliminating fraud, waste, and abuse.

To see the OMB press release, please visit: http://www.whitehouse.gov/the-press-office/2011/11/15/we-can-t-wait-agencies-cut-nearly-18-billion-improper-payments-announce-

To learn more about CMS efforts to cut improper payments, please visit: https://www.cms.gov/apps/media/press/factsheet.asp?Counter=4176

Source: HHS News Release

CMS Proposes Regulatory Reduction Rules

On October 18, the Centers for Medicare & Medicaid Services (CMS) took steps to reduce unnecessary, obsolete, or burdensome regulations on American hospitals and healthcare providers. These steps would help achieve the key goal of President Obama’s regulatory reform initiative to reduce unnecessary burdens on business and would save nearly $1.1 billion across the health care system in the first year for a total of over $5 billion over 5 years.

CMS proposed two sets of regulatory reforms and finalized a third. All are designed to improve transparency and help providers operate more efficiently by reducing their regulatory burden. One set proposes updates to the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). The second set addresses regulatory requirements for a broader range of health care providers and suppliers who are regulated under Medicare and Medicaid. CMS also finalized a third rule reducing regulatory burden for ambulatory surgical centers (ASCs).

CMS estimates that annual savings to hospitals from the proposed revisions to the Conditions of Participation could exceed $900 million in its first year as hospitals increasingly use this new flexibility. The Medicare Regulatory Reform rule could save up to $200 million in the first year. The final rule for ASCs could generate an extra $50 million in savings per year.

Taken together, these three rules would reduce hospital and other healthcare provider costs by nearly $1.1 billion the first year. These cost savings would come directly from reduced regulatory burdens, and are not accompanied by reimbursement reductions. As such, all of these savings would be available to help providers improve the quality of care they provide to Medicare beneficiaries and all Americans.

Click here to view the news release.

Source: CMS News Release

DOJ Requests Supreme Court Review of Health Care Reform Law

The U.S. Department of Justice (DOJ) requested that the United States Supreme Court review the constitutionality of President Obama's signature health care reform law after a 3 judge panel of the U.S. Court of Appeals for the 11th Circuit struck it down. The timing of the request virtually assures that a decision on the Affordable Care Act will come in the thick of next year's presidential campaign.

In a statement, DOJ stated:

“The Department has consistently and successfully defended this law in several court of appeals, and only the 11th Circuit Court of Appeals has ruled it unconstitutional. We believe the question is appropriate for review by the Supreme Court.

“Throughout history, there have been similar challenges to other landmark legislation such as the Social Security Act, the Civil Rights Act, and the Voting Rights Act, and all of those challenges failed. We believe the challenges to Affordable Care Act — like the one in the 11th Circuit — will also ultimately fail and that the Supreme Court will uphold the law.”

A Washington Post news story about the appeal may be viewed here.

Source: DOJ News Release

Report on Health Care Reform 1st Anniversary Issued

One year after the Affordable Care Act’s Patient’s Bill of Rights took effect, the U.S. Department of Health and Human Services (HHS) released a report summarizing some of the achievements of the health reform law. In the eighteen months since the president signed the Affordable Care Act into law, health reform has had a tangible effect in the lives of millions of Americans. The report discusses how the law is helping to give hardworking families the security they deserve and the reforms in the Affordable Care Act that have helped hold down insurance premiums, hold insurance companies more accountable and strengthen Medicare.

Recent reports, including the U.S. Census and the National Health Information Survey, have indicated that approximately one million additional young Americans now have insurance coverage due to the Affordable Care Act according to experts. The Patient’s Bill of Rights made it illegal for insurance companies to deny coverage to a child with a pre-existing condition or place a lifetime limit on the care they will provide. Through Affordable Care Act initiatives, 19 million seniors with Medicare have received new free preventive benefits, while efforts to cut fraud and abuse have extended the Medicare Trust Fund by 8 years, strengthening the Medicare program.

To read more about the many accomplishments of the law visit: http://www.healthcare.gov/law/resources/reports/patients-bill-of-rights09232011a.pdf


To read a blog commemorating the anniversary by Assistant Secretary for Public Affairs Richard Sorian visit: www.healthcare.gov/blog

Source: HHS News Release

Democrats Signal Discomfort with Obama's Openness to Health Care Cuts

According to a report in the New York Times, Democrats in Washington are concerned about President Obama's willingness to cut up to $300 billion over 10 years from popular programs such as Medicare.

To view the article, please click here.

Source: NYT Article

White House Proclaims National Health Information Technology Week

President Barack Obama has declared the week of September 11-16, 2011, National Health Information Technology Week.

National Health Information Technology Week is a time to highlight the importance of efficient information systems that protect the privacy and security of personal health information while improving the delivery of health care in the United States.

The Office of the National Coordinator for Health Information Technology (ONC) is encouraging everyone to help promote National Health Information Technology Week by posting one of ONC’s new web graphics on your website, in a blog post, or tweet. Visit HealthIT.gov for instructions on how to use the new web graphics.

This White House proclamation underscores the importance of using technology to transform the nation’s health care system and improve the privacy and security of personal health information.

For more information about National Health Information Technology Week, please click here.

Source: White House News Release

HHS Awards $40 million to Boost Public Health Infrastructure, Prepare Tomorrow’s Public Health Workforce

The U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced over $40 million in grant funding, partly supported by the Affordable Care Act, to state, tribal, local and territorial health departments and several schools of public health to enhance the nation’s public health infrastructure and strengthen the public health workforce. Awarded in nearly every state, this funding will improve the delivery of necessary public health services in communities, cities and states across the country.

“These funds will help health departments around the country maximize the impact of the essential services they provide every day, and build the public health workforce to ensure we’re ready to meet the public health challenges of tomorrow,” said Secretary Sebelius. “Strengthening our nation’s public health system is critical to protecting the health of all Americans.”

The grants will fund key state and local public health programs supported through the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA). Most of these grant dollars come from the Prevention and Public Health Fund created by the Affordable Care Act. Additional HRSA dollars supplement this investment.

This is the second year of CDC’s 5-year program known as the National Public Health Improvement Initiative (NPHII) Strengthening Public Health Infrastructure for Improved Health Outcomes grant program. Over 100 people have already been hired through the NPHII and an additional 116 positions are expected to be filled through today’s awards.

The NPHII funding allows health departments to improve the delivery and impact of the public health services they provide by improving how they track the performance of their programs; fostering the identification, dissemination and adoption of public health’s best and most promising practices; building a network of performance improvement managers across the country that share strategies for improving the public health system; and maximizing cohesion across states’ and communities’ public health systems to ensure seamless and coordinated services for residents.

“A strong, efficient, and effective public health system is critical for building a healthy society,” said CDC Director, Thomas R. Frieden, M.D., M.P.H. “Investing in preventive services, system improvement and comprehensive interventions is essential to reducing the burden of health care costs in the future.”

The awards will also support 10 Public Health Training Centers at accredited schools of public health and other public or non-profit institutions, bringing the total number of Public Health Training Centers to 37 across the country. HRSA’s Public Health Training Center (PHTC) Program provides our nation’s public health workforce education and training in areas such as environmental health, public health leadership, nutrition, and cultural competency. This expanded national educational network will provide highly-skilled training to nearly 500,000 public health and related healthcare practitioners.

“In a challenging economy, public health training and education are vital in our efforts to ensure access to affordable, high-quality health care,” said Mary K. Wakefield, Ph.D., R.N., HRSA administrator. “These grants provide learning opportunities that enhance technical, scientific, managerial, and leadership skills of public health workers, and help build a strong, well-rounded public health workforce for the future.”

The announcement is another part of the Obama Administration’s broader effort to improve the health and well-being of our communities through initiatives such as the President’s Childhood Obesity Task Force, the First Lady’s Let’s Move! campaign, the National Quality Strategy, and the National Prevention Strategy.

For a full list of grantees, please visit: http://www.hhs.gov/news/press/2011pres/08/state_workforce_grants.html

For more information on CDC’s National Public Health Improvement Initiative (NPHII), please visit http://www.cdc.gov/ostlts/nphii

For more information on HRSA’s Public Health Training Center (PHTC) Program, please visit: http://bhpr.hrsa.gov/grants/publichealth/index.html

Source: HHS News Release

Obama Administration Releases National Prevention Strategy

Members of the National Prevention, Health Promotion, and Public Health Council, including Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, Surgeon General Regina Benjamin (Chair), as well as Senator Tom Harkin and Domestic Policy Council (DPC) Director Melody Barnes, announced the release of the National Prevention and Health Promotion Strategy, a comprehensive plan designed to help increase the number of Americans who are healthy at every stage of life. The strategy was developed by the National Prevention Council, which is composed of 17 federal agencies who consulted with outside experts and stakeholders.

The National Prevention Strategy includes actions that public and private partners can take to help Americans stay healthy and fit and improve our nation’s prosperity. The strategy outlines four strategic directions that, together, are fundamental to improving the nation’s health. Those four strategic directions are:

The National Prevention Strategy was developed with guidance from the public and is supported by the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health as called for under the Affordable Care Act. Through listening sessions at national and regional meetings, webinars, and town hall meetings across the country, the advisory group and the public had the opportunity to work with the council members to craft the strategy. The National Prevention Council, the advisory group, and private and public partners will work together to help implement the strategy at the national, state, tribal, and local levels and recognize the importance of actively engaging all sectors of society in improving the health and well-being of our communities.

More information on the National Prevention Strategy and the National Prevention Council can be found by clicking here.

Source: HHS Press Release

HHS Requests Input on Retrospective Review of Regulations

The U.S. Department of Health and Human Services (HHS) released its Preliminary Plan for Retrospective Review of Existing Rules. The Plan is a part of President Obama's initiative announced earlier this year for a review of existing significant regulations to eliminate rules that are unnecessary, out of date, redundant, and are in conflict with other rules.

HHS is actively seeking public input to suggest which regulations could be eliminated or streamlined. To review the plan and make comments, please click here.

President's Advisory Council Releases Report on Health IT

The President's Council of Advisors on Science and Technology has released a report titled, "Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward." The report includes an assessment of the current health IT landscape as well as six major conclusions, which are:

• HHS’s vigorous efforts have laid a foundation for progress in the adoption of electronic health records, including through projects launched by ONC, and through the issuance of the 2011 “meaningful use” rules under HITECH.
  
  
• In analyzing the path forward, we conclude that achievement of the President’s goals requires significantly accelerated progress toward the robust exchange of health information.
  
  
• National decisions can and should be made soon to establish a “universal exchange language” that enables health IT data to be shared across institutions; and also to create the infrastructure that allows physicians and patients to assemble a patient’s data across institutional boundaries, subject to strong, persistent, privacy safeguards and consistent with applicable patient privacy preferences. Federal leadership is needed to create this infrastructure.
  
  
• Creating the required capabilities is technically feasible, as demonstrated by technology frameworks with demonstrated success in other sectors of the economy.
  
  
• ONC should move rapidly to ensure the development of these capabilities; and ONC and CMS should focus meaningful use guidelines for 2013 and 2015 on the more comprehensive ability to exchange healthcare information.
  
  
• Finally, as CMS leadership already understands, CMS will require major modernization and restructuring of its IT platforms and staff expertise to be able to engage in sophisticated exchange of health information and to drive major progress in health IT.
  

To read the full report, click here:
http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.pdf