hcca washington, dc regional conference
TRANSCRIPT
3/13/2015
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HCCA Washington, DC Regional Conference
Kimberly Brandt, Chief Oversight Counsel, U.S. Senate
Committee on Finance
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A View From Capitol HillThe 114th Congress and Health Care Oversight
Priorities
Kimberly Brandt,
Chief Oversight Counsel, U.S. Senate Committee on Finance
Michelle Turano,
Health Policy Advisor, U.S. Senate Committee on Finance
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Today’s Presentation
� The 114th Congress & The Senate Finance Committee
� A View from Capitol Hill
◦ What to expect for 2015
◦ Hot Issues
� SFC Oversight & Managed Care
◦ Medicaid Managed Care
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Disclaimer & Fine Print
The comments expressed by Kim Brandt and Michelle Turano are their own opinions and ideas, and do not reflect the opinions of the
Senate Finance Committee
or Senator Orrin G. Hatch.
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Part One: Congress & the Finance Committee
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114th Congress - Senate
54 Republicans
54 Republicans
46 Democrats
Standing Committees
Agriculture, Nutrition, and ForestryAppropriationsArmed ServicesBanking, Housing, and Urban AffairsBudgetCommerce, Science, and TransportationEnergy and Natural ResourcesEnvironment and Public WorksFinance
Foreign RelationsHealth, Education, Labor, and PensionsHomeland Security and Governmental AffairsJudiciaryRules and AdministrationSmall Business and EntrepreneurshipVeterans' Affairs
Special, Select, and Other
Indian AffairsSelect Committee on EthicsSelect Committee on IntelligenceSpecial Committee on Aging
Joint
Joint Committee on PrintingJoint Committee on Taxation
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Finance Committee Jurisdiction: • Tax matters• Social Security • Medicare & Medicaid• Supplemental security income • Family welfare programs • Social services • Unemployment compensation • Maternal and child health • Revenue sharing • Tariff and trade legislation• Oversees 50% of Federal Budget
History• During the 14th Congress (1815–1817), the
Senate created the Select Committee on Finance to handle some of the proposals set forth in President James Madison’s message to Congress
• On December 10, 1816, the Senate established the Committee on Finance as a standing committee of the Senate
What is it and What does it do?
Committee Leadership
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Ranking Member Ron WydenRanking Member Ron Wyden
Chuck SchumerChuck Schumer
Debbie StabenowDebbie Stabenow
Maria CantwellMaria Cantwell
Bill NelsonBill Nelson
Robert MenendezRobert Menendez
Tom CarperTom Carper
Ben CardinBen Cardin
Sherrod BrownSherrod Brown
Michael BennettMichael Bennett
Bob CaseyBob Casey
Mark WarnerMark Warner
DemocratsDemocrats
Chairman Orrin Hatch
Chuck Grassley
Mike Crapo
Pat Roberts
Mike Enzi
John Cornyn
John Thune
Richard Burr
Johnny Isakson
Rob Portman
Pat Toomey
Republicans
Dan Coats
Dean Heller
Tim Scott
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How a Bill Becomes a Law - Simplified
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Part Two: A View from Capitol Hill
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What to expect…
Medicare Sustainable Growth Rate (SGR)
◦ What is it?
The Medicare Sustainable Growth Rate (SGR) is a method currently used by the Centers for Medicare and Medicaid Services (CMS) in the to control spending by Medicare on physician services
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What to expect…
SGR continued
◦ What’s the big deal?
The methodology affects how much physicians will get paid every year.
The implementation of the “new” methodology has been delayed multiple times since 2010, because it will result in a decrease in physician payment.
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What to expect…
SGR continued
◦ What options does Congress have?
� Patch
� Permanent Fix
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OR
What to expect…
Affordable Care Act
� What will the Republican Congress do with the Affordable Care Act?
� Some legislation has already been introduced.
� Hot issues: 30 hour work week, individual & employer mandate, medical device tax
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2015 State Health Insurance Marketplace Types
What to expect…
ACA Litigation
�King v. Burwell
�Halbig v. Burwell
�Pruitt v. Burwell
�Indiana v. IRS
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What to expect…
ACA Litigation
King v. Burwell – The Supreme Court
� On November 7, 2014, the Supreme Court agreed to hear the King case
� Oral arguments expected to be held in March 2015
� And a decision expected by late June or early July 2015.
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Part Three: Medicaid Managed Care
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Medicaid and Managed Care
� Medicaid is a means-tested entitlement program that in FY2012 financed the delivery of primary and acute medical services as well as long-term services and supports….
� to an estimated 57 million people,
�and cost states and the federal government $431 billion.
� About 70% of Medicaid enrollees are served via managed care delivery systems
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Medicaid Expansion in the ACA
� Expansion of Medicaid, to an additional subset of individuals, is an optional ACA provision for states
� Every adult under 138% federal poverty level (FPL) would be covered by Medicaid; federal government would cover costs until 2016, and then states’ share will reach 10%.
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Current Status of Medicaid Expansion
Types of Medicaid Managed Care Programs
� Managed Care Organizations (MCOs)◦ Comprehensive benefits package
◦ Payment is risk-based with capitation
� Primary Care Case Management (PCCM)◦ Contracts with state
◦ Fee for service plus management fee
� Prepaid Inpatient Health Plan (PIHP)◦ Limited package, but includes hospital and institutional services
◦ Patients may be risk or non-risk
� Prepaid Ambulatory Health Plan (PAHP)◦ Limited package, does not include hospital and institutional services
◦ Patients may be risk or non-risk
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The SFC and Medicaid
Open letter sent to three industry groups, asking about best practices involving managed care with regard to nine areas:
� Rate-setting processes
� Development of provider networks
� Quality of care measurement
� Coordinated care for high-risk patients
� Communication among providers for vulnerable populations
� Data collection and utilization
� Program integrity strategies
� Accountable management culture
� Constructive collaboration
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Of Particular interest…
� Bipartisan, bicameral working group for data
◦ SFC led, Ways & Means, Energy & Commerce
� CMS’ Financial Alignment demonstration
◦ (the duals demo)
� Socioeconomic status and it’s effect.
� Oversight!24
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More about oversight…
� States and CMS have responsibility for overseeing the performance of Medicaid managed care plans
� Outside of Medicaid regulations, no recognized standards for what constitutes “sufficient monitoring”
� Florida example – with increased flexibility comes increased responsibility!
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Publications
� January 2015 Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid
◦ Jointly produced by MEDPAC and MACPAC
◦ http://www.macpac.gov/publications
� December 2014: Mathematica Issue Brief: Measuring up: A Novel Approach to Assessing State Oversight of Medicaid Managed Care
◦ http://www.mathematica-mpr.com/our-publications-and-projects
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