Weekly Washington Healthcare Update: September 22, 2014

This Week: CMS outlines option for hospitals to settle backlogged Medicare claim appeals... Energy and Commerce examines antibiotic resistance measures... Senate Finance explores Children's Health Insurance Program (CHIP) reauthorization.

1. CONGRESS

   House

   Small Business Committee Hearing on SHOP Exchange Implementation

   On Sept. 18, the House Small Business Subcommittee on Health and Technology held a hearing entitled "An Update on the Small Business Health Options Program: Is It Working for Small Businesses?" The purpose of the hearing was to examine the current state of the SHOPs and whether they are working for small businesses. The SHOP program has been the subject of significant delays in implementation, though CMS recently announced that small employers in five states -- Delaware, Illinois, New Jersey, Missouri and Ohio -- will have the opportunity to access the new online SHOP Marketplace on HealthCare.gov, in advance of the full SHOP Marketplace launch nationwide on November 15, under what is being called the "SHOP Early Access" program.

   Witnesses:

   Ms. Mayra Alvarez Director, State Exchange Group Center for Consumer Information and Insurance Oversight, CMS

   Dr. Roger Stark Health Care Policy Analyst Washington Policy Center

   Mr. Adam Beck Assistant Professor of Health Insurance The American College of Financial Services

   Mr. Jon Gabel Senior Fellow NORC

   For more information, or to view the hearing, please visit smallbusiness.house.gov.

   House W&M Subcommittee Chairman Sends Letter to HHS Concerning Backlog of Medicare Appeals

   In a letter dated Sept. 15 to Department of Health and Human Services (HHS) Secretary Sylvia Burwell, House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) inquired about the agency's unilateral action to clear the backlog of Medicare appeals through a "settlement" process and spoke to several other reservations. "Each discharge is unique and the circumstances that apply pertaining to medical necessity in one case do not necessarily transfer to all cases," Chairman Brady wrote, hinting that the Centers for Medicare and Medicaid Services (CMS) had prioritized how easy the process would be to implement over the due process rights of Medicare providers, which could set an "improper precedent." A press release from Rep. Brady's office said, "While the backlog of Medicare appeals is at an unacceptable high, settling all appeals without reviewing the merits of the appeals or coming up with any plan to address the backlog is just throwing money at a problem to make it go away. It hurts the integrity of Medicare and is a waste of taxpayer dollars." Chairman Brady requested that CMS make public its empirical analysis of the process for deriving the 68 percent settlement rate for the benefit of ensuring the solvency of the hospital insurance Trust Fund and to guarantee that hospitals are assured that the rate is indeed reflective of the current reimbursement standards in both CMS's inpatient and outpatient prospective payment systems.

   House OGR Committee Holds Hearing on Healthcare.gov Security Breaches

   The House Oversight and Government Reform Committee hosted several high-ranking Obama Administration officials at its 29th Healthcare.gov hearing on Sept. 18 at 11:00 a.m. in Rayburn House Office Building. The purpose of the hearing, titled "Examining Obamacare's Failures in Security, Accountability, and Transparency," was to examine whether the Administration has complied with the legal procedures for protecting Americans' personal information following the July 2014 healthcare.gov cyber-attack that the Department of Health and Human Services (HHS) said resulted in no serious data breaches. Committee members also requested that the Obama administration provide details on the security of HealthCare.gov after a recent report by the Government Accountability Office (GAO) found systemic security weaknesses in the website. Worth noting, in her opening statement CMS Administrator Marilyn Tavenner made a much anticipated announcment that as of Aug. 15, 7.3 million people had paid their Obamacare first month's premiums and were enrolled in health insurance plans sold through the federal and state health insurance exchanges.

   Witnesses:

   The Honorable Marilyn Tavenner Administrator, Centers for Medicare & Medicaid Services, Department of Health and Human Services

   Mr. Greg Wilshusen Director, Information Security Issues, U.S. Government Accountability Office

   Ms. Ann Barron-DiCamillo Director, U.S. Computer Emergency Readiness Team, U.S. Department of Homeland Security

   More information on the hearing can be found here.

   House E&C Health Subcommittee Holds Hearing on Antibiotic Resistance

   The House Energy and Commerce Subcommittee on Health held a two-panel hearing on Friday, Sept. 19 at 9:00 a.m. in 2123 Rayburn House Office Building. The hearing, entitled "21st Century Cures: Examining Ways to Combat Antibiotic Resistance and Foster New Drug Development," examined ways to combat ongoing drug resistant health threats. The abundant use of antibiotics in humans has caused many bacteria to develop resistance to current antibiotic drugs and the Committee panel looked to witnesses for ideas on how best to spur development of new drugs. As it stands, Reps. Phil Gingrey (R-GA) and Gene Green (D-TX)...