Health Care

DLA Piper Health Care Regulatory and Policy Update -- Week of March 24, 2014


SGR/Legislative Action

    • On March 11, Senate Finance Committee Chairman Wyden (D-OR) introduced his version of legislation to permanently repeal and replace the sustainable growth rate (SGR), the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 (S. 2110).  CBO scored the bill as costing $180.2 billion over an 11-year period.  CBO score:  On March 25, Chairman Wyden introduced an alternate version of the measure paid for with Overseas Contingency Operations (OCO) funds, which many Republicans have called a non-starter.   
    • On March 14, the House voted 238-181 to pass its SGR repeal-and-replace legislation, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015).  The final bill was offset by delaying the individual mandate for five years.  CBO scored H.R.4015 as saving $31.1 billion over ten years and resulting in 13 million additional uninsured in 2018. The Administration said the President would veto the bill if passed.  CBO score:  Statement of Administration Policy (SAP):
    • Without a bipartisan path forward for a permanent fix and with the March 31 expiration of the current patch rapidly approaching, House Republicans released a draft one-year patch on March 25.  This legislation would replace the scheduled 24% reimbursement cut with a 0.5% update for the remainder of 2014 and a 0% update through March 31, 2015, and would be paid for largely through policy changes impacting providers, including a SNF value-based purchasing program, changes to clinical laboratory payments, adjustments to payments for end-stage renal disease (ESRD), and adjustment and extension of reductions in Medicaid DSH payments.  The patch may reach the House floor as soon as tomorrow, and while the measure’s pathway in the Senate is unclear, Speaker Boehner said the patch was negotiated with Senate Majority Leader Reid.  House patch: 

New Legislation –

    • On March 18, House Ways & Means Chairman Camp (R-MI) and Ranking Member Levin (D-MI), along with Senate Finance Chairman Wyden (D-OR) and Ranking Member Hatch (R-UT) released a discussion draft, the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014.  The draft legislation “takes a crucial step toward the modernization of Medicare payments to post-acute care (PAC) providers and a more accountable, quality-driven PAC benefit,” with the goal of “serv[ing] as the core building block for future Medicare PAC reforms.”  Press release:  Bill text:  Summary:  Section-by-section: 

ACA Oversight

    • On March 13, House Energy & Commerce Republican Leadership sent letters to every health plan participating in the federal Exchanges requesting “specific enrollment data, including the number of individuals who have paid their first month’s premium and those who are identified as previously uninsured.”  On March 25, House Ways & Means Chairman Camp (R-MI) and Health Subcommittee Chairman Brady (R-TX) sent a letter to Secretary Sebelius requesting similar information.  Energy & Commerce press release with link to letter:  Camp and Brady press release with link to letter:
    • Also on March 13, Sen. Moran (R-KS) sent a letter to Secretary Sebelius asking for additional information about spending on the federal Exchanges.  Press release with link to letter:
    • Also on March 13, Senate Finance Ranking Member Hatch (R-UT), Senate HELP Ranking Member Alexander (R-TN), and Sen. Thune (R-SD) led a group of 22 Republican Senators in a letter to OMB Director Burwell asking her “to immediately rescind [a] rule creating an unwarranted special carveout for some unions from Obamacare fees.”  Press release with link to letter: 

Exchanges –

    • On March 14, CMS issued a number of Exchange-related regulations and guidance documents, including a 2015 Final Letter to Insurers in the Federally-facilitated Marketplaces (Exchanges); an interim final rule requiring qualified health plans (QHPs) to accept premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program, other federal and state government programs, and Indian tribes and organizations (comments due on May 13); and a proposed rule addressing a number of Affordable Care Act (ACA) requirements applicable to health insurance issuers, Exchanges, Navigators, non-Navigator assistance personnel, and other entities (comments due 30 days after publication).  Letter:  Interim final rule:  Proposed rule:
    • On March 17, CMS Administrator Tavenner announced that more than five million people had enrolled in a federal or state Exchange since October 1.  Blog post:
    • On March 18, House Energy & Commerce Democrats released a memo comparing Exchange enrollment with initial Medicare Part D enrollment, concluding that “Americans are signing up for health insurance under the ACA at a faster rate than seniors signed up for Medicare Part D.”  Press release and link to memo:

 High-Risk Pools – On March 14, CMS announced that it will further extend Pre-Existing Condition Insurance Plan (PCIP) coverage through April 30 for individuals who have not enrolled in an Exchange plan.  More information: 

MedPAC – On March 14, MedPAC released its March 2014 report to Congress on Medicare payment policy.  Press release:  Fact sheet:  Report: 

Medicare Advantage –

    • On March 11, Reps. Cassidy (R-LA) and Barrow (D-GA) led a bipartisan group of 190 Members in a letter to CMS Administrator Tavenner “urging CMS to keep 2015 Medicare Advantage payment rates at 2014 levels.”  Several days later, House Energy & Commerce Democratic Leadership sent a letter to Administrator Tavenner arguing that “removing plan overpayments is the right policy course for Medicare and the nation.”  Cassidy press release with link to letter:  Energy & Commerce press release and letter:  
    • On March 21, CMS released a fact sheet outlining how the ACA has “strengthened” Medicare Advantage.  Fact sheet: 

Health IT

    • On March 19, Sens. Bennet (D-CO), Hatch (R-UT), Harkin (D-IA), Alexander (R-TN), Warner (D-VA), and Burr (R-NC) sent a letter to FDA Commissioner Hamburg “urging the FDA to provide further clarity and transparency in its policy regarding medical mobile apps.”  Press release with letter:
    • On March 24, the Government Accountability Office (GAO) released a report on HHS’ approach to health information exchange (HIE), recommending that CMS and the Office of the National Coordinator for Health IT (ONC) develop and prioritize specific milestones and timeframes to advance HIE.  Summary with link to report: 

ACA Legal Challenges – On March 25, the Supreme Court heard oral arguments in two cases challenging the legality of the ACA’s contraception coverage requirements, Sebelius v. Hobby Lobby Stores and Conestoga Wood Specialties v. Sebelius.  Meanwhile, the U.S. Court of Appeals for the District of Columbia heard oral arguments in a case challenging the legality of premium subsidies for individuals purchasing insurance through federal Exchanges, Halbig v. Sebelius

Misc –

    • On March 11, a bipartisan, bicameral group of six Members sent a letter to CMS Administrator Tavenner “express[ing] concern regarding continued difficulties experienced by Medicare beneficiaries when appealing denials of coverage for prescription drugs.”  Press release and letter:  
    • On March 14, CMS issued an FAQ clarifying ACA coverage requirements for same-sex spouses.  Blog post:  FAQ:  
    • On March 18, the HHS Office of Inspector General (OIG) released an updated edition of its Compendium of Priority Recommendations, which “presents opportunities to achieve cost savings, improve program management, and ensure quality of care and safety of beneficiaries.”  Report:
    • Also on March 18, CMMI issued a Request for Applications (RFA) for the Medicare Care Choices Model, a new initiative “to develop innovative payment systems to improve care options for beneficiaries by allowing greater beneficiary access to comfort and rehabilitative care in Medicare and Medicaid.”  Fact sheet:  RFA:  FAQ:
    • On March 20, House Ways & Means Health Subcommittee Ranking Member McDermott (D-WA) sent a letter to Secretary Sebelius regarding the backlog of appeals pending with the Office of Medicare Hearings and Appeals (OMHA).  Press release with link to letter:
    • On March 25, the HHS OIG released a report recommending that CMS rebase Medicare payments for end-stage renal disease (ESRD).  Summary with link to report: 

For more information, contact Mary Langowski (202.799.4362 or, Niki Carelli (202.799.4367 or or Kristen Ratcliff (202.799.4715 or

Published by DLA Piper LLP (US)
Copyright © 2014  DLA Piper LLP (US)
All Rights Reserved

This bulletin is intended as a general overview and discussion of the subjects dealt with. It is not intended, and should not be used, as a substitute for taking legal advice in any specific situation. DLA Piper will accept no responsibility for any actions taken or not taken on the basis of this publication. Pursuant to applicable Rules of Professional Conduct, it may constitute advertising.

Circular 230 Notice: In compliance with US Treasury Regulations, please be advised that any tax advice given herein (or in any attachment) was not intended or written to be used, and cannot be used, for the purpose of (i) avoiding tax penalties or (ii) promoting, marketing or recommending to another person any transaction or matter addressed herein.

You are receiving this communication because you are a valued client or friend of DLA Piper.

DLA Piper is a global law firm operating through various separate and distinct legal entities. For further information about these entities and DLA Piper's structure, please refer to All rights reserved.

To unsubscribe from DLA Piper mailing lists, reply to this message with REMOVE in the subject line.

For more information about LexisNexis products and solutions, connect with us through our corporate site.