Tag Archives: Affordable Care Act

Updates to Medicare

The Centers for Medicare & Medicaid Services (CMS) have revised the Medicare prospective payment system to update payment rates and reporting requirements for hospital outpatient departments, ambulatory surgical centers, and inpatient rehabilitation facilities for 2013, and will continue the electronic reporting pilot for the Electronic Health Record, according to a recent final rule.  You can access the regulations here.

According to the Courthouse News, this is the summary of the changes:

Many of the changes were made to bring the Medicare payment system into alignment with provisions of the Affordable Care Act. The changes affect hospitals paid under the Outpatient Prospective Payment System (OPPS) as well as Community mental health centers (CMHCs) and Ambulatory surgical centers (ASCs). The agency estimates that most hospitals paid under the OPPS will see “a modest increase or a minimal decrease” in payment for services in 2013 with an expected 1.9 percent increase for all services over what was paid in 2012.

The agency estimates that some urban hospitals will experience a payment increase of 8.3 percent due to increased payments for partial hospitalization, group psychotherapy and hemodialysis services. CMHCs may see a decrease of 4.4 percent due to a decrease in estimated costs. The updates to the ASC payment system for 2013 will affect each center individually, depending on the mix of patients who are Medicare beneficiaries and the payment changes for the procedures offered by those centers, the rule said.

In addition to new payment rates, the agency decided to continue the electronic reporting pilot for the Electronic Health Record (EHR) Incentive Program “exactly as finalized for 2012” and made changes for the Quality Improvement Organizations (QIOs), including the secure transmission of electronic medical information, and beneficiary complaint resolution and notification processes, according to the CMS.

The agency maintains that “the use of an electronic infrastructure that supports the use of EHRs by eligible hospitals and CAHs [Critical access hospitals] to meet the requirements in various CMS programs” will reduce reporting burdens simultaneously with the submission of quality data “to provide a foundation for establishing the capacity of hospitals to send, and for CMS, in the future, to receive, quality measures via hospital EHRs for the Hospital IQR [Inpatient Quality Reporting] Program’s measures.

via Courthouse News Service.

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Sup. Ct to look at ACA health care again

The Supreme Court opened its new Term on Monday by asking the federal government to offer its views on whether the way should be cleared for new constitutional challenges to the federal health care law — including a new protest against the individual mandate that the Court had upheld last June. (You can access the order here).


The Supreme Court requested the Government’s position in response to a rehearing request that raises religious challenges regarding the individual mandate and the separate insurance coverage mandate for employers.


via New look at health care? (UPDATED) : SCOTUSblog.

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Affordable Care Act – Medicaid Expansion

The Court’s decision on the constitutionality of the Medicaid expansion is divided and complicated.  The bottom line is that: (1) Congress acted constitutionally in offering states funds to expand coverage to millions of new individuals; (2) So states can agree to expand coverage in exchange for those new funds; (3) If the state accepts the expansion funds, it must obey by the new rules and expand coverage; (4) but a state can refuse to participate in the expansion without losing all of its Medicaid funds; instead the state will have the option of continue the its current, unexpanded plan as is.

The votes for this outcome are divided among several opinions.

Three Justices – the Chief, Justice Kagan, and Justice Breyer – took the position that depriving a state of all of its Medicaid funding for refusing to agree to the new expansion would exceed Congress’s power under the Spending Clause.  Although Congress may attach conditions to federal funds, they concluded, it may not coerce states into accepting those conditions.  And in this case, taking away all the states’ funds for the entirety of its Medicaid program just because it disagreed with a piece of the program would be coercive.  But the remedy for that constitutional violation is not to declare the expansion unconstitutional – such that even states that want to participate would not have the option.  Instead, the plurality held that the provision of the statute that authorized the Government to cut off all funds for non-compliance with the expansion was unconstitutional.  The result is that states can choose to participate in the expansion, must comply with the conditions attached to the new expansion funds if they take that new money, but states can also choose to continue to participate only in the unexpanded version of the program if they want.

Justices Ginsburg and Sotomayor would have held the entire expansion program constitutional, even the provision threatening to cut off all funding unless states agreed to the expansion.  Their votes created a majority for the proposition that the overall expansion was constitutional, and that states could choose to participate in the expansion and would have to comply with the expansion conditions if they did.

But there was still no majority about what to do about the states that do not want to participate in the expansion – the Chief Justice’s 3-Justice plurality voted to strike down the provision allowing the Government to withhold all funds from states that reject the expansion; Justices Ginsburg and Sotomayor voted to uphold it.

The deadlock was broken by the dissenters.  Justice Scalia – writing on behalf of himself, and Justices Kennedy, Thomas, and Alito – agreed with the Chief’s plurality that the threat to withhold all funds was unconstitutionally coercive.  But they would have held that the consequence is that the entire expansion program should be stricken.  The result would have been that even states that wanted to participate in the program could not.  The plurality’s approach of simply striking down the provision that allowed withholding all funds if the state refused the expansion was, in the dissenters’ view, tantamount to rewriting the statute.

At this point, that meant that there were 2 votes to uphold the expansion in its entirety, 4 votes to strike the entire expansion down, and 3 votes to strike down only the provision withholding all funds for non-compliance with the expansion mandate.  So where does that leave things?

Fortunately (for the sake of clarity at least), Justices Ginsburg and Sotomayor resolved the ambiguity by voting with the plurality on the remedy question.  That is, these Justices voted that if the statute was unconstitutionally coercive, then the remedy would be only to strike down the all-or-nothing sanction.

The consequence was a bottom line of 7 Justices – the Chief, Breyer, Kagan and the four dissenters – finding the expansion unconstitutional.  But a different majority – the Chief, Ginsburg, Breyer, Sotomayor and Kagan – held that the remedy for the violation was to strike down only the provision allowing the federal government to withhold all Medicaid funds unless a state agrees to the expansion.

via Court holds that states have choice whether to join medicaid expansion : SCOTUSblog.

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Affordable Care Act – Mandate decision

From SCOTUS Blog:

Although the Court had four questions before it, the focus of the challenge to the Affordable Care Act (ACA) was the so-called individual mandate – the requirement that almost all Americans buy health insurance by 2014 or pay a penalty.  Defending the constitutionality of the mandate, the government’s primary argument was that Congress can require everyone to buy health insurance using its power under the Commerce Clause of the Constitution, because the failure to buy insurance shifts the costs of health care for the uninsured to health care providers, insurance companies, and everyone who does have health insurance.  Five Justices – the Chief Justice and Justices Kennedy, Scalia, Thomas, and Alito – all rejected that argument.  But the government still won, because a different set of five Justices – the Chief Justice, and Justices Ginsburg, Breyer, Sotomayor, and Kagan – agreed that the mandate was constitutional, but for a different reason.

The most important part of the Court’s opinion on the mandate came from the Chief Justice, John Roberts.  He acknowledged that Congress has a broad power under the Commerce Clause, but he emphasized that Congress’s power to regulate commerce assumes that there is commercial activity to regulate.  In his view, the mandate creates activity, rather than regulating it.  If the Court were to interpret the Commerce Clause the way that the government does, he contended, it would allow Congress to regulate all kinds of new things – including forcing people to buy vegetables (with no specific reference to broccoli, however).  “That is not the country” the Founding Fathers envisioned, he proclaimed.

Although the Chief Justice rejected the government’s Commerce Clause argument, he agreed with one of the government’s alternative arguments:  the mandate imposes a tax on people who do not buy health insurance, and that tax is something that Congress can impose using its constitutional taxing power.  He acknowledged that the mandate (and its accompanying penalty) is primarily intended to get people to buy insurance, rather than to raise money, but it is, he explained, still a tax.  If someone who does not want to buy health insurance is willing to pay the tax, that’s the end of the matter; the government cannot do anything else.

Justice Ginsburg (joined by Justices Breyer, Sotomayor, and Kagan) agreed with the Chief Justice’s bottom line – that the mandate is constitutional under Congress’s ability to tax – even while disagreeing with his Commerce Clause conclusion; those four Justices would have held that Congress could use its power to regulate commerce to pass the mandate.  With five votes to uphold the mandate, it will survive, and the Court did not need to consider the “severability” issue — that is, what other parts of the law would have to go if the mandate were unconstitutional.

via The mandate is constitutional: In Plain English : SCOTUSblog.

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