Transcript North Carolina Oncology Association & South Carolina

Washington State Medical
Oncology Society Conference
Legislative Update
Matt Farber
Director, Provider Economics & Public
Policy
Association of Community Cancer
Centers
Table of Contents
• Congress
– Action thus far in 2013
– Key actions necessary in 2013
– Outlook for remainder of 2013
• Key Issues
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Sequestration
Budget
SGR
ACA implementation
Oral Parity
113th Congress
http://exileonmoanstreet.blogspot.com/2010/12/in-order-to-form-more-perfect-union.html
113th Congress
• Still a divided Congress
– House controlled by GOP (they lost 8 seats in
election)
– Senate controlled by Democrats (55 seats)
• Comparatively, the beginning of this
Congress has been action packed
– Debt-ceiling, Sandy relief, confirmation
hearings, CR on the 2013 budget
113th Congress
• Congress has some significant deadlines
looming in the next 2-3 months and 5
months
– The Debt Ceiling
– The 2013-2014 Budget
• Continuation of Sequestration
• Tax reform
Sequestration
• Congress voted to delay the automatic cuts
until the end of February
• Since no agreement was reached, the cuts
went into effect March 1, 2013
– This will mean a 2% across the board cut to
Medicare payments starting on April 1, 2013
– Also, over $2 Billion cut to NIH funding
– One Congressional staffer said that this may be
for the best, as it will take cuts to discretionary
funding off the table for the foreseeable future
• Only problem with that assessment is that changes to
Medicare are very much still on the table
Sequestration
• What does it mean for you?
– By now, you should have received your first
payments from CMS reflecting the 2%
decrease in payments
– Cuts are to all items on the claim, including
drugs
• The cut brings drug reimbursement down to
roughly ASP+4.3%
Cuts to Drug Reimbursement
• ASP+6% to ASP+4.3% is more than 2%...
– An example: A drug’s ASP is $100, so the
ASP+6% is $106
– The beneficiary pays 20%, or $21.20
– Medicare would normally cover the remaining
80%, or $84.80
– After sequestration, Medicare pays $83.10
(98% of the $84.80)
– $83.10+$21.20=$104.30 or ASP+4.3%
Drug Reimbursement
• Is this fair, or even legal?
– Both are fair questions:
– As for fairness, the easy answer is no, but
nothing about sequestration was meant to be
fair. It is a blunt cutting instrument, that was
never meant to go into effect
– As for legality, that is a trickier question
• ASP+6% reimbursement is a mandate from
Congress, and therefore, the cuts may be in
violation of that mandate
– Tough to fight…
How did this happen?
• If sequestration was never meant to
happen, how did it happen?
• Also, there was this:
• Essentially, the President thought the cuts
to the Defense Department were going to
be enough to get the GOP to stop them
A little relief…
• At the end of March, Congress passed a
continuing resolution to fund the
government until Sept. 30th
– They did not stop the sequester, however,
they did change a few of the cuts
• Gave the DoD more flexibility with its cuts
• $70 million to NIH to offset some of the cuts
• $74 million to FDA so approval process will not
slow down
– None of this was new money
Sequestration
• It is not too late to let your elected officials
know what the 2% cut would mean to you
and your patients.
– Call, write, email Congress to explain how this
cut would impact the services you offer
– Many new members of Congress do not
understand issues facing oncology
• 1st District: Suzan DelBene (D); 6th District: Derek
Kilmer (D); 10th District: Kenny Heck (D)
Washington
Why get Involved?
• One of the big questions facing Congress
is:
– The keep sequestration on the books for all
10 years, or to write next year’s budget
without the sequester
Budget
• The Government has been
operating on a series of
continuing resolutions for a
long period of time
– It has been years since
Congress has passed all 12
appropriations bills
– The good news: Congress will
not shut down… for now…
Budget & Debt Ceiling
• To force Congress into action, the House
inserted language in the recent debt
ceiling bill that will withhold Senators
paychecks if they do not introduce a
budget
– Novel idea
– In case you are concerned, the money would
be held in escrow
– Senate introduced its budget in March
Congressional Budgets
• The budgets introduced in the House and
Senate are essentially meaningless
– So is the President’s budget, for that matter
• Why?
– The documents are VERY partisan, so they
act as starting points for negotiation
Debt Ceiling
http://minutemennews.com/2013/01/republicans-already-losing-debt-limit-war/
Debt Ceiling
• On Jan. 31st, the Senate voted to approve
the House debt ceiling bill
– Essentially, Congress is lifting the debt ceiling
temporarily, until May
– If Congress cannot determine spending cuts
and raise level again, the government may
default on its obligations in August
• This is following a very similar script to 2011
Remainder of 2013
• In addition to the previous issues, here are
some of the healthcare related issues
Congress will/ may take up this year:
– Repeal of the IPAB
– Repeal of the device tax (both from ACA)
– Drug Shortages, Drug track and trace
– Prompt Pay Discount
– SGR fix
Remainder of 2013
• Given the current environment, stand
alone bills may be very difficult
– However, there is bi-partisan support for many
of these issues, including IPAB repeal, SGR
reform
– Most likely to pass if attached to larger
legislative vehicle
SGR
• The House Ways and Means Committee
has floated an idea to permanently fix the
SGR formula and, over time, replace it
with a formula that would reward quality
care
– The details are still to be released fully
– Most importantly, the initial proposal did not
include offsets (the fix would cost roughly
$140 billion) ((a BARGAIN!!))
SGR
• This is the best chance for a long term
SGR that we have seen in recent memory
– Congress is reaching out to outside
organizations
– Lower cost
– Almost universal dislike of current system
Affordable Care Act
• The ACA is quickly moving into the
implementation phase
– The government is writing rules on everything
from set up of exchanges to Medicaid
expansion to the sunshine provisions
Sunshine
• CMS released the long awaited final rule
on sunshine on Feb. 1.
– Data collection to being on Aug. 1, 2013
– CMS will release the data from August
through Dec. 2013 on Sept. 30, 2014
– Payments for speaking at continuing
education programs are NOT required to be
reported, with certain conditions
Sunshine
• The per person value of the meal must be
reported as a payment only for covered
recipients who actually partook in the food
or beverage.
• Applicable manufacturers are not
required to report or track buffet meals,
snacks, soft drinks, or coffee made generally
available to all participants of a conference or
similar events where it is difficult to identify
the identity of those who partook in the
offering.
Sunshine
• CMS finalized “that small incidental items
that are under $10 (such as pens and note
pads) that are provided at large-scale
conferences and similar large-scale events
will be exempted from the reporting
requirements, including the need to track
them for aggregation purposes.”
Sunshine Exclusions
• Items “[]such as medical textbooks and journal
reprints[] … do not … fall within the statutory
exclusion of Educational Materials that Directly
Benefit Patients or are Intended For Patient
Use. Wall models and anatomical models which
are ultimately intended to be used with a
patient, are excluded.
• CMS clarified that “Payments or other transfers of
value to residents (including residents in medicine,
osteopathy, dentistry, podiatry, optometry and
chiropractic) will not be required to be reported for
purposes of this regulation.”
Oral Parity
• To date, there are 21 states and DC that
have oral parity legislation
– Washington passed oral parity legislation that
is effective as of Jan. 1, 2012
• There is a renewed federal effort to pass
oral parity legislation
– The House bill will be reintroduced this month
Oral Parity
Questions?
Thank you
Matthew Farber
[email protected]
(301) 984-9496 ext. 221