As Congress returned from its Thanksgiving recess, lawmakers this week grappled with their next steps in the wake of the Supercommittee’s failure to reach an agreement on a $1.2 trillion deficit reduction plan. Most of these efforts have centered on minimizing the impact of automatic, across-the-board spending cuts that were triggered when the Supercommittee could not produce a plan. These cuts will go into effect in 2013 and will fall equally on defense and non-defense spending. Many important social safety net programs – for example, Medicaid and SSI – are exempted from the cuts. 

 

Reports indicate that House Majority Leader Eric Cantor (R-VA) is working to build support for a new proposal that would reduce the impact of the automatic defense cuts by pairing a delay their implementation with a variety of measures that are widely considered to be “must-pass” legislation. Cantor’s plan would include $133 billion in spending cuts, a 1-year delay in the defense sequestration, a 1-year extension of unemployment benefits, a payroll tax break, and a “fix” for the scheduled reduction in Medicare physician payment rates. However, President Obama has threatened to veto any legislation that modifies the automatic cuts, and it is far from clear whether a majority of legislators would support such a bill.

 

Meanwhile, discussions continue among other legislators about how to reduce the deficit in the aftermath of the Supercommittee’s failure. A bipartisan, bicameral group fashioning itself as the “go big coalition” is holding meetings behind closed doors to discuss a $4-6 trillion deficit reduction plan. In addition, Representative Paul Ryan (R-WI) has suggested that he may try to replace some of the automatic defense cuts with a deficit reduction plan to be included in his outline for the 2013 budget. (With fiscal year 2012 already two months old, Congress and the White House have begun working on their budget proposals for FY 2013). Such a move could be largely symbolic, as election-year politics make it unlikely the Democratic-controlled Senate and the Republican-controlled House will reach an agreement on the same budget resolution. It is not uncommon for the two chambers to work from separate budget resolutions, smoothing out differences during their later-stage negotiations.

 

 

 

Congress is set to end its work for the year later this month, putting pressure on legislators to finish up the 2012 appropriations process before heading home for the holidays. However, with nine of the twelve annual appropriations bills yet to be completed, congressional leaders are struggling to reconcile their differences on the details of the bills.

 

The continuing resolution that is currently funding the government will expire on December 16. Some lawmakers have proposed enacting another continuing resolution (CR) that would maintain funding at 2011 levels through the end of the 2012 fiscal year, which ends on Sept. 30, 2012. Others have suggested a shorter-term CR that would take the government into the new year, when action on the spending bills could then be completed. There appears to be a widespread desire in Congress to avoid a situation similar to that in 2011, when a political impasse over spending levels led to a series of very short term CRs and ongoing threats of a government shutdown, that lasted well into April.

 

Nonetheless, passing a year-end omnibus budget bill will be tough. Some of the most fiscally conservative members of Congress have threatened to vote against the bill if legislators do not include a steeper cuts than those outlined in the Budget Control Act, meaning that at least some Democratic support will be needed to pass the bill through the House. However, if the bill includes too many cuts to domestic spending, House leaders may have a hard time winning Democratic votes. 

 

In related news, a report released this week by the National Governors Association and the National Association of State Budget Officers found that state budgets are still in the grip of the recession. Although state spending increased on average by about 3% in 2011, that figure remains well below pre-recession spending levels. The slow growth of state revenues is partly due to the loss of federal economic stimulus dollars. Ongoing budget pressures, combined with the uncertainty about the outcome of the 2012 budget process and the federal deficit debate, will likely prompt states to continue cutting programs so as to balance their budgets.

 

 

 

On October 20, 2011, the federal government announced final rules providing guidance on how Accountable Care Organizations should be structured. These final rules could create a tipping point to help behavioral health provider organizations become part of the new healthcare ecosystem under health reform.

 

A new resource from the National Council outlines the key elements of the final rules and their implications for behavioral health providers. It answers the key questions:

The report also explains how behavioral health organizations can “ride the wave” and make the case for their participation in ACO. This report is the latest in our series helping provider organizations prepare for the changes ahead under health reform. To view additional resources, visit our website or check out our blog, MentalHealthcareReform.org.  

 

 

 

The Centers for Medicare and Medicaid Services announced this week that preventive services for obesity will now be covered by Medicare with no cost-sharing requirements for enrollees. This move adds to Medicare’s existing portfolio of preventive services that are now available without cost sharing under the Affordable Care Act (ACA), including depression screening and alcohol abuse/misuse screening.

 

The obesity prevention services that will now be covered at no charge to Medicare enrollees include obesity screening and counseling in primary care providers’ offices. For a beneficiary who screens positive for obesity with a body mass index (BMI) of greater than 30, the benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months. The beneficiary may receive one face-to-face counseling visit every month for an additional six months (for a total of 12 months of counseling) if he or she has achieved a weight reduction of at least 6.6 pounds during the first six months of counseling.

 

So far this year, 22.6 million Medicare enrollees have received one or more of the free covered preventive services enacted under the ACA.

 

 

 

Health and Human Services Secretary Kathleen Sibelius this week announced that the agency will delay the effective date of Stage 2 Meaningful Use reporting requirements to 2014.

 

Under the system of health information technology incentive payments established in 2009, providers and organizations who receive the payments must attest to meeting certain criteria for the “meaningful use” of the technology. The Meaningful Use criteria are divided into three stages: Stage 1 criteria primarily focus on capturing and communicating health data, while Stages 2 and 3 require the use of that data to inform more advanced clinical processes.

 

Previously, providers and organizations that attested to meeting the Stage 1 Meaningful Use criteria in 2011 had to meet the Stage 2 criteria by 2013 in order to continue to receive their payments. That date has now been pushed back to 2014 to give providers more time to achieve Meaningful Use.

 

In her announcement, Secretary Sibelius noted that doctors’ adoption of health information technology has doubled in two years, while over 50,000 health IT-related jobs have been created since the passage of the federal incentive payment program. For more information on meeting Meaningful Use requirements, visit HealthIT.gov. 

 

 

 

On Tuesday, December 20 from 1:30-3pm eastern time, the Centers for Medicare & Medicaid Services (CMS) will host a national provider call on the Physician Quality Reporting System & Electronic Prescribing Incentive Program. Subject matter experts will provide an overview on electronic health record (EHR) and registry based reporting  options that are available for eligible professionals (EPs) participating or looking to participate in the Physician Quality Reporting System and/or Electronic Prescribing Incentive Program. A question and answer session will follow the presentation.

 

The target audience for this national call is Medicare fee-for-service (FFS) providers, medical coders, physician office staff, provider billing staff, and vendors. Visit http://www.eventsvc.com/blhtechnologies/ to register. Registration will close at 12:00 p.m. eastern time on December 20, 2011, or when available space has been filled. The presentation will be posted at least one day before the call at:  http://www.cms.gov/PQRS/04_CMSSponsoredCalls.asp in the “Downloads” section on the CMS website.