April 24, 2013

Deadline, delays loom over ObamaCare rule

From: The Hill

By Megan R. Wilson

The White House is conducting a final review of a proposal from the  healthcare reform law that would cut federal grants for hospitals that serve  poor patients.

The facilities, known as Medicaid Disproportionate Share Hospitals (DSH), are  eligible for state and federal funding to balance out the amount they spend  caring for patients who are unable to pay their bills.

The Department of Health and Human Services (HHS) spent more than $17 billion  on payments to DSHs in 2011, according to a Government Accountability Office  study. The Affordable Care Act aimed to slash those grants exponentially  from 2014-2020, starting with a $500 million cut next year.

The healthcare law assumes that the funding will no longer be needed once  provisions aimed at providing broader insurance coverage — including an  expansion of Medicaid — take effect.

Federal regulators hoped to have the proposal published last month, but it is  only now hitting the desk of the White House’s Office of Information and  Regulatory Affairs (OIRA), the agency tasked with sifting through the details.

The contents of the proposed rule will not be available the office finishes  its review, which is required to take 90 days or less. The document will likely  provide the health department’s plan for calculating the cuts.

Under the Affordable Care Act, the department has an obligation to finalize  these rules by this October,  but procedural and political delays could threaten that deadline.

Earlier this month, The Washington Post reported  that the Obama administration is hoping to delay the 2014 implementation date,  following a U.S. Supreme Court ruling that allows states to opt out of the  Medicaid expansion.

President Obama’s budget recommends delaying the cuts until 2015, the Post reports.

In addition, there are regulatory hurdles the proposal has to break through.

Many of OIRA’s reviews are behind schedule, and even if the White House  releases the proposal within 90 days, any changes the health department must  make before publishing means the draft may not reach the public until August.

Following the release, the department must hold a comment period — lasting  anywhere between 30 and 90 days — and then make changes to the proposal before  submitting its final rule to the White House for review.  Then, the second  90-day OIRA review process begins.

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