Building relationships across the state to increase awareness of TxSCO and our legislative concerns
TxSCO Submits Comments on the 2013 Proposed Physician Fee Schedule
TxSCO has submitted comments on the 2013 Proposed Physician Fee Schedule to the Centers for Medicare and Medicaid Services (CMS). As you know, procedures require CMS to annually issue proposed rules on physician reimbursement in the office setting. For 2013, CMS proposes to reduce the conversion factor to $24.7124, thereby reducing physician payment rates in 2013 by 27.4%. Other changes include the application of a new G-code for transitional care, reduced time inputs for SBRT and IMRT, and the implementation of a sliding scale interest rate assumption for capital equipment practice expense calculations, among other proposals. Therefore, it is important that TxSCO comment on these changes.
The public is given 60 days to comment on the proposal and TxSCO's comments can be found here. If you have any questions about the 2013 CMS Proposed Physician Fee Schedule or the comments submitted, please contact Sydney Abbott at email@example.com.
TxSCO Submits Comments on Essential Health Benefits in Texas
The Affordable Care Act calls for the establishment of state health insurance exchanges, run by either the state itself or the federal government. The US Department of Health and Human Services (HHS) has already released a bulletin, and is expected to release further guidance soon on the establishment of health exchanges with each state. However, it is anticipated that HHS will leave the bulk of the decision making on health exchanges, including the adoption of essential health benefits (EHBs), to the states.
The Texas Department of Insurance recently accepted public comments on the establishment of EHBs in the state. TxSCO worked with a coalition of similar organizations in the state to develop a roadmap for policy makers on EHBs. The roadmap encourages Texas to preserve access to the most appropriate cancer care therapies as decided by the physician, as well as protecting out-of-pocket costs for patients in its EHB package.
Supreme Court Upholds Affordable Care Act
As expected, the decision on the constitutionality of the individual mandate in the Affordable Care Act (ACA) came down to a vote of 5-4, with Chief Justice John Roberts providing the swing vote for the majority. The decision: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional.
What’s interesting is the grounds on which the justices determined the law to stand. As you may remember, the primary argument for the upholding of the individual mandate rested in Congress’s power to regulate commerce between the states to require everyone to buy health insurance (Commerce Clause). There were not five votes to uphold it on this ground. However, five Justices (Roberts, Breyer, Sotomayor, Ginsberg, and Kagan) did agree that the penalty a citizen must pay if he or she refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. What this means: Congress does not have the power to tell you to buy health insurance, but it does hold the power to tax you if you don't.
Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than lose all of their funding.
TxSCO continues to parse the Supreme Court’s decision. We will keep you updated on additional information as it becomes available. For any questions, please contact Sydney Abbott at firstname.lastname@example.org.
Texas Legislative Update
While the Texas Legislature is out until 2013, TxSCO is still working hard to raise its advocacy voice within the state. Please visit the TxSCO Legislative Issues page to learn more.
As you already know, on January 1, 2012, the Texas State Legislature eliminated simultaneous benefit coverage for Medicare patients who also are covered under Medicaid. This is unacceptable. The dual coverage currently barley reimburses enough to provide the most basic care.
Please call Senator Nelson to tell her how these cuts are hurting your patients, and her constituents, at (817) 488-6648 (District office) and (512) 463-0112 (Capitol office).
Thank you for your prompt attention to this important matter.
Please contact Brittney Fairman at BFairman@accc-cancer.org if you have any questions or need help identifying your members of Congress.