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• Independent Payment Advisory Board (IPAB): Frequently Asked Questions [August 02, 2017]

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  "This report responds to frequently asked questions about the Independent Payment Advisory Board (IPAB), including the board's background, current status, controversial issues including legal challenges, and recent legislative efforts to repeal the IPAB. For additional information, see Congressional Research Service (CRS) Report R41511, The Independent Payment Advisory Board, by Jim Hahn and Christopher M. Davis."

  Library of Congress. Congressional Research Service

  Hahn, Jim; Davis, Christopher M., 1966-; Liu, Edward C.

  2017-08-02
• The Independent Payment Advisory Board (IPAB): Frequently Asked Questions [March 17, 2017]

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  "This report responds to frequently asked questions about the Independent Payment Advisory Board (IPAB), including the board's background, current status, controversial issues including legal challenges, and recent legislative efforts to repeal the IPAB. For additional information, see CRS Report R41511, The Independent Payment Advisory Board, by Jim Hahn and Christopher M. Davis."

  Library of Congress. Congressional Research Service

  Hahn, Jim; Davis, Christopher M., 1966-; Liu, Edward C.

  2017-03-17
• Independent Payment Advisory Board [April 17, 2013]

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  "The Patient Protection and Affordable Care Act (PPACA, P.L. [Public Law] 111-148, as amended) created the Independent Payment Advisory Board (IPAB, or the Board) to 'reduce the per capita rate of growth in Medicare spending.' The Board's proposals will be implemented by the Secretary of Health and Human Services (the Secretary) unless Congress acts either by formulating its own proposal to achieve the same savings or by discontinuing the automatic implementation process defined in the statute. This report, which provides an overview of the Board, begins with a discussion of the rationale behind the creation of an independent Medicare board and briefly reviews prior proposals for similar boards and commissions. The report then describes the structure of the Board, the calculations and determinations required to be made by the Office of the Chief Actuary (the Chief Actuary) in the Centers for Medicare & Medicaid Services (CMS) that trigger a Board proposal, and the content of and constraints on Board proposals--including the Medicare productivity exemptions under Section 3401 of PPACA. In addition, the report reviews the expedited and other parliamentary procedures that relate to congressional consideration of Board proposals and other Board-related activities, and concludes with a description of how the Board's proposals are to be implemented and their possible impact."

  Library of Congress. Congressional Research Service

  Hahn, Jim; Davis, Christopher M., 1966-

  2013-04-17
• Independent Payment Advisory Board (IPAB): Frequently Asked Questions [October 30, 2015]

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  In the context of this document, 'Congressional Research Service' will be abbreviated 'CRS'. "This report responds to frequently asked questions [FAQ] about the Independent Payment Advisory Board (IPAB), including the board's background, current status, controversial issues including legal challenges, and recent legislative efforts to repeal the IPAB. For additional information, see CRS Report R41511, 'The Independent Payment Advisory Board', by Jim Hahn and Christopher M. Davis." FAQ include: "What Is the IPAB? […] Why Was the IPAB Created? […] Why Is the IPAB Controversial? […] What Triggers IPAB Action? […] Who are the Members of the IPAB, and How are They Appointed? […] Why Hasn't the IPAB Been Constituted? Why Haven't Any Members Been Appointed? […] What Are the Fast-Track Procedures That IPAB Legislation Would Receive in Congress? […] Are There Fast-Track Procedures for Legislation Discontinuing IPAB? […] What Internal Congressional Rules Have Been Adopted Addressing the IPAB? […] Are the House and Senate Required to Follow the Fast-Track Procedures in the Act? […] What Restrictions Did the ACA Place on Congressional Consideration of IPAB Legislation? […] What If the IPAB Fails to Submit a Required Proposal? […] What Legal Challenges Have Been Raised Regarding the IPAB, and What Is the Status of the Lawsuits? […] What Recent Legislative Activity Related to the IPAB Has There Been? […and] How Has CBO [Congressional Budget Office] Scored IPAB-Related Bills?"

  Library of Congress. Congressional Research Service

  Hahn, Jim; Davis, Christopher M., 1966-; Liu, Edward C.

  2015-10-30
• Health Care-Related Expiring Provisions, First Session of the 114th Congress [March 25, 2015]

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  "This report provides a list of selected health-related programs and activities under specified titles of the Social Security Act (SSA), including the Maternal and Child Health Services Block Grant (Title V), General Provisions, Peer Review, and Administrative Simplification (Title XI), Medicare (Title XVIII), Medicaid (Title XIX), and the State Children's Health Insurance Program (CHIP; Title XXI); the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended); as well as selected provisions from the Public Health Service Act (PHSA) that are scheduled to terminate during the first session of the 114th Congress (i.e., by December 31, 2015). This report includes only those health care-related expiring provisions for which congressional action would be needed to extend the application of a provision once the expiration date is reached, and it does not include demonstration projects or pilot programs. Although the Congressional Research Service (CRS) has attempted to be comprehensive, CRS cannot guarantee that every relevant provision is included here. The report defines what constitutes an expiring provision, clarifies which issues do not meet the definition of an expiring provision, lists the legislative history of each of the programs and policies that are due to expire before the end of the first session of the 114th Congress, and includes future deadlines, when applicable, for those programs and policies. The historical legislative actions that created, modified, or extended the expiring provisions covered in this report are also summarized. Expiring provisions are organized by SSA section, ACA section, or PHSA title and section, as appropriate. The last part of the report includes provisions with expiration dates in 2013 that were not extended in any subsequent legislation. The main body of the text also includes a number of provisions that expired in 2014."

  Library of Congress. Congressional Research Service

  Hahn, Jim

  2015-03-25
• Medicare Accelerated and Advance Payments and COVID-19: Frequently Asked Questions [Updated April 8, 2021]

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  "In rare situations, Medicare Part A providers (e.g., acute care hospitals, skilled nursing facilities, and other inpatient care facilities) and Part B suppliers (e.g., physicians, nonphysician practitioners, durable medical equipment [DME] suppliers, and others who furnish outpatient services) face cash flow challenges due to specified circumstances beyond their control. Under such circumstances, the Centers for Medicare & Medicaid Services (CMS) can provide temporary relief through the accelerated payment program (Part A) and the advance payment program (Part B). CMS has offered these programs, collectively referred to as the Accelerated and Advance Payment (AAP) programs, in an attempt to alleviate some concerns about the financial challenges faced by Medicare suppliers and providers. These amounts eventually are recovered by Medicare, typically by withholding payment for subsequent claims up to the amount of the accelerated or advance payments. [...] This report addresses frequently asked questions about the Medicare AAP programs, including the terms and conditions of eligibility, payment amounts and sources of funds, recovery of payments, applicable interest charges, and administrative and legislative changes during the COVID-19 [coronavirus disease 2019] PHE [public health emergency]."

  Library of Congress. Congressional Research Service

  Hahn, Jim; Villagrana, Marco A.

  2021-04-08
• Medicare Accelerated and Advance Payments and COVID-19: Frequently Asked Questions [March 1, 2021]

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  From the Summary: "In rare situations, Medicare Part A providers (e.g., acute care hospitals, skilled nursing facilities, and other inpatient care facilities) and Part B suppliers (e.g., physicians, nonphysician practitioners, durable medical equipment [DME] suppliers, and others who furnish outpatient services) face cash flow challenges due to specified circumstances beyond their control. Under such circumstances, the Centers for Medicare & Medicaid Services (CMS) can provide temporary relief through the accelerated payment program (Part A) and the advance payment program (Part B). CMS has offered these programs, collectively referred to as the Accelerated and Advance Payment (AAP) programs, in an attempt to alleviate some concerns about the financial challenges faced by Medicare suppliers and providers. These amounts eventually are recovered by Medicare, typically by withholding payment for subsequent claims up to the amount of the accelerated or advance payments. [...] This report addresses frequently asked questions about the Medicare AAP programs, including the terms and conditions of eligibility, payment amounts and sources of funds, recovery of payments, applicable interest charges, and administrative and legislative changes during the COVID-19 [coronavirus disease 2019] PHE [public health emergency]."

  Library of Congress. Congressional Research Service

  Hahn, Jim; Villagrana, Marco A.

  2021-03-01
• COVID-19 Vaccine: Financing for Its Administration [February 19, 2021]

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  From the Document: "A U.S. COVID-19 [coronavirus disease 2019] vaccination campaign is underway. 'For this effort, all vaccines and some supplies for their administration to patients have been purchased by the federal government, with appropriations provided for this purpose.' These are available at no cost to providers and patients. When the vaccine delivery approach allows for individual patient transactions, providers may seek reimbursement from available payers for their costs to administer the vaccines, including the costs of their time, vaccine storage, recordkeeping, and additional supplies. In general, by law and regulation, patients should not be charged for the COVID-19 vaccine or the costs of its administration during the campaign. There may be exceptions when the vaccine is administered during a visit in which other services--such as a check-up for a chronic condition--are also furnished, and a visit fee unrelated to vaccine administration may be billed. This Insight explores the provision of COVID-19 vaccines and payment for their administration, where applicable, from the perspectives of patients, providers, and public and private payers. It does not discuss (1) federal entities that provide direct health care services, such as the Departments of Defense and Veterans Affairs; (2) vaccination sites that are fully financed and do not involve individual patient transactions; or (3) payment policies that may apply after the initial vaccination campaign in spring 2021."

  Library of Congress. Congressional Research Service

  Baumrucker, Evelyne P.; Forsberg, Vanessa C.; Hahn, Jim . . .

  2021-02-19
• Major Fiscal Issues Before Congress in FY2013 [August 10, 2012]

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  From the Document: "The federal budget deficit has exceeded $1 trillion in each of the last three fiscal years and is expected to exceed that level in FY2012. Concern over these large deficits, as well as the long-term trajectory of the federal budget, has resulted in significant debate during the 112th Congress over how to achieve meaningful deficit reduction and how to implement a plan to stabilize the federal debt. At the same time, the economy is recovering from its largest downturn since the Great Depression, and concerns have been expressed that growth in the United States may falter to the point where the U.S. economy again experiences recession. This has resulted in some renewed debate over whether additional stimulus may be needed. Over the next few months through the early part of calendar year 2013, Congress will be facing choices on how to deal with numerous expiring provisions, across-the-board spending cuts, and other short-term considerations that will have major effects on the federal budget. Some have referred to this as the 'fiscal cliff.' Choosing how to address these issues will have a significant impact on the size of the budget deficit and the pace of economic recovery going forward. Further changes to other spending and revenue policies could also address some of the longer-term drivers of projected budgetary imbalance, while simultaneously impacting the economy. This report provides a brief overview of the major tax and spending policy changes set to take effect under current law at the end of 2012 or early in 2013. Collectively, these policies have been referred to by some as the 'fiscal cliff.' The report also includes links to other CRS [Congressional Research Service] reports which provide more information and analysis of the individual provisions discussed below."

  Library of Congress. Congressional Research Service

  Levit, Mindy R.; Sherlock, Molly F.; Hahn, Jim

  2012-08-10
• 'Fiscal Cliff' and the American Taxpayer Relief Act of 2012 [January 4, 2013]

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  "In the context of large budget deficits, Congress was faced with a variety of policies that were set to reduce spending and increase revenues at the end of 2012, referred to by some as the 'fiscal cliff.' Had these policies taken effect, CBO [Congressional Budget Office] projected that the ensuing fiscal contraction would have resulted in a recession in 2013. On January 2, 2013, President Obama signed into law the American Taxpayer Relief Act of 2012 (ATRA; H.R. 8 as enacted), which prevented many--but not all--of the fiscal cliff policies from going into effect. Budget issues are likely to continue into the 113th Congress surrounding two issues that the ATRA did not resolve. First, financing of the federal budget for the last six months of the fiscal year is unresolved because of uncertainties associated with the debt limit and appropriations. More specifically, the continuing resolution to fund the federal government, enacted in September, runs out at the end of March and current fiscal policy would require an increase to the debt limit in early 2013 to meet existing obligations. Second, the federal debt remains on an unsustainable path in the long-term because of the imbalance between spending and revenues. This report provides a brief overview of the major tax and spending policies that comprised the 'fiscal cliff.' It discusses how the provisions of ATRA did and did not address these policies and provides information on additional budget-related considerations for the 113th Congress."

  Library of Congress. Congressional Research Service

  Levit, Mindy R.; Crandall-Hollick, Margot L.; Hahn, Jim

  2013-01-04
• Independent Payment Advisory Board [March 12, 2012]

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  "In response, in part, to overall growth in Medicare program expenditures and growth in expenditures per Medicare beneficiary, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148, as amended) created the Independent Payment Advisory Board (IPAB, or the Board) and charged the Board with developing proposals to 'reduce the per capita rate of growth in Medicare spending.' The Secretary of Health and Human Services (the Secretary) is directed to implement the Board's proposals automatically unless Congress affirmatively acts to alter the Board's proposals or to discontinue the automatic implementation of such proposals. The annual IPAB sequence of events begins each year, starting April 30, 2013, with the Chief Actuary would establish an applicable savings target--the amount by which the Board must reduce future spending. […] The Board cannot ration care, raise premiums, increase cost sharing, or otherwise restrict benefits or modify eligibility. In generating its proposals, the Board is directed to consider, among other things, Medicare solvency, quality and access to care, the effects of changes in payments to providers, and those dually eligible for Medicare and Medicaid. […] Board proposals are 'fast-tracked' in Congress, and IPAB proposals go into force automatically unless Congress affirmatively acts to amend or block them within a stated period of time and under circumstances specified in the act. […] The Board's charge is to develop proposals for the Secretary to implement that reduce the per capita growth in Medicare expenditures, not to reduce Medicare expenditures. Therefore, while the CBO projects that the cumulative impact of the Board's recommendations from 2015 through 2019 will reduce total spending by $15.5 billion, during the same period, Medicare expenditures will total $3.9 trillion with average spending per beneficiary forecast to increase from $13,374 to $15,749. While the Board's potential impact on total expenditures is likely to be relatively small compared to overall Medicare expenditures, its impact on particular Medicare providers or suppliers may be significant, particularly if the Board alters payment mechanisms." This report also contains graphs and tables.

  Library of Congress. Congressional Research Service

  Hahn, Jim; Davis, Christopher M., 1966-

  2012-03-12
• Medicare Primer [March 16, 2017]

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  "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or have amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease). The program is administered by the Centers for Medicare & Medicaid Services (CMS), and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services. [...] This report provides a general overview of the Medicare program including descriptions of the program's history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes."

  Library of Congress. Congressional Research Service

  Davis, Patricia A.; Binder, Cliff; Hahn, Jim . . .

  2017-03-16
• Medicare Primer [March 31, 2016]

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  "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or have amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease). The program is administered by the Centers for Medicare & Medicaid Services (CMS), and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services."

  Library of Congress. Congressional Research Service

  Davis, Patricia A.; Talaga, Scott R.; Binder, Cliff . . .

  2016-03-31
• Medicare Primer [August 02, 2017]

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  "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under 65. The program is administered by the Centers for Medicare & Medicaid Services (CMS), within the U.S. Department of Health and Human Services (HHS)."

  Library of Congress. Congressional Research Service

  Davis, Patricia A.; Binder, Cliff; Hahn, Jim . . .

  2017-08-02
• Medicare Primer [Updated August 13, 2019]

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  From the Summary: "This report provides a general overview of the Medicare program including descriptions of the program's history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes."

  Library of Congress. Congressional Research Service

  Davis, Patricia A.; Binder, Cliff; Hahn, Jim . . .

  2019-08-13
• Health Care-Related Expiring Provisions of the 116th Congress, First Session [June 21, 2019]

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  From the Document: "This report describes selected health care-related provisions that are scheduled to expire during the first session of the 116th Congress (i.e., during calendar year [CY] 2019). For purposes of this report, 'expiring provisions' are defined as portions of law that are time-limited and will lapse once a statutory deadline is reached absent further legislative action. The expiring provisions included in this report are those related to Medicare, Medicaid, State Children's Health Insurance Program (CHIP), and private health insurance programs and activities. The report also includes health care-related provisions that were enacted in the Patient Protection and Affordable Care Act (ACA; P.L. 111-148) or last extended under the Bipartisan Budget Act of 2018 (BBA 2018; P.L. 115-123). In addition, this report describes health care-related provisions within the same scope that expired during the 115th Congress (i.e., during CY2017 or CY2018). Although the Congressional Research Service (CRS) has attempted to be comprehensive, it cannot guarantee that every relevant provision is included here."

  Library of Congress. Congressional Research Service

  Voorhies, Phoenix; Colello, Kirsten J.; Fernandes-Alcantara, Adrienne L. . . .

  2019-06-21
• Health Care-Related Expiring Provisions of the 116th Congress, Second Session [April 28, 2020]

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  From the Summary: "This report describes selected health care-related provisions that are scheduled to expire during the second session of the 116th Congress (i.e., during calendar year [CY] 2020). For purposes of this report, 'expiring provisions' are defined as portions of law that are time-limited and will lapse once a statutory deadline is reached, absent further legislative action. The expiring provisions included in this report are those related to Medicare, Medicaid, the State Children's Health Insurance Program (CHIP), and private health insurance programs and activities. The report also includes health care-related provisions enacted in the Patient Protection and Affordable Care Act (ACA; P.L. 111-148) or extended under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136). In addition, this report describes health care-related provisions within the same scope that expired during the first session of the 116th Congress (i.e., during CY2019). Although the Congressional Research Service (CRS) has attempted to be comprehensive, it cannot guarantee that every relevant provision is included here."

  Library of Congress. Congressional Research Service

  Voorhies, Phoenix; Colello, Kirsten J.; Fernandes-Alcantara, Adrienne L. . . .

  2020-04-28
• Health Care-Related Expiring Provisions of the 117th Congress, First Session [June 14, 2021]

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  From the Summary: "This report describes selected health care-related provisions that are scheduled to expire during the first session of the 117th Congress(i.e., during calendar year [CY] 2021). [...] This report focuses on two types of health care-related provisions[.] [...] The first, and most common, type of provision provides or controls 'mandatory spending,' meaning it provides temporary funding, temporary increases or decreases in funding (e.g., Medicare provider bonus payments), or temporary special protections that may result in changes in funding levels (e.g., Medicare funding provisions that establish a floor). The second type of provision defines 'the authority of government agencies or other entities to act,' usually by authorizing a policy, project, or activity. Such provisions also may temporarily delay the implementation of a regulation, requirement, or deadline or establish a moratorium on a particular activity. Expiring health care provisions that are predominantly associated with discretionary spending activities--such as discretionary authorizations of appropriations and authorities for discretionary user fees--are excluded from this report."

  Library of Congress. Congressional Research Service

  Keyser, Julia A.; Hahn, Jim; Voorhies, Phoenix . . .

  2021-06-14