Health Care Slog

There were mixed signals again on Thursday for Democrats in the Congress, as the House Energy and Commerce Committee moved ahead on a health reform bill, while bipartisan negotiations in the Senate ground to a halt.

On what should have been a day of smiles after a deal with more moderate Blue Dogs allowed committee work to resume, Democrats instead found themselves on the defensive on several fronts.

On the House side, progress in the Energy & Commerce panel was offset by fierce complaints from liberal Democrats, who oppose the deals cut earlier this week with the more moderate Blue Dogs, as over 50 liberals threatened to vote against the reform bill.

Over in the Senate, there was little positive on Thursday for Democrats.  After hints of a breakthrough earlier in the week, there were no negotiations, a lot of posturing, and an announcement that the Senate Finance Committee won't craft a bill until after Labor Day.

That was yet another setback for Democrats, as that will further delay efforts in the Senate to forge a bill for floor debate.

There was even the oddity of Senate Majority Leader Harry Reid accusing the media of setting up Democrats and the President for failure on health care, by talking up a deadline of early August for action by both the House and Senate.

"That is a deadline that you created," Reid said Thursday.

Ah, yes, the ole "Blame It On The Media" strategy that both parties use at times.

That line of argument left a lot of us up in the Press Gallery a bit incredulous, because we certainly remembered President Obama being the one who was urging action on health reform by early August in the House and Senate.

But we digress.

So how about a few more details from the bill to whet your appetite today?

Go to the bottom of page 124, and you will find a subsection entitled, "Limitations on Review."

This deals with Section 223, "Payment Rates for Items and Services."

"There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224 (Modernized Payment Initiatives and Delivery System Reform.)

In other words, if the federal government sets a payment rate that a doctor or hospital thinks is too low, there is nothing you can do about it, short of an Act of Congress.  No court, not even the Supreme Court would be allowed to review those decisions.

Of course, I immediately searched the Energy & Commerce bill to see if there were other occurrences of this, and sure enough, there were.  But this story has a little bit of a twist to it.

On page 294 there is a "Limitations on Review" that deals with Section 1151, "Reducing Potentially Preventable Hospital Readmissions."

The limits deal with the payment system under Medicare and Medicaid for hospital stays involving a technique known as Diagnosis Related Groups, which from what I can discern, factor in information like hospital readmissions.

From reading this, it would seem that there is no administrative or judicial appeal allowed, for example, on "the determination of a targeted hospital," increases in payments, hospital-specific limits and more.

There is another "Limitations on Review" on page 462, which deals with Section 1301 on "Accountable Care Organization Pilot Program."

This specifically says there is "no administrative or judicial review" of the "elements, parameters, scope and duration of the pilot program," no review of determinations on incentive payments and much more.

Also, there is an interesting exemption, as it says "Chapter 35 of title 44 United States Code shall not apply to this section."

That section of the U.S. Code is titled, "Coordination of Federal Information Policy."

Even more interesting about this was that while doing another search, I stumbled on a variation of the "Limitations on Review."

This time, it was labeled "Limitation on Review." (no 's' on the end of limitation.)

You can find those on page 257, p. 332 and page 489.  They deal with sections involving "Payments for Efficient Areas," "Limitation on Medicare Exceptions to the Prohibition on Certain Physician Referrals Made to Hospitals," and "Payment Incentive for Selected Primary Care Services."

You can check out all the specifics yourself, but that's a lot of limits on the right to appeal an administrative judgment and the right to sue in the courts.

Of course, all of this work could go up in smoke as soon as House Democrats fuse together three different bills and the Senate stitches together plans from two different committees.

It will just give us more to do after Labor Day.

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