Welcome to The Hill's early evening roundup of the day's health policy news and advance look at tomorrow's schedule.

We'll no longer be posting our Roundup in the morning, but please check our Healthwatch blog in the a.m. for overnight breaking news.

Monday's health news

Senate fails again to strike 1099 healthcare reform provision: The Senate Monday evening failed for the second time to repeal a tax reporting requirement of the healthcare reform law that both parties agree should be scrapped. Monday's failed votes were on two amendments to food-safety legislation.

The 1099 provision requires businesses to file tax forms for business purchases of more than $600 a year. The Senate considered two amendments to repeal the provision — the first, from Sen. Mike Johanns (R-Neb.), would have offset the cost with unspent and unobligated federal dollars, to be identified by the Office of Management and Budget. It failed 61 to 35 because a two-thirds majority was needed for passage. 

The second amendment, from Sen. Max Baucus (D-Mont.), was not paid for and would have added $19 billion to the deficit. It failed 44 to 53.

Similar amendments from Johanns and Sen. Bill Nelson (D-Fla.) already failed in September.

Before taking up the 1099 amendments, the Senate voted 69 to 26 to move forward on the food safety bill Monday evening. A vote on final passage has been scheduled for Tuesday (see below), and the House is then likely to pick up the Senate bill despite having passed its own version in July 2009.

The Obama administration has acknowledged that the 1099 provision creates unduly burdens on businesses and called for the Senate to repeal it. http://bit.ly/gOqWSZ

Read more...

California’s seven largest health insurers face $4.85 million in fines for improper and late claim payments, according to The Associated Press.

On average, the insurers paid about 80 percent of claims correctly, well below the 95 percent required by state law, the California Department of Managed Health Care said Monday.

The following fines were issued:
• Anthem Blue Cross and Blue Shield of California: $900,000
• United/Pacificare: $800,000
• HealthNet: $750,000
• Kaiser Foundation Health Plan: $750,000
• Cigna: $450,000
• Aenta: $300,000

The insurers also have to pay restitution to hospitals and health providers, which may cost tens of millions of dollars, the department said.

The California Association of Health Plans is preparing a response on behalf of insurers, a spokeswoman told the AP.

The House passed a one-month, $1 billion “fix” to the Medicare physician payment formula Monday afternoon, two days before doctors were scheduled to take a 23 percent hit in Medicare payments.

The House approved by voice vote the Senate’s plan to fund the fix through cuts to payments for certain therapy services. The bill, which had passed the Senate on Nov. 18, now awaits the president’s signature.

If signed into law, a 2.2 percent update in physician payments will be put in place through the end of the year. This will be funded by expected savings from a 20 percent reduction in payments for therapy services.

The payment cuts to physical therapists are not as steep as the 25 percent cut previously proposed by the Centers for Medicare and Medicaid Services. Savings from the cuts will be used to pay for the "doc fix" instead of being redistributed to participants in the Medicare Physician Fee Schedule.

When the Senate approved its fix earlier this month, Finance Committee Chairman Max Baucus (D-Mont.) and ranking member Chuck Grassley (R-Iowa) said in a statement they would work on a year-long fix to the Sustainable Growth Rate formula that can be enacted before the end of the year.

The American Medical Association praised Congress for passing a one-month fix, but it urged lawmakers to quickly delay the scheduled payment cuts for an additional year.

"While this short-term delay helps ensure that physicians can continue to care for seniors for the next month, congressional action early in December to stop the cut for one year will inject stability into the Medicare program and ensure that Medicare delivers on its promise of health coverage for America’s seniors," the AMA said. "It is crucial that Congress act well before the January 1 deadline so there are no disruptions in care for seniors."

Senate leaders have agreed to postpone a vote on two amendments and final passage of food-safety legislation until Tuesday morning, congressional sources tell The Hill.

The move would give Sen. Tom Coburn (R-Okla.) time to debate the merits of his two amendments to the legislation. One amendment is a stripped-down substitute to the bill — the other is a moratorium on congressionally directed appropriations.

"A morning vote is the right move," a spokesman for Coburn told The Hill. "Reid would be sending the wrong message to have a late night vote on keeping the lights on at the earmark favor factory."

Votes on two other amendments to repeal the healthcare reform law's 1099 tax reporting requirements are still scheduled for Monday evening.

The Senate bill would give the Food and Drug Administration the power to recall tainted food, quarantine geographic areas and access food producers’ records.

The House passed its version of food-safety legislation in July 2009. House leaders say the lower chamber could pass the Senate bill as is during this lame-duck session in order to get the bill to the president's desk before a new Congress is sworn in.

Rep. Joe Barton (R-Texas) is calling on Centers for Medicare and Medicaid Services (CMS) Administrator Donald Berwick to brief the House Energy and Commerce Committee before the end of the lame-duck session.

Earlier this month, Berwick provided his first testimony to Congress since his recess appointment. After the Senate Finance Committee hearing, Republicans complained they were not given enough time to question the CMS chief.

"Although I was happy to see you finally appear before a Congressional committee to discuss both your work at the Centers for Medicare and Medicaid Services and the Patient Protection and Affordable Care Act (PPACA), you would agree that your time before the Senate Finance Committee was short," Barton wrote in a Monday letter to Berwick.

Barton, who is seeking the Energy and Commerce Committee chairmanship, asked Berwick to brief the committee's Republican members, and he also invited Democrats to participate.

"I believe many would respond favorably to your willingness to brief Members of the House before the Majority changes hands in the new year," Barton said.

Berwick has been heavily criticized by Republicans, who claim he wants to ration seniors' healthcare.

The number of HIV/AIDS cases in Africa is on pace to far outpace treatment resources by the end of the decade, according to an Institute of Medicine report released Monday.

By 2020, the number of infected people in Africa will grow to more than 30 million from today's approximately 22 million. Only about 12 million of those 30 million will be eligible for antiretroviral therapy (ART) paid for in part by the President's Emergency Plan for AIDS Relief (PEPFAR) and other international efforts; and of those eligible, a little more than half — 7 million — will be likely to receive treatment, according to the report.

"Already in Uganda and a few other nations, we don't have enough healthcare workers or ART to meet demands, and health centers are increasingly turning away patients who need these drugs to survive," said David Serwadda, a former dean of a School of Public Health in the east African nation and co-chair of the committee that wrote the report. "There is an urgent need for African countries and the U.S. to share responsibility and initiate systematic planning now for the future. If we don't act to prevent new infections, we will witness an exponential increase in deaths and orphaned children in sub-Saharan Africa in just a couple of decades."

The report calls for a renewed emphasis on reducing the rate of new infections, promoting more efficient models of care and encouraging shared responsibility between African nations and the U.S. for treatment and prevention efforts. In particular, the report notes that because treatment can only reach a fraction of those who need it and its costs are "not sustainable for the foreseeable future," preventing new infections should be a central tenet of a long-term response to HIV/AIDS in Africa.

The House and Senate both have hefty health agendas Monday as they attempt to pass several remaining items before the new Congress takes over.

Delaying the SGR showdown … again: The House is expected to take up a one-month "fix" to the Medicare Physician Payment System under suspension of the rules this evening. If the House doesn't act, doctors face a 23 percent cut in Medicare payments starting Wednesday.

The Senate passed a bipartisan, $1 billion fix on Nov. 18. It's paid by cutting therapy service payments by 20 percent and using those savings to pay for the "doc fix" instead of redistributing them into the Medicare Physician Fee Schedule. http://bit.ly/cZd9fw

Food-safety bill includes 1099 provisions: The Senate may for the first time repeal a provision of Democrats' healthcare reform bill when it takes up food-safety legislation today.

According to Senate staff, the timeline should start with a cloture vote on the final bill, as amended by the small-farms exemption from Democratic Sens. Jon Tester (Mont.) and Kay Hagan (N.C.). The procedural motion will need 60 votes to pass.

This will be followed by a vote on four amendments, all requiring a 67-vote threshold: 

• Sen. Mike Johanns's (R-Neb.) amendment to repeal the 1099 provision (this is offset by unspent and unobligated federal dollars, to be identified by the Office of Management and Budget);

• Sen. Max Baucus's (D-Mont.) alternative amendment to repeal 1099 without paying for it (this would add to the deficit but at the same time lower the cost of repealing healthcare reform, a Republican priority);

• Sen. Tom Coburn's (R-Okla.) moratorium on congressionally directed appropriations; and 

• Coburn's food-safety substitute amendment, which is an alternate, stripped-down food-safety proposal.

The vote on amendments will be followed by a final vote on the food-safety bill, which will require a 51-vote threshold.

The House passed its version of the legislation in July 2009. It's not clear how the Senate and House versions would be reconciled.

Healthcare law repeal gains momentum in courts: A decision this week by a federal judge in Ohio marks at least the third time a legal challenge to Democrats' healthcare law has been allowed to go forward, underscoring the extent to which the legal push for repeal is gaining momentum.

While top-ranking Republicans have acknowledged that they won't be able to fulfill their campaign promise to “repeal and replace” the law so long as a Democrat sits in the White House, many see promise in the court fight against it. A number of Republicans have signed onto a 21-state challenge to the law that seems almost certain to end up at the Supreme Court. 

Newly elected governors in at least five states are also preparing to join the fray, even as advocates of the law push back. http://bit.ly/h1wESs

Administration says healthcare law can survive without mandate: Obama administration officials this week told a federal judge that even if the healthcare reform law's individual mandate is ruled unconstitutional, other parts of the law should be allowed to stand. http://bit.ly/g49YFA

Medicaid could be paying for unapproved drugs: A new report from the Health and Human Services Department's Office of Inspector General found that 38 percent of drugs paid for by Medicaid in 2008 did not have an approved application number in the National Drug Code (NDC) Directory or were not in the NDC directory at all.

"As a result, Medicaid could potentially pay for drugs that are not approved by FDA," the report found. "Without accurate approval and listing information, it is impossible to determine whether these drugs were paid for appropriately." http://bit.ly/dSZ14V

Task force created to protect agents and brokers: The National Association of Insurance Commissioners announced Wednesday the creation of a new task force to try to protect insurance agents and brokers from the side effects of Democrats' healthcare reform law. Some liberals say agents and brokers should go the way of the travel agent when state insurance exchanges with standardized offerings are up and running in 2014, but the NAIC says they will still serve an important function. http://bit.ly/eLBSMw

Kuwait disses U.S. model in pursuit of healthcare reform: According to Nadeem Al-Duaij, chairman of the nonprofit Kuwait Health Initiative that's helping reform the health sector in that country: "There currently exists no evidence to support the use of for-profit insurances to finance a nation's health care in a fair and cost-effective manner. Quite the contrary, such mechanisms have time and again resulted in poor health outcomes, in inequalities in health care access and delivery, and in an inability to contain rising health care costs. We believe in the need for health insurance to protect the individual from catastrophic health expenditures but this must be done through the adoption of a non-profit social health insurance or similar scheme that is supported by current health policy evidence." http://bit.ly/e28UIZ

A number of Republicans have signed onto a 21-state challenge that seems certain to end up at the Supreme Court.

That argument, known as severability, is crucial to the law's survival should a judge rule that the mandate is unconstitutional.