Wednesday, April 23, 2014

Biden In Ukraine: "Thank You For Making Me Feel Relevant Again"

    Vice President Biden addressed Ukrainian legislators Tuesday in a committee room of the Rada, the Ukrainian parliament, where he began his remarks by thanking the legislators for "making me feel relevant again." Biden is in Ukraine to show support for the Ukrainian government as that country faces continued pressure and threats from Russia.  Biden's "relevant" comments were a reference to his time as a legislator in the United States:
I want to thank my colleagues for bringing me back home. For 36 years I sat in our legislature, and I used to actually have this seat in our -- I was the chairman of our committee. Thank you for making me feel relevant again, back in a legislative body.
He went on to encourage the Ukrainians to continue to strive for energy independence with the goal of being able to tell Russia to "keep your gas":
And as you attempt to pursue energy security, there’s no reason why you cannot be energy secure. I mean there isn’t. It will take time. It takes some difficult decisions, but it’s collectively within your power and the power of Europe and the United States. And we stand ready to assist you in reaching that. Imagine where you’d be today if you were able to tell Russia: Keep your gas. It would be a very different world you’d be facing today. It’s within our power to alter that.
Biden is well known for his colorful comments throughout his career in public service, and his remarks to the Ukrainians are no exception.  Some additional excerpts:
I signed the book in the hotel as I was leaving today. The management asked me to sign their book, and I signed, “Ukraine united, Joe Biden.” 
I’ve been around, literally met every major leader in the world in the last 40 years... 
[A]n expert is anyone from out of town with a briefcase. Well, I don't have a briefcase, and I’m not an expert. 
I have an expression I use as I’ve gone around the world through my career is you never tell another man or woman what’s in their interest. 
Also to be very blunt about it, and this is a delicate thing to say to a group of leaders in their house of parliament, but you have to fight the cancer of corruption that is endemic in your system right now. It’s not just the United States. You need a court system that not only you and your people, but the rest of the world assumes can actually adjudicate fairly disputes among people. But you have a chance. You have a chance. 
And you may have different traditions. It’s not quite the same, but we understand different traditions in our country -- not as deeply as you do, but we are the most heterogeneous democracy in the world. We’re soon going to get the point where over 50 percent of the United States of America is made up of people of non-European stock; the majority of the American people are not of European origin in 2020. We understand. We have millions of Muslims. We have hundreds -- but it’s not quite the same. We’re not up against a border. We’re not sitting against a border of another powerful nation.
    The Vice President's complete comments are available here.

Note: A version of this post first appeared at The Weekly Standard.

Wednesday, April 16, 2014

U.S. Cosponsors U.N. Resolution to Fight Texting and Driving

    While crises continue in Ukraine, Syria, Iran, and the Central African Republic, the United Nations turned its attention to a different kind of crisis on Thursday: the "global road safety crisis."  The U.N. General Assembly held a session on Improving Global Road Safety in which the United States cosponsored a resolution "which calls for laws to fight texting and driving."  Ambassador Samantha Power tweeted the following:
    In her remarks at the session, Power noted that although "improvements in road design, traffic management, safety equipment, and emergency response" could help reduce the 1.2 million annual worldwide traffic fatalities, "[m]ost important, however, is driver behavior." She continued:
Excessive speed and a failure to obey traffic rules are both killers. The role of alcohol in traffic fatalities is also well documented and should never be understated. In recent years, however, we have faced a new and deadly threat in the form of driving while texting or talking on the phone. Research shows that cell phone users are over 5 times more likely to get in an accident than undistracted drivers. And that texting while driving can delay a driver’s reactions as much as a 0.08 blood-alcohol level, the same as a drunk driver. Already, in the United States, more teenagers are killed while texting than because they have been drinking. But the problem is neither confined to teenagers nor to highly-industrialized countries; it is spreading as fast as technology.
    It is unclear how the push for such bans will fare, particularly in less developed countries where drivers routinely take shortcuts on sidewalks, and red lights and stop signs often seem optional. However, Power cited a new law just passed in Maryland that was named for Jake Owen, a five-year-old who was killed when a distracted driver rammed the boy's family's car.  The law increases penalties for drivers found responsible for causing an accident while talking on a cell phone or texting.

Note: A version of this post first appeared at The Weekly Standard.

Under Obamacare, HHS Begins Fingerprinting "High Risk" Medicare Providers and Suppliers

    Four years after Obamacare became law, the Department of Health and Human Services (HHS) is notifying Medicare providers and suppliers of new fingerprint-based background checks.  Eventually, all individuals who hold a five percent or greater stake in a Medicare supplier or provider that is categorized as "high risk" will be subject to the requirement.  The provision is part of the Medicare, Medicaid, and CHIP Program Integrity Provisions (Title E) of the Affordable Care Act, and gives the HHS secretary broad discretion in applying the background check requirements depending on the potential for abuse, fraud and/or waste.
    The new requirements are spelled out in a document posted online on the website of the Centers for Medicare and Medicaid Services (CMS) last Friday.  The new rules will apply to both current and future enrollees who are classified as "high risk," the stated purpose being to weed out "bad actors" in the Medicare program and prevent any more from enrolling.
    This particular document is a "News Flash" from CMS's Medicare Learning Network and is addressed to suppliers and providers who submit claims for "Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and Home Health and Hospice (HH&H) MACs for services provided to Medicare beneficiaries."  There is no effective date or implementation date listed on the document; rather, the document states that "fingerprint-based background check implementation will be phased in beginning in 2014," and that those affected will receive letters after which the individuals will have thirty days to comply with the finger-printing requirement.  The fingerprints will be submitted to the FBI for a background check and will be stored by the government in accordance with federal requirements and FBI guidelines.
    Although initially the new regulations will only be applied to providers and suppliers of "Durable Medicare Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers or Home Health Agencies (HHA)," the "high risk" category is defined at the discretion of the HHS secretary and may be expanded in the future.

Note: A version of this post first appeared at The Weekly Standard.

Saturday, April 12, 2014

State Department Posts "Embargoed" Climate Change Press Release a Day Early

    Apparently someone at the State Department hit the "publish" button too soon.  This press release regarding the "Intergovernmental Panel on Climate Change Working Group 3 Report" appeared Saturday night on the State Department website, well ahead of its 5 AM Sunday scheduled release:

    No need to get up at 5 AM Sunday now. Whew!

Friday, April 11, 2014

White House Retweet: 'Kathleen Sebelius Is Resigning Because Obamacare Has Won'

    The first official word from the Obama administration on Kathleen Sebelius's resignation as secretary of health and human services is a retweet by the official White House Twitter account of a tweet by Vox.com's Ezra Klein:

    After news broke yesterday of Sebelius's imminent departure, Klein quickly posted an article entitled "Kathleen Sebelius is resigning because Obamacare has won."  The article was largely met with derision on the right, and even mainstream news reporting called into question the victorious characterization of Sebelius's exit.
    The president is set to speak at eleven o'clock Friday morning and is expected to announce that Sylvia Mathews Burwell, currently director of the Office of Management and Budget, will take Sebelius's place.

Note: A version of this post first appeared at The Weekly Standard.  Some nice coverage at Memeorandum, too.

Thursday, April 10, 2014

HHS Spending $800K on Studies to Help Family Planning Clinics Survive Obamacare

    Despite the Obama administration's insistence that everyone -- the government, insurance companies, doctors, medical providers, and consumers -- will reap benefits from Obamacare, a recent grant proposal by the Department of Health and Human Services (HHS) suggests that the agency does have concerns about the ongoing financial viability of one player in the health care market: so-called family planning centers.
    HHS intends to spend up to $800,000 to fund studies to "conduct data analysis and related research and evaluation on the impact of the Affordable Care Act (ACA) on Title X funded family planning centers." At least part of the concern centers on the ACA's provision that allows those 26 and under to stay on their parents' insurance, and how confidentiality considerations may impact the ability of Title X centers to cover their costs.
    The Title X program, which began in 1970 as part of the Public Service Health Act, is "the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services."  Included are contraceptives, breast and cervical cancer screening, pregnancy testing, screening/treatment for sexually transmitted infections (STIs), and HIV testing. Although Title X funds may not be used for abortion, many Title X centers provide abortions using funds from other sources. For instance, Planned Parenthood clinics perform over 300,000 abortions each year, and that organization is the only Title X provider actually listed by name on HHS's Title X website home page:
Services are provided through state, county, and local health departments; community health centers; Planned Parenthood centers; and hospital-based, school-based, faith-based, other private nonprofits.
     The studies that HHS's Orwellian-sounding Office of Population Affairs is soliciting fall into two categories.  The first seeks to assess the national impact, primarily financial, of Obamacare on Title X centers.  The second seeks a qualitative analysis on the impact of the Title X centers providing confidential services. Preserving confidentiality for Title X clients can hurt the centers' ability to be reimbursed for services due to the reporting requirements of state laws and regulations, as well as insurance company rules.  HHS is hoping to acquire case studies on how various Title X centers have managed to overcome this obstacle in order to share those techniques and strategies with other Title X providers.
    The financial concerns of family planning centers center on two areas.  First, HHS has been fielding complaints from family planning centers about "significant challenges" they are facing "negotiating adequate payment terms" with Marketplace private health plans.  On top of this are "continuing challenges" with Medicaid's "varying reimbursement policies around onsite dispensing of contraceptives and education and counseling[.]"  Mandated free contraceptives has been one of the highest profile and most controversial parts of Obamacare, but ironically that increased availability may end up financially harming the very family planning centers that are a significant provider of those contraceptives -- particularly to low income clients.
    The second category of studies looks for ways to mitigate the impacts of confidentiality requirements on family planning centers that can hamstring efforts to secure reimbursements, a problem that Obamacare will only exacerbate.  Since Obamacare aims to increase use of private insurance through the marketplaces, family planning centers will likely see an increase in difficulties obtaining reimbursements without the Explanations of Benefits (EOB) required by insurers.  Since claims details are available to the policy holders, clinics are often not able to file claims for family members wishing to keep their treatment at a family planning clinic private from a spouse or a parent.
    HHS says that "[f]ifty percent of family planning clients are under the age of 25," and under Obamacare, millions of young adults ages 19-25 are now able to remain on their parents' policies.  But along with that coverage comes a lack of privacy for those young adults who may not want their parents to know of their contraceptive use, HIV testing, or treatment for STIs.  HHS says that in "the long term, this practice [of not billing to maintain confidentiality] may result in unsustainable revenue losses for Title X centers."
    To help family planning centers, HHS would like these studies to find ways the clinics can deliver "services confidentially while being able to bill insurance for the visit," which would likely require suppression of EOBs and claims history:
Title X centers regularly forego billing for clients that request confidential services. They are generally unable to negotiate EOB and claims history suppression with issuers because of State laws and regulations. OPA [Office of Population Affairs] is requesting case studies and other qualitative data to identify mechanisms where Title X providers have successfully provided services confidentially while being able to bill insurance for the visit. The specific regulatory issues are not well understood and potential solutions have not been identified.
    HHS is also looking for these studies to provide the following:
  • An analysis of statutes, regulations, or other policies (such as issuer or provider policies) across the U.S. that affect the ability of Title X providers to bill insurance when services are requested confidentially. Such an analysis should discuss both challenges as well as potential policies that could serve as best practices. 
  • An analysis of successful business practices (such as contract negotiations) or issuer policies, business practices or other mechanisms that have resulted in the ability of centers to successfully bill insurance while maintaining client confidentiality. 
  • If “best practices” are located as part of the study, provide an evaluation of the impact to the Title X center’s revenue as a result of the practice. 
  • Based on the findings of the initial case studies, an intervention to test whether solutions (or “best practices”) can be implemented at other centers and an evaluation of such implementation in terms of the impact to revenue. Applicants should propose a methodology for an intervention.
    Grant applications from public or non-profit private entities interested in doing the studies are due by April 24, 2014.  Awards will be from $250,000 to $400,000 per year, and may be approved for a project extending up to three years, depending on the availability of grant funds in future years.

Note: A version of this article first appeared at The Weekly Standard.

Sunday, April 6, 2014

$1.5M Hotel Contract for President's One-Day Visit to Brussels

    In late March, President Obama took a week-long trip through Europe which included a stop of less than 24 hours in Brussels, Belgium for meetings with the European Union and NATO.  The president stayed at The Hotel, a twenty-seven story hotel in the center of the city.  The estimated cost for the president's stay, including about two weeks for an advance team, was $1,522,646.36.

    Despite reports that the president travelled with an entourage of 900, the Justification and Approval documents only indicate a need for "283 Lodging Rooms."  However, sometimes more than one hotel is used during VIP trips.  For instance, when the president travelled to South Africa for Nelson Mandela's funeral, five different hotels were used.
    Contracts for lodging have not yet been posted for the president's other stops during his European trip which included the Netherlands and Rome, Italy.

Note: A version of this post first appeared at The Weekly Standard.