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Health Care Issues to Follow in 2015

Republican control of both the House and the Senate has the potential to change the dynamic on a number of major health care issues in the 114th Congress.

Efforts to repeal or modify provisions of the Patient Protection and Affordable Care Act (PPACA) are to be expected. Republicans will likely focus on changes like repeal of the medical device tax and repeal of the Independent Payment Advisory Board (IPAB), both of which have some Democratic support. As House Republicans do not have enough votes to override a veto by President Obama, any attempts to repeal the law in its entirety will not be successful.

Further evolution in the transition to value-based reimbursement is expected in 2015. On December 1, 2014, the Centers for Medicare and Medicaid Services (CMS) released their proposed rule that would make a number of significant changes to the Medicare Shared Savings Program (MSSP). Most significantly, CMS proposes to implement changes to the beneficiary assignment process that would allow certain specialists to participate in multiple Accountable Care Organizations (ACOs). Many specialty groups have chosen not to participate in ACOs due to the exclusivity requirement in current regulations.

The issue of network adequacy will also be important to monitor in the coming year. Some of the new health plans on the exchanges have begun offering consumers networks that exclude certain doctors, hospitals and other medical providers in an attempt to control costs. Concerns have been raised that these networks will have a negative impact on provider access and choice. In November of 2014, the National Association of Insurance Commissioners (NAIC) released a draft model law to revise the Managed Care Network Adequacy Model Act, which has not been updated since it was first introduced in 1996. CMS has stated its intent to revise the agency's own network adequacy laws based on NAIC's recommendations.