AHCAA, Div A, Tit 2, part 2: Deciding what’s ‘basic service’

Woke up and realized the preceding posts are monsters even for me. Further, while I read really, really fast my typing skills are not keeping up. Finally, even though I’m a lot shorter than the bill there’s no way the preceding method is going to help ANYONE find what the bill says. So I’m going to try doing a LOT of shorter bursts, all with somewhat identifying titles as well as the bill location.

Sections 223 and 224 are, respectively, determining the committee that determines what is and is not the standards for basic essential services, and what the process for changing and approving the list.

It’s a huge committee with 19 members. The Surgeon General is the chair – and suddenly that position got more important. The President will appoint 9 non-federal employees (just like a lot of other boards such as the FCC) and the Comptroller General will pick 9 Federal employees. They’ll serve 3 year terms except for the initial assignment, at which 3 of each group get one year and three get two years – yep, another rolling committee.

Wait, Comptroller General? Who? What? That’s the head of the GAO (General Accounting Office), selected by the president from a group of three picked by a committee that is guaranteed to be somewhat bipartisan (includes majority and minority leaders of house and senate) who serves a non-renewable 15 year term. More relevantly, he also picks some members of the Medicare Payment Advisory commission.

Anyway, the members are supposed to be reflective of the breadth of health care services, needs, and relevant government agencies, with no single sector so large as to have undue influence. They make ‘recommendations’ to the secretary of HHS for standards of medical benefits to include cost-sharing numbers. In the process they’re supposed to look at the laws and policies of the states and to get public input. Once more it’s pretty much old hat to anyone who’s examined the starting of a major regulatory committee. Oh – recommendations. Technically most of these committees can’t make regs, they make recommendations which are then run through the relevant agencies’ regulatory engine. The agency refuse to accept them as is, but that is a serious can of worms (and the blowback gets nasty). See some of what happened under Bush with the FEC.

But when giving instructions on sausage making, all the nuts and bolts need to be there. So 224 details that move from recommendation to regulation. In this case, basically, the SecHHS has 45 days to take the recommendations and put them in the process or reject them as is (can of worms). For startup, the SecHHS and the committee have 18 months from passage of the bill to get regs and rules in place for the 2013 kickoff. If you’re counting and assume this gets passed at the end of this year, that’s summer of 2011 for a January 2013 kick-off. That gives everyone 18 months to get changes in place and deal with the inevitable lawsuits. mutter.

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