CMSA Today - Issue 6, 2012 - (Page 24)

CMSA View from Capitol Hill continued from page 23 Case Management and the Law them to leave behind with their legislators. They contained key, clear, concise information about CMSA, NTOCC, the Case Management Model Act, some of the successful integrated care models and care transitions projects, and links to the websites hosting these projects’ evidence-based outcome data. Again, we would not have this data if it weren’t for research. So as you can see, research has a great deal to do with politics. Research is not a bad word; it should no longer send chills up a case manager’s spine. We should all embrace it, have fun with it, and make sure everyone involved in your research understands the goal and buys into them and predicted outcomes. Good outcomes can equal good care. Good care can equal cost savings for everyone. So the next time you see an RFP (request for proposal) or a grant opportunity come across your desk, take the time to look at it and think about how you can get involved and make it fun. By the way, there is a new grant funding entity on the scene that you should be aware of. It is called the Patient-Centered Outcomes Research Institute (PCORI). It was created to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions. For those of you who attended our last CMSA Public Policy Summit, you got to meet PCORI’s executive director and hear what Dr. Joe Selby had to say about PCORI’s funding opportunities first hand. You can find out more about PCORI at Your PPC is ready to answer your questions, support your lobbying activities, and communicate your research efforts. So don’t hesitate to contact us. And remember to be a partner in your own health care; it is the only way we are going to make a difference. Stay involved, be active. Together we can make a difference. ■ U.S. Supreme Court Upholds Health Care Reform Law n June 28, the U.S. Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (ACA) on several key legal issues. The focus of the ruling was the Court’s decision to uphold the health care reform law’s Individual Mandate by a vote of 5 to 4. The decision is being considered a victory for the Obama Administration with one small caveat: the ruling does limit part of the BY GARRY CARNEAL, JD, MA Medicaid expansion provision. O AND CATIE FULTON, JD In an opinion drafted by Chief Justice John Roberts and four other Justices (aka the majority), the Court found that the mandate was not constitutional under the Commerce Clause. However, the Court upheld the Individual Mandate under Congress’ taxing power. In contrast, Justices Anthony Kennedy and three other justices (aka the minority) asserted that the entire health care reform law should have been struck down. The Court also rejected the states’ challenge to the expansion of the state Medicaid programs, although the Court held that this provision must be narrowed. Specifically, the decision states, “Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.” The other legal issues in the case were either dismissed or not acted upon with any affirmative action by the Court. order of the oral arguments that took place last March. • Legal Issue No. 1: Understanding the Tax Issue. Last spring, the Justices received legal briefs and heard oral arguments that centered on the issue of legal standing – specifically, whether the parties suing have the ability to bring the case before the U.S. Supreme Court at this point in time. At issue is whether or not the Anti-Injunction Act of 1867 effectively renders the case moot, or premature, until the tax goes into full effect several years from now. Uninsured individuals will not begin paying the tax penalty for being uninsured until 2014. Thus, some argued that the Court should delay ruling on the case until the tax was fully implemented. The majority opinion did not address this issue, but the Court effectively ruled that the Anti-Injunction Act does not apply in this case. • Legal Issue No. 2: Is the Individual Mandate Legal? The Court also considered whether the Commerce Clause of the U.S. Constitution delegates to the federal government the authority to regulate interstate commerce pursuant to PPACA’s Individual Mandate. More simply, can the federal government force someone two buy health insurance or pay a penalty if they don’t already About the Author Margaret Leonard, MS, RN-BC, FNP is Senior Vice President for Clinical Services at Hudson Health Plan. 24 CMSA TODAY A REVIEW OF THE FOUR LEGAL ISSUES As covered in the last issue of this column, here are the four central issues that were decided by the Justices in Issue 6 • 2012 • DIGITAL

Table of Contents for the Digital Edition of CMSA Today - Issue 6, 2012

VA Connecticut Healthcare System Improves Cancer Care
Operation: We Care
The Path to Payment for the Medicare and Medicaid EHR Incentive Programs

CMSA Today - Issue 6, 2012