MedPAC Approves Recommendations to Congress

Last week the Medicare Payment Advisory Commission voted to approve several Medicare payment policy changes.  The recommendations on therapy caps requested by Congress would: reduce the certification period for outpatient therapy plan of care from 90 to 45 days; develop national guidelines for therapy services, implement payment edits at the national level based on guidelines that target implausible amounts of therapy and use PPACA authority to target high-use geographic areas and aberrant providers; reduce the cap for physical therapy and speech-language pathology services combined and the separate cap for occupational therapy to $1,270 in 2013 and update the caps annually by the Medicare Economic Index; direct HHS to implement a manual review process for requests to exceed cap amounts and provide the resources to CMS for this purpose; permanently include services delivered in hospital outpatient departments under therapy caps; apply a multiple procedure payment reduction (MPPR) of 50% to the practice expense portion of therapy services provided to the same patient on the same day; prohibit the use of V-codes as principal diagnoses on therapy claims; and collect functional status information on therapy users using a streamlined, standardized assessment tool that reflects factors such as a patient’s demographic information, diagnosis, medication, surgery and functional limitations to classify patients across all therapy types.  The recommendations on Medicare physician payment work adjustments would provide for adjustments to reflect geographic differences across labor markets for physicians and other health professionals.  However, MedPAC said Congress should allow the geographic practice cost index (GPCI) floor to expire as under current law and adjust payments for the work of physicians and other health professionals only by the current one-quarter GPCI.  HHS should be directed to develop an adjuster to replace the current one.  As to current three temporary add-on payments for ambulance services, MedPAC recommended that they be allowed to expire this year.  MedPAC also recommended that HHS "rebalance" ambulance payments in a revenue neutral way to pay less for basic life support and to pay more for other ground services.  MedPAC also discussed but could not resolve whether or not to recommend a penalty on home health care agencies whose patients are admitted to hospitals at an unusually high rate.  The commission also discussed, without resolution, making several changes with respect to MA special needs plans, such as to permanently reauthorize institutional needs plans and D-SNP plans covering dual eligibles if they assume clinical and financial responsibility for integrated benefits.  However, they are considering the current authority for chronic care plans to expire.

HHS OIG Approves Flat Rate Compensation

In an advisory opinion released by the HHS Office of Inspector General, the agency said that the practice by hospitals to pay flat or per diem fees to specialty physicians for providing on-call services in hospitals is ok if the arrangements meet certain conditions, including an independent review of set rates paid for actual and necessary services.

NIH Creates National Down Syndrome Registry

NIH has provided a contractor with $300,000 to develop and operate a national Down syndrome patient registry to facilitate care coordination and information sharing among families and researchers.  Individuals with Down syndrome and their families would be able to access the registry to create a customized profile, access the patient’s health history, input and update contact information, select which patient data should be displayed, receive reminders about the patient’s medical care and compare the patient’s medical information with anonymous data on other registry participants.

Health Legislation Recently Introduced

H.R. 6580 (VETERANS’ HEALTH), to amend Title 5, United States Code, to allow veterans who receive health care from the Department of Veterans Affairs to be eligible for supplemental dental and vision insurance under the Federal Employees Health Benefits Program; FUDGE; jointly, to the committees on Oversight and Government Reform and Veterans’ Affairs, Oct. 26.

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