CMS Releases Final Payment Rules for Physicians, Hospitals, HHA and ESRD Facilities

CMS issued final Medicare payment rules under which physicians could see a 21.2% reduction from current rates between April and November 2015 if Congress does not act on either another temporary fix or permanent legislation to replace the sustainable growth rate (SGR) formula. For physicians managing the care of beneficiaries with two or more chronic conditions, CMS will make a payment of $40.39 up to once per month for non-face-to-face chronic care management services. The 2017 Physician Quality Reporting System (PQRS) payment adjustments will include 20 new individual quality measures and two new measure groups. The final rule also removes 50 measures from the PQRS. Of note, CMS said it will revise the process used for establishing fee schedule payment rates by allowing for public comments to be made on changes before they become effective. The CMS final outpatient prospective payment rule for hospitals for 2015 will allow for an increase of 2.3% over the level of payments this year. Among other things, the Outpatient Prospective Payment System (OPPS) rule also encourages the packaging of items and services for 25 high-cost device related services by allowing for an encounter-based comprehensive payment. CMS said that ambulatory surgical center (ASC) payment rates will increase by 1.4%. The CMS final rule for end-stage renal disease (ESRD) facilities includes a zero percent increase in the payment rate and a $30 million increase in outlier threshold payment amounts. Among other things, the rule includes the PPACA mandate for the use of competitive bidding for durable medical equipment. The CMS final rule for home health agencies provides for a reduction of 0.3% in the payment rate for 2015. Among other things, the rule also includes the establishment of a minimum threshold for the submission of Outcome and Assessment Information Set (OASIS) assessments for purposes of quality reporting compliance.

Push to Restrict MA Plan Ability to Limit Provider Networks

Senator Richard Blumenthal (D-CT) and Rep. Rosa DeLauro (D-CT) announced that they are prepared to press for the passage of their legislation, the Medicare Advantage Participant Bill of Rights Act (H.R. 4998/S. 2552), which would require Medicare Advantage organizations to offer 60 days’ notice to enrollees before removing a physician from their provider networks and prohibit such removal in the middle of a plan year.

MACPAC Considers Extension of Medicare Payment Rates for MDs

The Medicaid and CHIP Payment and Access Commission (MACPAC) discussed whether to recommend that Congress extend the 100% matching federal funds program for states that pay Medicare rates to primary care physicians serving the Medicaid population. A recommendation was not made in that the commission concluded there is a lack of data on the effectiveness of the current policy. In related news, CMS said that regulations are coming next year with respect to managed care organizations providing services to Medicaid beneficiaries.

Upcoming Congressional Hearings and Markups

Senate Appropriations Committee: hearing to be held on U.S. Government Response to the Ebola Outbreak; 2:00 PM; SD-G50 Dirksen SOB; November 12.

House Veterans’ Affairs Committee: hearing to be held on Assessing the Implementation of the Veterans Access, Choice, and Accountability Act of 2014; 10:00 AM; 334 Cannon HOB; November 13.

House Veterans’ Affairs Subcommittee on Health: will hold a hearing on the following health bills: H.R. 4720 (Medal of Honor Priority Care Act); H.R. 4977 (COVER Act – related to mental health issues); H.R. 5059 (Clay Hunt SAV Act - related to mental health and suicide prevention); H.R. 5475 (to improve newborn care); and H.R. 5484 (Toxic Exposure Research Act); 9:00 a.m., 334 Cannon Building; November 14.

House Veterans’ Affairs Committee: hearing to be held on VA’s Longstanding Information Security Weaknesses are Increasing Patient Wait Times and Allowing Extensive Data Manipulation; 1:30 PM; 334 Cannon HOB; November 18.

December 31, 1969: | Page 1 Page 2 Page 3



 -  2018