Policy Update

i Apr 5th No Comments by

The NOSORH Policy Committee is working to review language for reauthorization of the State Office of Rural Health program. It’s been 25 years since this legislation has been enacted.  The NOSORH Legislative Liaisons are working together with Policy Committee leaders to review the language for any needed changes and continues to monitor the appropriations process.  The following update is provided by Hall Render.

Stalled Budget Proposal Delays Appropriations Process

On March 16, the House Budget Committee passed a fiscal year 2017 budget resolution that continues to divide Republican lawmakers. House conservatives want the government funded at an amount less than the $1.07 trillion included in the budget resolution, which could force the Republican Leadership to pass a continuing resolution (CR) that funds the government at current levels. Although the House Appropriations Committee will begin consideration of the 12 annual spending bills that fund federal agencies, including HHS, Speaker Paul Ryan (R-WI) has indicated the full House will not vote on any of the bills until a budget is adopted.

The House budget proposal also requires Congress to consider legislation to reduce spending by at least $30 billion over the next two years and at least $140 billion over ten years. The budget resolution would repeal all of the Affordable Care Act and establish a private Medicare program to compete with the traditional Medicare program in 2024. Means-testing would be increased for Medicare enrollees with high incomes. Medicaid would transition into a block grant to give states more flexibility in operating the program, and able-bodied Medicaid beneficiaries would be subject to a work requirement. None of these proposals are expected to become law this year.

Senate Advances Mental Health Legislation

On March 16, the Senate Health, Education, Labor and Pensions (HELP) Committee passed a set of bipartisan mental health and opioid abuse bills that include provisions that address access to care, early intervention and shortages in the behavioral health workforce.

The HELP legislation includes a training demonstration program that would award grants to providers, including rural health clinics, to support training for medical residents, nurse practitioners, and physician assistants who provide mental and substance abuse disorder services in underserved settings. The bill does not address the Medicaid Institutions for Mental Diseases (IMD) exclusion because the committee does not have jurisdiction over the issue. The Senate Finance Committee may offer amendments that would repeal the IMD exclusion, which prohibits Medicaid reimbursements for enrollees receiving mental health care at hospitals with more than 16 psychiatric beds, before the legislation goes to the Senate floor.

The full Senate could take up the mental health legislation as early as late April. In the House, a path forward on mental health legislation is less clear. Rep. Tim Murphy (R-PA), sponsor of the major piece of mental health legislation (H.R. 2646) in that body, was critical of the Senate for not addressing the IMD exclusion language, among other provisions.

CMS Discusses New RHC Billing Requirements

On March 3, the Centers for Medicare and Medicaid (CMS) hosted a Rural Health Open Door Forum to discuss new requirements for Rural Health Clinic (RHC) billing. Beginning April 1, 2016, RHCs will be required to report the appropriate Healthcare Common Procedure Coding System (HCPCS) code for each service line along with a revenue code on their Medicare claims. Services furnished through March 31, 2016, should be billed without a HCPCS code.

A RHC visit must include one of the services listed on the RHC Qualifying Visit List. RHC qualifying medical visits are typically Evaluation and Management services or screenings for certain preventive services. RHC qualifying mental health visits are typically psychiatric diagnostic evaluation, psychotherapy, or psychoanalysis.

An RHC encounter must include one of the services on the qualifying visit list. The total charges for the encounter must be included on the qualifying visit line minus any charge for an approved preventive service. Encounters with more than one RHC practitioner on the same day, or multiple encounters with the same RHC practitioner on the same day, will be considered a single RHC visit and is payable as one visit, except for the following circumstances:

  • The patient, subsequent to the first visit, suffers an illness or injury that requires additional diagnosis or treatment on the same day;
  • The patient has a qualifying medical visit and a qualifying mental health visit on the same day; or
  • The patient has an Initial Preventive Physical Exam (IPPE) and a separate medical and/or mental health visit on the same day.

Medicare Administrative Contractors (MACs) will return to the RHC all claims with service lines that do not contain a valid HCPCS code.

CMS Proposes Overhaul of Part B Drug Payments

On March 8, CMS announced a proposed rule to change the way it pays for billions of dollars in Medicare drugs.  The new project through the Center for Medicare and Medicaid Innovation (CMMI) would allow the government to vary what it spends on drugs provided in the hospital or doctor’s office to test whether the existing payment model is encouraging doctors to use more expensive medicines that are less effective. The pricing experiment only applies to Medicare Part B, which pays for prescription drugs that are administered in a physician’s office or hospital outpatient department.

The program would let Part B pay 2.5 percent and a flat fee of $16.80 per day. Part B currently pays the so-called average sale price plus six percent for drugs administered by care providers. The agency would then study whether it has an impact on doctors’ prescribing patterns. CMS is accepting comments on the proposed rule through May 9, 2016. Republican lawmakers in the House and Senate issued a statement critical of the Administration’s proposal, vowing aggressive oversight of CMMI moving forward.

Rural Health Related Bills Introduced in March

Rep. Cathy McMorris Rodgers (R-WA) introduced the Unauthorized Spending Accountability (USA) Act (H.R. 4730) which is aimed at cutting funding for unauthorized government programs. The bill would pressure Congress to take action on government programs that have expired authorizations by subjecting the programs to a rolling sequester over three years. Funding for unauthorized programs would be reduced by 10 percent in the first fiscal year following expiration of authorization, and 15 percent in the second and third years following expiration of authorization. The unauthorized program would then sunset if Congress fails to act not later than three years after the date of reauthorization.

Sens. John Thune (R-SD) and Heidi Heitkamp (D-ND) introduced a bill (S. 2736) to protect access to durable medical equipment for Medicare beneficiaries living in rural areas. The Patient Access to Durable Medical Equipment Act would extend the current payment phase-in period for durable medical equipment from 6 months to 15 months to avoid significant cuts in reimbursement for such products.

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