The Policy Committee and the Policy and Program Monitoring Team continue the NOSORH efforts to ensure a response to CMS regarding payment methodologies for rural practices and the growing needs for technical assistance.  Comments are being crafted with information provided by SORH to the CMS Request for Information.  Request for Information (RFI) for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). “Our plan is to share the NOSORH comments with SORH to inform their efforts to respond to the CMS request.” Says Teryl Eisinger, NOSORH Executive Director.  Watch for emails on this later this week.

In an update from Capitol Associates last week, Nathan Baugh shared information on outgoing Speaker of the House, John Boehner, and the Obama Administration announcement that they have reached a tentative deal (full text) that would set spending levels for the next two years and extend the country’s borrowing authority until March, 2017. This deal (see summary) would avert the looming deadline in early November to raise the debt limit while also providing some amount of budgetary certainty for the next two years by setting top-line spending amounts. The deal also includes many other policy provisions such as changes to social security benefits and Medicare. “I want to make it clear that this deal does not avert a potential government shutdown this December. It does not fund the government. Rather, the deal sets the budget caps for various departments for the next year and raises the debt ceiling.” According to Baugh.

In regards to Medicare, this bill would prevent a pending 52% ($54 per month) increase in Medicare Part B premiums for 30% of the wealthiest beneficiaries. Under this bill, premiums would only rise by around $20 per month for those beneficiaries.

This bill increases federal spending by $80 billion over the next two years, which is split evenly between defense and domestic programs. Much of this is offset by selling oil from the country’s Strategic Petroleum Reserves. As an additional offset, the deal maintains 2% spending cuts in Medicare payments put in place by sequestration.

The bill also would lower some Medicare hospital payments by applying site-neutral payments to new, off-campus provider-based hospital outpatient department services (HOPD). The operative words in this policy are “new” and “off-campus”. “Off-campus” is defined as more than 250 yards from the main campus. For purposes of “new”, HOPDs that exist prior to the enactment of this law are not subject to this provision. Any provider-based HOPD that executes a provider agreement after this bill is enacted would not be eligible for reimbursement from the Medicare Hospital Outpatient Prospective Payment System (HOPPS). “New” provider-based HOPDs would be paid either under the Ambulatory Surgical Center Prospective Payment System (ASC PPS) or the Medicare Physician Fee Schedule (PFS), thus aligning payments for services paid by the HOPPS with other payment systems.

The provision in the bill excludes emergency department services (HCPCS codes 99281-99285) and maintains the exclusions established in Section 1833(t) of the Social Security Act for ambulance services, outpatient rehabilitation therapy services, diagnostic mammography or screening mammography. It also does not include services covered under a personalized prevention plan. Hospitals would be required to provide information to HHS in a method to be determined on how to implement this provision. The bill suggests using a code or modifier on claims to indicate the service was provided in an off-campus outpatient department. This is the first time site-neutral payments are implemented after a number of recommendations for such a policy from influential entities such as MedPAC.

This bill also repeals a provision from the Affordable Care Act (ACA) regarding the employer mandate. Under this bill, employers with more than 200 employees will no longer be required to automatically enroll new full-time equivalents (FTE) into a qualifying health plan and to automatically continue enrollment of current employees in one of the employer’s health plans.


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