The Policy Committee took a break while congress was in recess this month.  The Policy Program Monitoring Team PPMT hosted an “all SORH” invited meeting in October. Harvey Licht (Varela Associates) shared information on essential community providers, comparison of changes in benefits for qualified health plans. To listen to a recording of the meeting click here

The following update was provided by Hall Render, NOSORH Legislative Liaison:

Congress Breaks in October

With the November elections looming, the House and Senate are out of session for the bulk of October and early November.  Both chambers will return on November 14 for the final month of legislative business in the 114th Congress.  Upon return, Congress will have until December 9, to pass an omnibus spending bill to fund the federal government.  Any rural health related legislation that moves in the lame duck session will most likely be included in the omnibus measure.

CMS Issues Final MACRA Rule

On October 14, CMS published the Final Rule for the new Merit-Based Incentive Payment System (“MIPS”) and Advanced Alternative Payment Models (“AAPMs”) pathways to payment pursuant to the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). MACRA will impact providers starting January 1, 2017.

As background, MACRA permanently repealed the sustainable growth rate formula for calculating physician fee schedule payments and, in its place, implemented two performance-based incentive payment pathways.  The two pathways are to either: (1) participate in MIPS and receive a positive or negative physician fee schedule adjustment associated with MIPS performance; or (2) participate in an AAPM, earn separate incentive payments and be excluded from participating in MIPS.

An “Eligible Clinician” under the QPP is a provider who bills under the Medicare Physician Fee Schedule for at least $30,000 per year or provides care for more than 100 Medicare patients per year and is: (1) a physician; (2) a physician assistant; (3) a nurse practitioner; (4) a clinical nurse specialist; or (5) a certified registered nurse anesthetist. If 2017 is the first year a provider is participating in Medicare Part B, the provider may be exempt.

In the Final Rule CMS sought to address concerns about the impact on small and rural practices by broadening its exclusion for providers who treat a low volume of Medicare patients from MIPS. CMS will exempt physician practices with less than $30,000 in Medicare charges or fewer than 100 unique Medicare patients per year. The draft rule had set the threshold at $10,000 a year.

The final rule also puts in effect policies related to blocking of health information and EHR surveillance that apply to all hospitals, critical access hospitals and physicians.

One area not addressed in the Final Rule relates to telemedicine.  The 2015 MACRA law called for telehealth and remote monitoring to be included in scoring under the MIPS program. But the CMS rule only included a couple of ways to use the technology. CMS said Medicare’s long-standing legal limits on only paying for live interactions at rural facilities as the reason for the little mention of telehealth.  Congress will attempt to address telehealth legislation following the November elections.

CMS acknowledges in the Final Rule the significant administrative burden associated with transitioning to MIPS and AAPMs and has provided substantial flexibility through various transition year participation options starting in 2017.

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