Hospital Payment Bills Introduced in the House

On July 29, the House Ways and Means Committee introduced a number of bills seeking to reform Medicare’s payment to hospitals. The bills are said to be part of a larger hospital-related bill that will be introduced this fall.

Health Subcommittee Chairman Kevin Brady (R-TX) introduced H.R. 3292, the Medicare IME Pool Act. The legislation would instruct the HHS Secretary to give each teaching hospital a lump-sum payment to reimburse indirect medical education costs instead of paying the hospital an additional percentage based on each inpatient case.

Ways and Means Committee Chairman Paul Ryan (R-WI) introduced H.R. 3291, the Medicare Crosswalk Hospital Code Development Act of 2015. The bill would allow the Medicare program to compare what it pays for similar surgical services in different payment systems. The bill seeks to create a coding system for 10 surgical Medicare Severity-Diagnosis Related Groups and serve as a guide to connecting the inpatient and outpatient coding and payment systems for hospitals.

The third bill (H.R. 3288) would instruct the HHS Secretary to provide eligible hospitals DSH payments on a lump sum basis, rather than as a per discharge add-on payment. The bill summary states this legislation is needed because hospitals in states that didn’t expand Medicaid are receiving lower DSH payments compared to hospitals in states that expanded under the ACA.

House Holds Rural Health Hearing

On July 28, the Ways and Means Health Subcommittee held a hearing on rural health care disparities created by Medicare regulations.

In his opening statement, Chairman Kevin Brady (R-TX) criticized Medicare’s 96-hour rule, which requires physicians to certify that it is reasonable that a patient would be discharged or transferred to a hospital within 96 hours after admission to a critical access hospital. Brady indicated that the 96-hour cutoff does not always match the medical reality for patients seeking treatment in rural areas. He also discussed physician shortages and the disruption of access to care for rural beneficiaries due to Medicare rules that bar physician assistants from providing certain services.

At the hearing, rural hospital leaders urged Congress to support legislation that would prevent CMS from enforcing the 96-hour rule and adopt a default “general supervision” standard that provides relief from Medicare rules that require practitioners to provide direct supervision over various routine outpatient services.

NOTICE Act Passes Senate, Heads to White House

On July 27, the Senate unanimously passed the Notice of Observation Treatment and Implication for Care Eligibility Act (“NOTICE Act”) (H.R. 876). The Senate Finance Committee approved the bill in June after it passed the House earlier this year. The legislation has been delivered to President Obama for his signature and could be signed into law as early as next week.

Under the NOTICE Act, hospitals are required to notify Medicare enrollees when they receive hospital observation care under outpatient status within 36 hours of being placed under observation. The bill also requires hospitals to explain how outpatient observation status impacts beneficiaries’ treatment costs and eligibility for Medicare coverage for post-acute and nursing home care.

Post-Acute Care Legislation Introduced in the House

Also on July 29, Ways and Means Health Subcommittee Chairman Brady introduced a bill (H.R. 3298) that would establish a value-based purchasing program across four settings in Medicare: home health agencies; skilled nursing facilities; inpatient rehabilitation facilities; and long-term care hospitals.

The program would use one quality measure, the Medicare Spending per Beneficiary measure, for which the HHS Secretary would be required to establish a performance standard for each provider type. HHS would award a point value to each provider based on the level of improvement or achievement in any given year and calculate incentive payments based on that performance.

Health-Related Bills Introduced This Week

Rep. Renee Ellmers (R-NC) introduced the Further Flexibility in HIT Reporting and Advancing Interoperability Act (H.R. 3309) to delay Meaningful Use Stage 3 rulemaking for the Medicare and Medicaid EHR Incentive Programs. The bill would delay rulemaking until at least 2017 or until at least 75 percent of physicians and hospitals are successful in meeting Stage 2 requirements. The legislation would also institute a 90-day reporting period for each year and expand hardship exemptions.

Rep. Sam Graves (R-MO) introduced the Save Rural Hospitals Act to address rural health care shortages. The bill (H.R. 3225) is intended to improve local access to emergency care and allow hospitals to offer outpatient care in rural communities. The bill would also eliminate the Medicare sequester for rural hospitals and permanently extend the rural ambulance payment.

Rep. Lynn Jenkins (R-KS) introduced a bill (H.R. 3355) to allow non-physician providers to supervise cardiac, intensive cardiac and pulmonary rehabilitation programs. The legislation would apply to physician assistants, nurse practitioners and clinical nurse specialists.

Next Week in Washington

The House finished its summer session this week and will return in September. The Senate returns next week to debate a bill prohibiting the federal funding of Planned Parenthood. The measure will require 60 votes and it’s unclear whether enough Democrats will join Republicans in supporting the bill to win passage.