Lawmakers Continue Negotiations on Doc Fix Package, Working Framework Announced

With the current patch expiring on March 31, lawmakers continued over the weekend to negotiate a legislative package to permanently repeal Medicare’s automatic payment cut to physicians. H.R. 1470 is very similar to the bipartisan legislation that key committees in both chambers approved last year. It provides an annual pay increase of 0.5 percent to physicians through 2019 and establishes an incentive payment program, titled “Merit-Based Incentive Payment System” (MIPS), to assess eligible professionals in quality, resource use, electronic health record (EHR) Meaningful Use (MU), and clinical practice improvement activities. It consolidates three current incentive programs – the Physician Quality Reporting System (PQRS), the Value-Based Modifier, and MU of EHRs. The legislation also provides financial incentives for professionals to become involved in alternative payment models.

Other provisions of H.R. 1470 address care management for individuals with chronic care needs, transparency of utilization and payment data for physicians and professionals, expansion of claims data availability, automatic renewal for professionals who opt-out of Medicare, and the reporting of such professional characteristics. The bill requires EHRs to be interoperable by 2018 and prohibits the purposeful blocking of information sharing with other EHR vendor products. The Secretary of the Department of Health and Human Services is required to issue a report providing recommendations on a permanent physician-hospital gainsharing program, as well as a report to examine the feasibility of establishing mechanisms to assist providers in comparing and selecting EHR technology products. The Government Accountability Office is to report on aspects of telehealth and remote patient monitoring services.

The working summary of the SGR package released by the House committee leaders includes fully funding the Children’s Health Insurance Program (CHIP) through September 30, 2017. It extends all of the extenders in the current patch, in addition to funding for Community Health Centers, through 2017. The framework would permanently extend the Qualifying Individual Program and the Transitional Medical Assistance program, and the Tennessee Disproportionate Share Hospital (DSH) Allotment would be extended through 2015. The legislation also includes two Medicare bills: H.R. 284, the Medicare DMEPOs Competitive Bidding Improvement Act and H.R. 1021, the Protecting Integrity to Medicare Act.

The policies that reduce the legislation’s cost that are provided in the working framework include: income-related Medicare Part B and D premium adjustments, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, an incremental phase-in of the 3.2 percentage point adjustment to hospital’s base payment rate in FY 2018, a delay of Medicaid DSH changes until FY 2018 and extension of the policy through 2025, and a 1 percent market basket update for post-acute care providers.

Negotiations are steadily making progress, and the House could consider the legislation as early as this week. Notably, Democrats on the Senate Committee on Finance have expressed concerns about the current package, including the two-year extension of the Children’s Health Insurance Program (CHIP) (where they would like a four-year extension), offsets that would increase costs to beneficiaries, and the impact of health centers language on women’s health services. On the other side of the aisle, some conservative lawmakers remain concerned about the cost of the total proposed package and the potential approach that would only provide for partial offsets.

This Week’s Hearings:

  • Tuesday, March 24: The House Committee on Ways and Means Subcommittee on Oversight will hold a hearing titled “The Use of Data to Stop Medicare Fraud.”
  • Tuesday, March 24: The House Committee on Agriculture will hold a hearing titled “Examination of the Costs and Impacts of Mandatory Biotechnology Laws.”
  • Tuesday, March 24: The House Committee on Energy and Commerce Subcommittee on Health will hold a hearing titled “Examining the 340B Drug Pricing Program.”
  • Tuesday, March 24: The Senate Committee on Health, Education, Labor, and Pensions (HELP) will hold a hearing titled “Continuing America’s Leadership: Advancing Research and Development for Patients.”
  • Tuesday, March 24: The Senate Committee on Veterans’ Affairs will hold a hearing titled “The Veterans Choice Act – Exploring the Distance Criteria.”
  • Wednesday, March 25: The House Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will hold a hearing titled “Centers for Disease Control and Prevention Budget.”
  • Wednesday, March 25: The House Committee on Veterans’ Affairs will hold a hearing titled “Examining Access and Quality of Care and Services for Women Veterans.”
  • Wednesday, March 25: The Senate Committee on Appropriations Subcommittee on Defense will hold a hearing to review the FY 2016 funding request and budget justification for the Defense Health Program.
  • Wednesday, March 25: The Senate Committee on Aging will hold a hearing titled “The Fight Against Alzheimer’s Disease: Are We on Track to a Treatment by 2025?”
  • Thursday, March 26: The House Committee on Energy and Commerce Subcommittee on Oversight and Investigations will hold a hearing titled “Examining the Growing Problems of Prescription Drug and Heroin Abuse: State and Local Perspectives.”
  • Thursday, March 26: The House Committee on Appropriations Subcommittee on Commerce, Justice, Science, and Related Agencies will hold a hearing titled “Federal Investments in Neuroscience and Neurotechnology Oversight.”
  • Thursday, March 26: The Senate Committee on Veterans’ Affairs will hold a hearing titled “VA Opioid Prescription Policy, Practice, and Procedures.”