Congress chose to end 2015 with some last-minute Medicare reforms impacting healthcare providers. Significantly, the Patient Access and Medicare Protection Act, signed into law by President Obama on December 28, 2015, includes provisions aimed at identity theft protections, exception from meaningful use requirements, radiation therapy rates, fee awards for Medicare Administrative Contractors (MACs), and payment for complex rehabilitative wheelchair accessories.

Identity Theft Protections

The Act strengthens the penalties for the knowing and willful purchase, sale, or distribution of a Medicare, Medicaid, or CHIP beneficiary identification number or a unique health identifier for a healthcare provider. The penalty is now imprisonment for up to 10 years or a fine of not more than $500,000 ($1 million in the case of a corporation) or both. Providers should make their employees aware of the enhanced penalties and also consider the safeguards they have in place to prevent the distribution of beneficiary identification numbers or unique health identifiers inasmuch as the Act does not define the term “distribution.”

Exceptions From Meaningful Use Requirements

Hospitals, physicians, and other eligible professionals seeking relief from financial penalties for failing to meet Stage 2 Meaningful Use requirements in 2015 will find it easier to apply for hardship exceptions. The Act permits the Centers for Medicare and Medicaid Services (CMS) to grant certain exceptions to the meaningful use penalties on a blanket basis rather than case-by-case to eligible professionals and hospitals for hardships described on the CMS website prior to December 15, 2015. For hospitals, the exceptions include (1) areas with significant Internet infrastructure limitations, (2) new eligible hospitals, (3) extreme and uncontrollable circumstances (e.g., natural disaster areas), and (4) electronic health records (EHR) vendor difficulties. Eligible hospitals must apply for these new exceptions by April 1, 2016, and eligible professionals must apply by March 15, 2016. Certain case-by-case exception deadlines are later.

However, the impact of the Act is uncertain, given that Acting CMS Administrator Andy Slavitt recently announced that “the meaningful use program as it has existed, will now be effectively replaced with something better.” Slavitt laid out the themes of the new program, which are consistent with the agency’s value-based purchasing approach:

  • Moving away from rewarding providers for the use of technology and rewarding providers for the outcomes they achieve with the technology
  • Adopting provider-specific technology goals to meet the provider’s rather than government’s needs
  • Requiring open application programming interfaces so providers are not locked in by their EHR decisions (e.g., they can easily move data in and out of their programs securely)
  • Requiring technology interoperability

Radiation Therapy Rates

The Act also freezes Medicare payment rates for certain radiation therapy services (HCPCS G-codes G6001 through G6015) provided in freestanding radiation oncology centers in 2017 and 2018, as CMS transitions those services to a new, episodic alternative payment model in 2019. The new law also requires HHS to submit a report to Congress on the development of the episodic payment model within 18 months.

MAC Fee Awards

Providers can expect to see additional efforts focused on reducing improper payments from the MACs. The new law provides incentives to MACs to reduce the improper payment error rates, which may include a sliding scale of award fee payments and additional incentives as well as “substantial reductions” in award fee payments under cost-plus-award MAC contracts. The incentives apply to contracts entered into or renewed by CMS on or after December 2018.

Payment for Complex Rehabilitative Wheelchair Accessories

Finally, the Act limits CMS’s ability to consider competitive pricing information when establishing payment rates for complex rehabilitative wheelchair accessories prior to January 1, 2017.