House Approves Legislation to Reduce Medicaid Fraud

On March 2, the House of Representatives unanimously passed a bill to improve program integrity in Medicaid and CHIP. The Ensuring Removal of Terminated Providers from Medicaid and CHIP Act (H.R. 3716) would help states identify health care providers whose participation in Medicaid or CHIP was terminated in another state to comply with the Affordable Care Act requirements that those providers be terminated nationwide. The Obama administration expressed its support for the passage of the bill on March 1.

The Energy and Commerce legislation follows an inspector general report issued by HHS that found that nearly 12 percent of terminated providers still participated in another state’s Medicaid or CHIP program. The bill would require providers participating in Medicaid and CHIP managed care to enroll with the state and would increase required reporting and standardized documentation of termination. The Congressional Budget Office (“CBO”) estimates that H.R. 3716 would save $28 million over 10 years.

Timeline for Post-Hospital Care Overhaul Under Review by MedPAC

On March 3, members of the Medicare Payment Advisory Commission (“MedPAC”) recommended that CMS officials take administrative action to more quickly create a path toward changing how Medicare pays for the care of seniors and disabled beneficiaries after being released from a hospital. According to MedPAC, the program paid $59 billion in 2013 for post-hospital care, more than double the amount in 2001.

Medicare has different reimbursement rates for four types of facilities, including skilled nursing homes, specialty inpatient rehabilitation centers, long-term care hospitals and at-home care, for patients that often have similar conditions. The Improving Medicare Post-Acute Care Transformation Act of 2014 (PL 113-185), sponsored by Ways and Means Chairman Kevin Brady (R-TX), introduced provisions to simplify the fragmented payment system and collect evidence on how different approaches to post-hospital care work. The law requires MedPAC to release its first report on the post-acute care payment overhaul and sets in place subsequent deadlines that leave the current system largely in place through 2026 or 2027.

CMS already is implementing several major demonstration projects in other fields of care to try to reward medical practices and hospitals for better coordinating care for patients. Commissioners also considered extending the time that patients are monitored from 60 days to 90 days after admission to determine the quality of care provided under a less fragmented approach to Medicare payments for post-hospital services. The group will vote in April on material for the report in which MedPAC will advise Congress on how to work toward a more unified payment system for the care that Medicare enrollees receive after being discharged.

Health-Related Bills Introduced This Week

Sen. Chuck Grassley (R-IA) introduced the Medicaid Directory of Caregivers Act (S. 2618) requiring state Medicaid programs operating on a fee-for-service or primary care case management basis to post on their website a directory of providers who billed Medicaid in the prior year. The online directory on the state’s Medicaid website would include the provider’s name, specialty, office location and telephone number. Rep. Chris Collins (R-NY) introduced a companion bill (H.R. 3821) in the House.

Rep. Vern Buchanan (R-FL) introduced the Preserving Patient Access to Post-Acute Hospital Care Act of 2016 (H.R. 4650). The bill extends certain long-term care hospital Medicare payment rules, including payment for hospitals-within-hospitals and the 25 percent patient threshold payment adjustment, until October 1, 2018.

Next Week in Washington

The House begins a week-long recess and will return March 14. The Senate returns next week to address a comprehensive bill on opioid addiction. The Senate HELP Committee will mark up a number of bills on Wednesday including a bill to encourage drug companies to develop Zika virus treatments and a number of FDA-related bills that are seen as a companion to the House 21st Century Cures Act.