Senator Urges Appropriators to Increase Hospital Preparedness Funding

On October 13, Sen. Bob Casey (D-PA) asked the Senate Appropriations Committee to increase funding for the Hospital Preparedness Program (“HPP”) to $375 million in light of the Ebola outbreak spreading from West Africa. The HPP was authorized through the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 and could be one of many programs that will see increased funding when Congress returns following the elections.

The HPP provides resources to hospitals engaged in planning for a public health emergency.  With the current government funding expiring on December 11, Congress could include increased HPP funding in the must-pass spending measure to fund the government.

OIG Report Seeks to Equalize Cost-Sharing at CAHs

The HHS Office of Inspector General (“OIG”) recently released their October report calling on CMS to seek legislative authority to change how Critical Access Hospitals (“CAHs”) are paid.  The report cited the problem of Medicare beneficiaries’ pay being nearly half of the costs of outpatient services at CAHs, which is substantially more than those beneficiaries would have paid if they accessed the same care at other hospitals.

OIG suggests that Medicare could limit increases in the program’s costs by cutting back on the number of CAHs through looking at distance requirements.  The report found that nearly two-thirds of the CAHs are too close together to meet the location requirements.  The American Hospital Association and the National Rural Health Association were critical of the report and said decertifying CAHs that didn’t meet the location requirements would threaten the rural health system.

CMS responded to the OIG report, but neither concurred nor nonconcurred with the OIG recommendations.

CMS and OIG Extend ACO Waivers for Fraud and Abuse

On October 16, CMS and OIG extended waivers they had earlier granted for Accountable Care Organizations (“ACOs”) until November 2, 2015.  The notice extends a November 2011 interim final rule issued by CMS that provided fraud and abuse waivers to ACOs participating in the Medicare Shared Savings Program.

According to a report from Bloomberg BNA, the interim final rule waived provisions of several fraud and abuse laws, including the Stark Law, the Anti-Kickback Statute and the Civil Monetary Penalties Law. Interim final rules expire if a final rule isn’t published within three years.  However, the HHS Secretary can publish a notice of continuation that grants an additional year to publish the final rule.

HHS to Host Forum on Audit Appeals Backlog

On October 29, HHS will host an open forum on the backlog of Medicare appeals. Representatives from the HHS Office of Medicare Hearings and Appeals will address the appeals backlog and provide updates on initiatives they have undertaken to streamline the appeals process. Interested parties can participate in the hearing either in person or through a webinar.

MedPAC Weighs In on Allowing Hospitals to Steer Patients to Post-Acute Providers

On October 10, the Medicare Payment Advisory Commission (“MedPAC”) discussed proposals that would give hospitals more flexibility in steering fee-for-service Medicare beneficiaries to preferred high-quality post-acute care sites.  MedPAC Chairman Glenn Hackbarth said the commission would like to offer recommendations on managing post-acute care in the near future but was unclear when that would be.

Medicare fee-for-service currently prevents hospitals from recommending particular post-acute care providers to beneficiaries.  However, commissioners decided to explore finding a middle ground for hospitals by recommending tweaks to current Medicare rules.

MedPAC is an independent congressional agency established to advise Congress on issues affecting Medicare.

Health Care-Related Bills Introduced This Week

There were no health care-related bills introduced this week.

Next Week in Congress

Congress remains out of session ahead of the November midterm elections.