On May 22, the American Hospital Association sued HHS over a backlog at the third level of the Medicare appeals process. The suit would compel HHS to meet the deadlines for reviewing an appeal, which at the Administrative Law Judge level is 90 days.
At a House Ways and Means Health Subcommittee hearing on May 20, CMS Deputy Administrator Sean Cavanaugh said HHS assembled an agency-wide workgroup to examine the appeals backlog. According to Cavanaugh, the internal recommendations are not yet finalized.
In an FAQ on the Office of Medicare Hearings and Appeals' ("OMHA") website, the agency recognizes the time period for decisions on appeals is generally 90 days but says that timeframe can be extended. Last summer, OMHA put out a moratorium on assigning most appeals to Administrative Law Judges until they reduce the appeals backlog. Some hospitals have blamed the Recovery Audit Contractors for contributing to the clogged appeals system.
CMS Announces Phase Two for Sunshine Act Submissions Starts June 1
On May 22, CMS announced through a blog post that phase two data collection for CMS's Open Payments program will begin June 1. The Open Payments program, commonly referred to as the physician's Payments Sunshine Act, requires manufacturers of drugs, devices and other medical supplies and group purchasing organizations to report certain payments to physicians or teaching hospitals. All payment data must be submitted by June 30.
June 1 will also mark the first day physicians and teaching hospitals will be able to register on the CMS Enterprise Portal, which will allow them to review data submitted about them by manufacturers and GPOs. Beginning July 1, physicians and teaching hospitals will also be able to register for the CMS Open Payment system, which will alert them when any data about them is submitted and will allow them to review and dispute the data before it is publicly posted.
GAO Announces New MedPAC Members
On May 29, the Government Accountability Office named three new members to the Medicare Payment Advisory Commission ("MedPAC") and reappointed two members. The newly appointed members are Kathy Buto, MPA, who is an expert in U.S. and international health policy, Francis Crosson, MD, who is group vice-president at the American Medical Association, and Warner Thomas, who is President and CEO of the Ochsner Health System in New Orleans. Their terms will expire in April 2017.
Congress established MedPAC in 1997 to analyze access to care, cost and quality of care and other key issues affecting Medicare. MedPAC advises Congress with non-binding recommendations on payments to health plans participating in the Medicare Advantage program and providers in Medicare's fee-for-service programs.
Bills Introduced This Week
Rep. Glenn Thompson (R-PA) introduced a bill (H.R. 4755) to amend Title XVIII of the Social Security Act to include recreational therapy among the therapy modalities that constitute an intensive rehabilitation therapy program in an inpatient rehabilitation hospital or unit.
Rep. Earl Blumenauer (D-OR) introduced a bill (H.R. 4762) that would amend Title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare program.
Rep. Phil Gingrey (R-GA) introduced a bill (H.R. 4750) to clarify the treatment of health care provider standards of care under federal health care provisions.
Next Week in Washington
The House and Senate return next week. The Senate plans to vote on Sylvia Burwell's confirmation next week. With broad support from Democrats and many Republicans, Burwell's confirmation to head HHS is all but a given.