Senate Committee Urged to Reform Stark Law

On July 12, the Senate Finance Committee heard from hospital stakeholders on various options to reform the Stark Law. Chairman Orrin Hatch (R-UT) said he would like to undo what he sees as the law’s “outdated regulations.” Hatch also stated he would like the committee to do “something” before the end of 2016.

The hearing followed the committee’s release of a 19-page white paper examining potential reforms to the Stark Law. The white paper is in response to a roundtable held in December 2015 by the majority side of the Senate Finance and House Ways and Means Committees in which Hall Render shareholder Gregg Wallander participated in a small roundtable of outside Stark Law experts. Hall Render has organized a coalition of hospitals from across the country to get Stark reform legislation passed in each of the past two Congresses that would limit the penalties for technical violations and create an expedited process for their resolution by CMS.

In the course of his witness testimony, former CMS Director of Technical Payment Policy Troy Barsky told the committee that Congress should limit the penalties for technical violations or eliminate them from the Stark Law altogether. Sen. Dan Coats (R-IN) said the intent of the Stark Law is not being exercised and suggested there is a way to address the issue in a bipartisan manner. Sen. Ron Wyden (D-OR), the committee’s ranking Democrat, agreed that changes should be made but also expressed reservations on wholesale changes to the law.

Slavitt Says CMS Will Consider Postponing MACRA Start Date

The Senate Finance Committee held a hearing on July 13 to review CMS’s proposed implementation of physician payment reforms under the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). During the hearing, committee members highlighted the importance of ensuring that all health care providers who care for Medicare beneficiaries receive fair treatment under MACRA and have the flexibility to participate in the program in a way that best fits their practices before the rule is implemented.

Of special note was the testimony of CMS Acting Administrator Andy Slavitt who said the agency would consider postponing the January 1, 2017 MACRA implementation date to give physician practices enough time to prepare for the changes in Medicare payments. He also said CMS is open to establishing shorter reporting periods to decrease the time that clinicians spend reporting data and increase the time they can devote to providing care to patients. To ease the burden of reporting on providers, Slavitt suggested that CMS could adjust reporting requirements to allow for data collection through registries and to exempt practices that display strength in a specific area of care or physicians who do not see a high volume of Medicare enrollees from data reporting. A final rule on new payment models under MACRA is expected to be released in November.

Meaningful Use Legislation Introduced in the Senate

On July 13, Sen. John Thune (R-SD) and a host of Senate Republicans introduced the Electronic Health Record (“EHR”) Regulatory Relief Act (S. 3173) to provide flexibility and hardship relief to clinicians and hospitals participating in the meaningful use program. The legislation would help health care providers and facilities to transition into the new patient-focused payment models created under MACRA.

The EHR Regulatory Relief Act would codify CMS’s proposal for a 90-day meaningful use reporting period and extend hardship exceptions for providers through 2017. The bill would also remove the “100 percent-is-passing” policy as a measure of compliance for meaningful use and would instead create a new threshold that requires that participating clinicians and hospitals meet no more than 70 percent of their metrics to comply with meaningful use requirements.

Ways and Means Committee Approves Long-Term Care Hospital Bill

On July 13, the House Ways and Means Committee passed the Sustaining Healthcare Integrity and Fair Treatment Act (“SHIFT”) (H.R. 5713) to provide relief for long-term care hospitals (“LTCHs”) from CMS’s 25 percent rule, which does not allow for more than 25 percent of patients to come from one inpatient acute hospital in one quarter. Currently, LTCHs are ineligible to receive full reimbursement from CMS if their total annual Medicare patient population coming from one inpatient acute hospital exceeds the 25 percent requirement.

The SHIFT Act, which was introduced by Health Subcommittee Chairman Pat Tiberi (R-OH), would delay the 25 percent rule through June 30, 2017 and reinstate a 50 percent threshold for LTCHs. The legislation would also provide targeted relief from site-neutral payment policies for four specific groups of LTCHs: any new LTCH that entered the Medicare program on or after December 26, 2013; any LTCH that was in existence before September 3, 1982 and was exempt from the prospective payment system created under the Tax Equity and Fiscal Responsibility Act of 1982; any LTCH that primarily treats Medicare beneficiaries with severe spinal cord injuries; and any LTCH that was established between September 3, 1982 and September 30, 1995 and is a small facility operating within another existing hospital.

Health-Related Bills Introduced This Week

Sen. Al Franken (D-MN) introduced a series of rural health-focused bills (S. 3189, S.3190 and S. 3191). The bills seek to reauthorize and address a number of rural health programs, including: the reauthorization of the Medicare Rural Hospital Flexibility Grant Program; the redistribution of unused residency positions to rural hospitals; and a requirement on the Federal Communications Commission to simplify and strengthen its Healthcare Connect Fund, which expands access to broadband services for providers in rural areas.

Next Week in Washington

Members of Congress left town Thursday night for a seven-week recess that includes the national conventions, which start Monday in Cleveland. When Congress returns after Labor Day, they will need to tackle a bevy of issues, including a spending measure to keep the government funded past September 30.

With Congress out of session, the next full edition of This Week in Washington will be published on September 9. In the meantime, brief editions will be published if developments warrant.