Hall Render Provides Recommendations to Congress on Stark Law Changes

On January 29, Gregg Wallander, Hall Render attorney and leader of the firm’s Health Care Practice Group, provided recommendations to congressional staff on changes to the Stark Law that would provide relief for hospitals and health systems that are required to comply with its burdensome requirements. The recommendations come in follow up to Mr. Wallander’s participation in a small roundtable of outside Stark Law experts organized by the Senate Finance and House Ways and Means committees late last year.

The recommendations include limiting the penalty providers can incur for technical violations of the Stark Law and an expedited process for their resolution by CMS; codifying the Risk Sharing Arrangement Exception into law and expanding it to permit risk-sharing arrangements that are related and unrelated to enrollees of a health plan; and creating a statutory definition of commercial reasonableness. The recommendations regarding limited penalties for technical violations make up the core of the Stark Administrative Simplification Act of 2015 (H.R. 776), which is strongly supported by members of the Hall Render Stark Law Correction Coalition.

CBO Projects Slow Growth in Per Beneficiary Spending

On January 25, the Congressional Budget Office (“CBO”) issued a report providing budget and economic projections for 2016.  The agency estimates that gross federal spending for Medicare, Medicaid and exchange subsidies will rise to $1.1 trillion in 2016, up from $1 trillion in 2015, and is expected to increase to $2 trillion by 2026. The CBO said that nearly three-fifths of total spending on health care programs would pay for care for people ages 65 and above.

The agency anticipates that per beneficiary spending on Medicare will grow at an annual rate of 1.6 percent over the next ten years. Its analysts believe the slower growth in per beneficiary spending is related to a greater influx of Medicare enrollees, which will reduce the average age of beneficiaries and therefore decrease average health care costs because younger beneficiaries use fewer services. The Medicare Access and CHIP Reauthorization Act of 2015 is also expected to contribute to the reduced rate of growth in spending because it limits annual increases in payment rates for physician services to between 0 and 0.75 percent from 2016 to 2026.

In light of the CBO report, House Ways and Means Chairman Kevin Brady (R-TX) announced that his committee will move ahead with reforms for hospitals and post-acute care, including bills such as the Medicare Post-Acute Care Value-Based Purchasing Act (H.R. 3298), the Medicare Crosswalk Hospital Code Development Act (H.R. 3291), the Medicare IME Pool Act (H.R. 3292) and the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act (H.R. 3288), that were introduced last year. Senate Health, Education, Labor and Pensions Committee Chair Lamar Alexander (R-TN) said that President Obama should push reforms from legislation introduced by Alexander and Sen. Bob Corker (R-TN) in 2013 that would raise the Medicare eligibility age and prohibit Medigap coverage after 2017.

CMS Releases Report on Hospital Star Ratings

On January 25, CMS published a report detailing its guiding principles for overall hospital quality star ratings and a summary of the results from the first overall star ratings that will be added to the Hospital Compare website in April 2016.

Overall hospital quality star ratings for the April update will be available to hospitals participating in the inpatient and outpatient quality reporting programs on the QualityNet Secure Portal through February 14. Inpatient psychiatric facilities, ambulatory surgical centers and cancer hospitals exempt from the prospective payment system can also review their quality data until February 14.  CMS said that it plans to post a factsheet and answers to frequently asked questions for the overall hospital star ratings on the QualityNet website.

CMS Proposes Changes to ACO/Medicare Shared Savings Program

On January 28, CMS released a proposed rule to “update the methodology used to measure the performance of Accountable Care Organizations (“ACOs”) in the Medicare Shared Savings Program.”  The 199-page proposed rule is complex and, at its core, intended to modify the process for calculating the benchmarks that are used to determine ACO performance.  Among other areas, the proposal calls for the use of regional, rather than national, spending growth trends when establishing and updating an ACO’s rebased benchmark.  There will be a 60-day comment period on the proposed rule that closes on March 28, 2016.

CMS Introduces New Star Ratings for Home Health 

On January 28, CMS announced its first ever home health patient experience of care star ratings on the Home Health Compare website. The Home Health Care Consumer Assessment of Healthcare Providers and Systems (“HHCAHPS“) Survey will measure patients’ care experiences with home health providers and agencies. More than 11,000 home health agencies have provided data to Home Health Compare, and over 6,000 now have patient experience of care star ratings on the website.

The HHCAHPS Survey star ratings evaluate patients’ care experiences with Medicaid-certified agencies on a scale of one to five stars, with five stars reflecting the best care experience, using information from patients or patients’ families. Home Health Compare will list data for five HHCAHPS Survey start ratings, including care of patients, communication between providers and patients, specific care issues, overall rating of care provided by the home health agency and survey summary star ratings for each home health agency registered on the website.

Health-Related Legislation Introduced This Week

Sen. Sheldon Whitehouse (D-RI) introduced a bill (S. 2467) that is intended to address health care-associated infections in hospitals and post-acute care settings.  The bill would establish a grant program to support collaboration between health care stakeholders for the purpose of designing and implementing strategies for the prevention and reporting of health care-associated infections.

Next Week in Washington

It was a quiet week on Capitol Hill as the House canceled legislative action for the week due to the blizzard.  The House returns on Monday for a full week with consideration of overriding the president’s veto on a bill (H.R. 3762) to repeal major portions of the Affordable Care Act. The Senate also returns Monday, February 1 for a full week of work.