Ways and Means Releases Draft Program Integrity Legislation

On September 9, the House Ways and Means Subcommittee on Health released a draft bill that includes the Hall Render Stark Initiative legislation. The Protecting Integrity in Medicare Act (“PIMA”) of 2014 is aimed at combating fraud, waste and abuse in the Medicare program, and central to the draft bill is language from H.R. 3776, the Stark Administrative Simplification Act (“SASA”).

The SASA language included in the draft bill would limit the excessive and disproportionate penalties that hospitals can incur by creating a fixed penalty structure for “technical noncompliance” with the Stark Law. The noncompliance is defined as any: (1) arrangement not signed by one or more parties; (2) verbal agreement not put into writing; or (3) expired arrangement where the parties continued to provide services as if the arrangement was still in effect.

The PIMA discussion draft also includes provisions ranging from removing social security numbers from Medicare cards to increasing efficiencies and education for providers to reduce waste, fraud and abuse. The Ways and Means Committee hopes to advance PIMA when Congress returns following the November elections.

House Passed Bill Would Delay Rural Hospital Supervision Requirements

Also on September 9, the House passed legislation (H.R. 4067) extending the delay in enforcing physician supervision (“direct supervision”) requirements. The bill seeks to delay a CMS policy that says hospitals, including critical access and small rural hospitals, must have a doctor or non-physician practitioner immediately available when outpatient therapeutic services are provided.

CMS has enforced the policy since January 1, 2014. The legislation, however, would delay Medicare’s enforcement through the end of 2014. The Senate passed an identical measure in February and the bill should now go to the President for his signature. Hospital groups have been pushing Congress to enact legislation that would put in place a default standard of “general supervision” for outpatient therapeutic services.

HHS Announces Marketplace Grant Recipients for 2014

On September 8, HHS announced $60 million in Navigator grants that will be distributed to 90 organizations in states with federally run and state partnership exchanges. The funding is slightly less than 2013 funding, which awarded $67 million to grantees.

The navigators will serve as an in-person resource for people who want additional assistance with Marketplace enrollment in 2014-2015. Among the requirements imposed, the grant recipients must maintain a physical presence in the Marketplace service area, be trained on and comply with security and privacy standards and submit weekly progress reports to HHS.

Bills Introduced This Week

Rep. Elliot Engel (D-NY) introduced legislation (H.R. 5435) that would amend title XVIII of the Social Security Act to provide for the coverage of home as a site of care for infusion therapy under the Medicare Program.

Rep. Greg Walden (R-OR) introduced a bill (H.R. 5460) that would amend title XVIII of the Social Security Act to increase access to ambulance services under Medicare. The bill also seeks payment reform for ambulatory under Medicare.

Sen. Mark Begich (D-AK) introduced legislation (S. 2800) seeking to create a patient-centered quality of life initiative. The initiative would create an advisory committee focused on palliative care education and research.

Next Week in Washington

Both the House and Senate return to session on September 15. With the federal government’s fiscal year ending September 30, Congress will attempt to pass a continuing resolution (“CR”) funding the government through the November elections. Last year, opposition to the ACA prevented the CR from being passed on time and led to a government shutdown. The ACA is not a factor complicating action this year and passage of the CR is expected next week.