Republican Election Victories Mean Changes for Health Care

The results of the November 4 midterm elections have given Republicans on Capitol Hill control of the Senate and their largest majority of the House since 1932.  Senate Republicans gained seven seats and should increase that number once races in Alaska and Louisiana are official.

In Alaska, the Republican challenger leads by 3.5% while votes are still being counted.  In Louisiana, the race is headed for a December 6 runoff, which the Republican challenger is widely expected to win. Winning both states would provide Senate Republicans with greater flexibility to move legislation; however, they would still fall short of the 60 votes needed to override a filibuster and the 67 necessary to overcome a presidential veto.

Republican control of the Senate means legislation aimed at repealing or replacing parts of the Affordable Care Act (“ACA”) will now force President Obama to decide whether to sign or veto such a measure.  The President indicated he will veto any measure repealing the ACA in full; however, he may be forced to sign targeted legislation that repeals narrow portions of the ACA that have bipartisan support among lawmakers. Those measures include repeal of the medical device tax and the individual and employer mandates.

CMS Releases Final Medicare Payment Rules

On October 31, CMS published three separate rules on Medicare payments for physicians, hospital outpatient services and end-stage renal disease (“ESRD”). The rules also address quality-reporting programs for hospitals and the quality incentive program for ESRD.  The final rules are effective January 1, 2015.  The payment rule added three new categories to the list of Medicare-covered telehealth services.  The Medicare reimbursable services now include:  an annual wellness visit; psychoanalysis; and prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service.

The physician payment final rule also created a new, two-part category under which hospitals and providers can qualify for a hardship exception to the meaningful use program.  To qualify, the provider must not have been able to fully implement the 2014 edition of certified EHR technology, “due to delays in the 2014 CEHRT availability” and must not have been able to attest by their deadline in 2014.

The final rule on 2015 payments for physician services also projected a 21.2%  reduction in doctors’ fees next year unless Congress enacts another “doc-fix” measure delaying the cuts.

Doctors Caucus Pushes for Lame Duck Passage of SGR

On November 3, the Republican Doctors Caucus wrote Republican House leadership, asking Speaker Boehner to prioritize a permanent repeal of the Sustainable Growth Rate (“SGR”) before the end of the year.  Despite the push from the Doctors Caucus and provider groups, like the AMA, Republican leadership will likely wait until new committee chairpersons take their gavels in January before taking action on the issue.  There is no other significant health care-related legislation that is expected to pass the House and Senate before the end of the year.

Health Care-Related Bills Introduced This Week

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

Next Week in Congress

Both the House and Senate return to Washington next week to begin the traditional lame duck session.