Hall Render Continues to Advance Stark Law Initiative
The Hall Render Stark Law Correction Initiative (“SLCI”) continued to advance its efforts to obtain a technical correction amendment to the physician self-referral law this week when the Office of Legislative Counsel produced a draft of the proposed legislation. The SLCI, a coalition of health systems from across the country, is lobbying Congress for a measure that would limit the monetary penalty a health care entity can incur for having a verbal, lapsed or unsigned agreement that is otherwise compliant with federal fraud and abuse law to a maximum of $10,000. The proposed legislation would also give CMS 90 days to reject such a disclosure; otherwise, the disclosure would be deemed to be accepted. The measure is expected to be introduced in the House of Representatives in late September by its author, Rep. Charles Boustany, M.D. (R-LA).
House Committee Approves SGR Bill
On July 31, the House Energy and Commerce Committee unanimously approved a bill (H.R. 2810) to permanently repeal and replace Medicare’s Sustainable Growth Rate formula (“SGR”) that sets physician payments. The legislation would freeze physician payments through 2018 and set up a new system in 2019 that would tie quality reporting metrics with incentives for physicians to move into new payment models.
While the bill passed by a 51-0 margin, the current legislation contains no offsets, therefore making it much easier for members to support. Expect the legislation to become more contentious once offsets are included. Also this week, the Senate Finance Committee met to discuss strategy for replacing the SGR. The Senate committee is still in the early stages of crafting their own SGR reform bill, which is likely to be introduced in fall.
The House Ways and Means Committee, which has jurisdiction over a number of relevant offsets, may choose to take up the Energy and Commerce bill in the fall and add spending offsets. If Congress does not avert the cuts by the end of 2013, physicians will see their Medicare reimbursements reduced by 25% on January 1, 2014.
False Claims Act Protections Bill Introduced
On August 1, Rep. Howard Coble (R-NC) introduced legislation (H.R. 2931) that would amend the False Claims Act by requiring federal agencies to review their own rules and regulations to determine whether a billing dispute should be pursued as fraud before launching the investigation.
The bill would raise the burden of proof for False Claims Act health-related claims from a “preponderance of the evidence” to a “clear and convincing evidence standard.” The bill would also provide safe harbors for providers that rely on written statements or audits from federal contractors or implement federal model hospital compliance programs. Finally, the bill establishes a “de minimus” threshold for removing smaller disputes from litigation.
CMS Releases Batch of Payment Updates
This week, CMS issued a number of annual payment reimbursement rules. On July 29, CMS issued the fiscal year (“FY”) 2014 payment rule for inpatient psychiatric care. The rule would boost payments by 2.3% in 2014, adding an estimated $115 million to the sector. The rule applies to 481 freestanding inpatient psychiatric facilities and 1,143 inpatient units in hospitals. The new rates will apply to services furnished to Medicare beneficiaries during FY 2014, beginning with discharges on or after October 1, 2013.
On July 31, CMS also issued the final inpatient rehabilitation rule for FY 2014. The rule would boost FY 2014 Medicare payment rates to inpatient rehabilitation facilities by 2.3%. This is the same increase that was seen in the May proposed rule.
On July 31, CMS also issued a final rule that would increase payments to skilled nursing facilities next year by 1.3%. That means Medicare payments, overall, to the facilities will be $470 million higher than in FY 2013. This rule’s payment rates and policies will be effective on October 1, 2013.
Bills Introduced This Week
H.R. 2869: Rep. Mike Rogers (R-MI) introduced a bill that would amend title XVIII of the Social Security Act to establish payment parity under Medicare for ambulatory cancer care services. The parity would be applied toward services being furnished in the hospital outpatient department and the physician office setting.
H.R. 2853: Rep. Dan Lipinski (D-IL) introduced a bill to amend the Public Health Service Act to provide for the public disclosure of charges for certain hospital and ambulatory surgical center treatment episodes.
H.R. 2867: Rep. Lee Terry (R-NE) introduced a bill that would amend title XVIII of the Social Security Act to provide for the recognition of attending physician assistants as attending physicians to serve hospice patients.
Next Week
Congress begins its annual summer recess. Thus, This Week in Washington will be in recess until Congress returns the week of September 9. Updates will be provided as developments warrant.
For more information, please contact John F. Williams, III at 317-977-1462 or jwilliams@hallrender.com.
Please visit the Hall Render Blog at http://blogs.hallrender.com for more information on topics related to health care law.
