HFMA Endorses Stark Administration Simplification Act
On January 24, the Healthcare Financial Management Association (“HFMA”) officially endorsed the Stark Administrative Simplification Act (H.R. 3776). The bill is the result of a lobbying effort by the Hall Render Stark Law Correction Coalition (“SLCC”). An organization of hospital and health systems from across the country, the SLCC seeks to limit the monetary penalty a provider can incur for certain technical violations of the Stark Law and a more streamlined self-disclosure process at CMS. The bipartisan bill is pending before the respective Health Subcommittees in the House of Representatives.
“Currently, healthcare organizations are forced to set aside large cash reserves for years while waiting for a technical violations disclosure to proceed through the existing protocol,” HFMA President and CEO Joseph J. Fifer wrote in a letter to House Energy and Commerce Committee Chairman Fred Upton (R-MI). “The simplified self-disclosure process and fixed-penalty structure described in H.R. 3776 would give these organizations more certainty and predictability regarding the outcome of a technical violation of the Stark Law,” he added.
Senate Finance Issues SGR Bill Report
On January 17, the Senate Finance Committee released a report for its Medicare Sustainable Growth Rate (“SGR”) reform bill. The report does not include the estimated cost of the legislation (S. 1871) because the Congressional Budget Office (“CBO”) has yet to score the measure. However, on January 24, CBO said the House Ways and Means SGR repeal bill would cost $121 billion over 10 years. The agency also reduced its estimate of the House Energy and Commerce SGR bill from $175 billion to $146 billion.
The committee report refers to the latest CBO estimate of $116.5 billion as the cost of freezing physician pay for a decade. Congress has until March 31, 2014 to replace the SGR formula to avert Medicare physician payment cuts. In December, Congress passed a two-year budget agreement (H.J. Res 59) that provides for an extension of Medicare reimbursement rates through March 31.
The legislative push from Congress could be expedited due to the appointment of Senate Finance Committee Chairman Max Baucus (D-MT) as the new ambassador to China. The incoming chairman, Senator Ron Wyden (D-OR), will likely make staff changes, which could slow the momentum of SGR reform.
Congress and Hospitals Continue Push for Medicare RAC Reform
Tucked into the recently passed $1.1 trillion appropriations deal were a number of Medicare anti-fraud requests. In particular, Congress is pushing HHS to address long-standing provider concerns that the Recovery Audit Contractor (“RAC”) program, which operates on a contingency basis, has created incentives for RACs to be overly aggressive.
Future limits on RACs remain on the table in the March doc fix bill, as Congress continues to hear from hospitals regarding the Medicare RAC program. Last week, in a letter dated January 14, the American Hospital Association asked Medicare to suspend all RAC audits until the existing backlog of hospital appeals is reduced. While it is unlikely that CMS or Congress will delay all RAC reviews, many are expecting some type of RAC reform included in the March doc fix bill.
IRS Notice Details Exceptions to Individual Mandate
On January 25, the IRS released a notice spelling out exceptions to the Affordable Care Act’s (“ACA’s”) individual mandate penalty. Even if the individual’s coverage does not constitute minimum essential coverage under the ACA, individuals enrolled in the programs listed in the notice will be treated by HHS as though they are adequately covered.
According to the notice, exemptions from the mandate’s penalty include those with “coverage under family planning services Medicaid, tuberculosis-related services Medicaid, pregnancy-related Medicaid, emergency medical conditions Medicaid, a Section 1115 demonstration project authorized under section 1115(a)(2) of the Social Security Act (42 U.S.C. 1315(a)(2)), coverage for medically needy individuals, space-available care or line-of-duty care.”
Bills Introduced This Week
There were no bills introduced this week.
Next Week in Congress
The President will give his State of the Union Address on January 28.
The House plans to vote on a bill banning federal ACA subsidies from being used to buy private insurance plans that include abortion coverage. The legislation, sponsored by Rep. Chris Smith (R-NJ), was passed by the House Judiciary Committee this month.
The Senate will continue to mull possible pathways toward action on an unemployment benefits extension bill (S. 1845). The Senate will also hold a nomination hearing for the President’s newly appointed Surgeon General. Also on the upcoming agenda is congressional action to increase the federal debt limit, which has an imprecise February deadline.
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.
