Practice Management

Late last night, House Republicans released the text of a continuing resolution (CR) (section-by-section) that would fund most government programs until March 23, while funding defense programs for the remainder of fiscal year (FY) 2018 - a non-starter for most Democrats, who have demanded parity in spending for defense and non-defense programs.

The 515-page measure also includes a significant slate of health care provisions, including several health care "extenders" (one-page summary attached), funding for community health centers (CHCs), delayed cuts to safety net hospitals, the CHRONIC Care Act, the Part B Improvement Act, revisions to MACRA, and pay-fors that could impact biosimilar reimbursement, provider payments, and more. The bill also makes extensive updates to child and family services and support programs, such as foster care. The health care provisions included in the bill are generally bipartisan, and while they are still subject to change, are relatively likely to become law.

With respect to process, GOP leaders will be whipping the bill today - including discussions on the floor during an 11:30am vote series - with the goal of bringing up the package later this afternoon. The House has put same-day authority in place (martial law) to allow them to consider a bill the same day it is advanced by the House Rules Committee.  Members of the House Freedom Caucus have indicated that they support the CR, a key barrier that could ease passage in the House.

Meanwhile, Senate Democrats are expected to have enough votes to block any bill that fully funds defense programs without a longer-term commitment on domestic spending. Assuming the measure passes the House today, it is expected that the bill will be amended in the Senate and sent back to the House on Thursday. While House Democrats are scheduled to have their policy retreat Wednesday afternoon through Friday, they will be in Cambridge, Maryland and can be brought back to vote as necessary. Congress currently has a deadline on Thursday at midnight to avoid another government shutdown.

While the bill is summarized in more detail in the section-by-section summary, here is an overview of the health care provisions:

• Extends certain health care programs for two years, five years, or permanently:
• repeals the Medicare-pay cap for therapy services;
• removes the rental cap for durable medical equipment for speech-generating devices;
• makes Special Needs Plans in Medicare Advantage permanent;
• forestalls for two years Medicaid Disproportionate Share Hospital (DSH) pay cuts;
• funds community health centers (CHCs) for two years;
• extends for two years the Geographic Practice Cost Index (GPCI) floor, which boosts pay for the work component of physician fees in areas where labor cost is lower than the national average;
• funds quality measure development for two years;
• extends add-on pay for Medicare-dependent hospitals and hospitals with low volumes of patients for two years;
• funds the National Health Service Corps for two years;
• funds teaching health center graduate medical education for two years;
• funds family-to-family health information centers for two years;
• funds the Sexual Risk Avoidance Education Program for two years;
• funds the Personal Responsibility Education Program for two years;
• extends home health rural add-on pay for five years; and
• extends ground ambulance add-on pay for five years.

• The package is fully paid for, with offsets including:
• modifies payments for early discharges to hospice care;
• cuts home health market basket payment updates;
• reduces pay for non-emergency ambulance transports of kidney patients;
• extends the target for relative value adjustments for misvalued codes;
• delays CMS' authority to terminate contracts for certain Medicare Advantage plans;
• cuts pay for outpatient physical and occupational therapy services furnished by a therapy assistant;
• cuts long-term care hospital (LTCH) payments;
• rescinds unspent money from the Medicare and Medicaid Improvement Funds;
• changes Medicaid's third-party liability requirements;
• allows states to kick lottery winners off of Medicaid;
• changes reductions in Medicaid DSH allotments;
• includes biosimilars in the Medicare Part D coverage gap discount program);
• removes an "additional payment" for biosimilars receiving "pass-through status," per Sec. 2709, the impact over which we are still analyzing; and
• reduces funding in the Prevention and Public Health Fund.

• Makes technical corrections to MACRA, which created the quality payment program (QPP), including:
• changes the inclusion of "items and services" to clarify the limitation to "covered professional services;"
• allows CMS flexibility in applying the 30 percent resource use performance score for three additional years;
• allows CMS three additional years to ensure a gradual and incremental transition to the performance threshold; and,
• makes updates to the ability of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to further aid the development of physician led alternative payment models.

• Advances policies included in the CHRONIC Care Act, including enhanced access to telehealth for Medicare beneficiaries:
• extends the Independence at Home Demonstration Program;
• expands access to home dialysis therapy;
• expand the testing of the CMMI Value-Based Insurance Design (VBID) Model;
• allows Medicare Advantage (MA) plans to offer a wider array of targeted supplemental benefits to chronically ill enrollees beginning in 2020;
• allows MA plans to offer additional telehealth benefits in its annual bid amount beginning in 2020;
• allows more accountable care organizations (ACOs) to expand the use of telehealth;
• expands the use of telehealth for individuals with stroke;
• allows beneficiaries to elect to be part of an ACO;
• allows certain ACOs to make incentive payments to beneficiaries who receive qualifying primary care services;
• requires Government Accountability Office (GAO) studies on care planning services under Part B, improving medication management, and obesity drugs.

• Adopts provisions from the Medicare Part B Improvement Act,
• creates a temporary transition service and education Medicare payment for home infusion beginning in 2019;
• allows additional information provided by prosthetists and orthotists to be considered by Medicare to support documentation of medical necessity;
• allows dialysis providers to seek outside accreditation, from organizations approved by Medicare, in order to be able to bill Medicare for ESRD services;
• makes permanent the removal of the rental cap for durable medical equipment under Medicare with respect to speech generating devices;
• increases civil and criminal penalties and increased sentences for health care fraud and abuse;
• removes the mandate that meaningful use standards become more stringent over time and allows HHS to be more deliberative in related evaluations;
• provides for coverage of DNA Specimen Provenance Assay (DPSA) testing; and
• updates rules under the competitive bidding program regarding Diabetes Test Strips (DTS).

The House is currently expected to vote on the package at approximately 7pm this evening. We will continue to keep you apprised of any major developments.

Late last night, House Republicans released the text of a continuing resolution (CR) (section-by-section) that would fund most government programs until March 23, while funding defense programs for the remainder of fiscal year (FY) 2018 - a non-starter for most Democrats, who have demanded parity in spending for defense and non-defense programs.

The 515-page measure also includes a significant slate of health care provisions, including several health care "extenders" (one-page summary attached), funding for community health centers (CHCs), delayed cuts to safety net hospitals, the CHRONIC Care Act, the Part B Improvement Act, revisions to MACRA, and pay-fors that could impact biosimilar reimbursement, provider payments, and more. The bill also makes extensive updates to child and family services and support programs, such as foster care. The health care provisions included in the bill are generally bipartisan, and while they are still subject to change, are relatively likely to become law.

With respect to process, GOP leaders will be whipping the bill today - including discussions on the floor during an 11:30am vote series - with the goal of bringing up the package later this afternoon. The House has put same-day authority in place (martial law) to allow them to consider a bill the same day it is advanced by the House Rules Committee.  Members of the House Freedom Caucus have indicated that they support the CR, a key barrier that could ease passage in the House.

Meanwhile, Senate Democrats are expected to have enough votes to block any bill that fully funds defense programs without a longer-term commitment on domestic spending. Assuming the measure passes the House today, it is expected that the bill will be amended in the Senate and sent back to the House on Thursday. While House Democrats are scheduled to have their policy retreat Wednesday afternoon through Friday, they will be in Cambridge, Maryland and can be brought back to vote as necessary. Congress currently has a deadline on Thursday at midnight to avoid another government shutdown.

While the bill is summarized in more detail in the section-by-section summary, here is an overview of the health care provisions:

• Extends certain health care programs for two years, five years, or permanently:
• repeals the Medicare-pay cap for therapy services;
• removes the rental cap for durable medical equipment for speech-generating devices;
• makes Special Needs Plans in Medicare Advantage permanent;
• forestalls for two years Medicaid Disproportionate Share Hospital (DSH) pay cuts;
• funds community health centers (CHCs) for two years;
• extends for two years the Geographic Practice Cost Index (GPCI) floor, which boosts pay for the work component of physician fees in areas where labor cost is lower than the national average;
• funds quality measure development for two years;
• extends add-on pay for Medicare-dependent hospitals and hospitals with low volumes of patients for two years;
• funds the National Health Service Corps for two years;
• funds teaching health center graduate medical education for two years;
• funds family-to-family health information centers for two years;
• funds the Sexual Risk Avoidance Education Program for two years;
• funds the Personal Responsibility Education Program for two years;
• extends home health rural add-on pay for five years; and
• extends ground ambulance add-on pay for five years.

• The package is fully paid for, with offsets including:
• modifies payments for early discharges to hospice care;
• cuts home health market basket payment updates;
• reduces pay for non-emergency ambulance transports of kidney patients;
• extends the target for relative value adjustments for misvalued codes;
• delays CMS' authority to terminate contracts for certain Medicare Advantage plans;
• cuts pay for outpatient physical and occupational therapy services furnished by a therapy assistant;
• cuts long-term care hospital (LTCH) payments;
• rescinds unspent money from the Medicare and Medicaid Improvement Funds;
• changes Medicaid's third-party liability requirements;
• allows states to kick lottery winners off of Medicaid;
• changes reductions in Medicaid DSH allotments;
• includes biosimilars in the Medicare Part D coverage gap discount program);
• removes an "additional payment" for biosimilars receiving "pass-through status," per Sec. 2709, the impact over which we are still analyzing; and
• reduces funding in the Prevention and Public Health Fund.

• Makes technical corrections to MACRA, which created the quality payment program (QPP), including:
• changes the inclusion of "items and services" to clarify the limitation to "covered professional services;"
• allows CMS flexibility in applying the 30 percent resource use performance score for three additional years;
• allows CMS three additional years to ensure a gradual and incremental transition to the performance threshold; and,
• makes updates to the ability of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to further aid the development of physician led alternative payment models.

• Advances policies included in the CHRONIC Care Act, including enhanced access to telehealth for Medicare beneficiaries:
• extends the Independence at Home Demonstration Program;
• expands access to home dialysis therapy;
• expand the testing of the CMMI Value-Based Insurance Design (VBID) Model;
• allows Medicare Advantage (MA) plans to offer a wider array of targeted supplemental benefits to chronically ill enrollees beginning in 2020;
• allows MA plans to offer additional telehealth benefits in its annual bid amount beginning in 2020;
• allows more accountable care organizations (ACOs) to expand the use of telehealth;
• expands the use of telehealth for individuals with stroke;
• allows beneficiaries to elect to be part of an ACO;
• allows certain ACOs to make incentive payments to beneficiaries who receive qualifying primary care services;
• requires Government Accountability Office (GAO) studies on care planning services under Part B, improving medication management, and obesity drugs.

• Adopts provisions from the Medicare Part B Improvement Act,
• creates a temporary transition service and education Medicare payment for home infusion beginning in 2019;
• allows additional information provided by prosthetists and orthotists to be considered by Medicare to support documentation of medical necessity;
• allows dialysis providers to seek outside accreditation, from organizations approved by Medicare, in order to be able to bill Medicare for ESRD services;
• makes permanent the removal of the rental cap for durable medical equipment under Medicare with respect to speech generating devices;
• increases civil and criminal penalties and increased sentences for health care fraud and abuse;
• removes the mandate that meaningful use standards become more stringent over time and allows HHS to be more deliberative in related evaluations;
• provides for coverage of DNA Specimen Provenance Assay (DPSA) testing; and
• updates rules under the competitive bidding program regarding Diabetes Test Strips (DTS).

The House is currently expected to vote on the package at approximately 7pm this evening. We will continue to keep you apprised of any major developments.