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From Health Law Daily, July 21, 2017

Subcommittee hearing explores bipartisan Medicare legislation

By Sheila Lynch-Afryl, J.D., M.A.

Witnesses before the House Committee on Energy and Commerce Subcommittee on Health testified about the effects of current Medicare policy and supported recently proposed bipartisan legislation at the hearing titled, "Examining Bipartisan Legislation to improve the Medicare Program." Witnesses and Subcommittee members discussed the reform of a number of Medicare coverage and payment policies.

At the hearing, the Subcommittee discussed the following legislation:

  • H.R. 3120, which would remove the requirement that meaningful use standards become more stringent over time;
  • H.R. 1148, which would expand access to telehealth-eligible stroke services;
  • H.R. 2465, which would make coverage of speech-generating devices under routinely purchased durable medical equipment (DME) permanent;
  • H.R. 3263, which would extend the Independence at Home Medical Practice Demonstration Program;
  • H.R. 3163, which would provide a temporary transitional payment under Part B for home infusion therapy services from 2019 through 2021;
  • H.R. 2557, which would provide for Medicare coverage under the of certain DNA Specimen Provenance Assay clinical diagnostic laboratory tests;
  • H.R. 3271, which would address several issues under the competitive bidding program regarding diabetes test strips;
  • H.R. 3245, which would update Medicare civil and criminal penalties;
  • H.R. 849, which would repeal the Independent Payment Advisory Board (IPAB), as created by Sections 3403 and 10320 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148);
  • a discussion draft that would create a new payment methodology for laboratory services provided in nursing homes and to homebound individuals; and
  • a discussion draft related to therapy caps.

IPAB. Mary R. Grealy, president of the Healthcare Leadership Council, testified that, while IPAB has not been triggered (see Medicare trustees predict the future of HI, SMI Trust Funds, July 18, 2017), when it is, it will "most likely to focus on short-term savings in the form of payment cuts to providers." She urged Congress to repeal IPAB to keep Medicare decision making "in the hands of the public’s elected representatives."

Laboratory services for nursing home and homebound patients. Alan E. Morrison, on behalf of the National Association for the Support of Long Term Carestated that the Medicare payment model for clinical laboratory services provided to nursing home and homebound patients is out of date and has been essentially unchanged for over 30 years. It is, he said, a complex model that includes three components: (1) a fee for the laboratory tests performed; (2) a separate fee for the collection of specimens; and (3) a separate travel allowance.

He supported the proposed new payment model, which would bundle the three components into a single per-episode payment covering all included tests provided on a single calendar day to a beneficiary. He estimated that the proposed model would save Medicare $130 million over 10 years and address program integrity concerns.

Therapy caps. Under Soc. Sec. Act §1833(g), annual per-beneficiary limitations apply to the amount of expenses that can be considered as incurred expenses for outpatient therapy services under Part B. An exception to the cap expires December 31, 2017 (see Ding dong, the SGR is dead!, April 15, 2015).

At the hearing, Justin Moore, chief executive officer (CEO) of the American Physical Therapy Associationestimatedthat almost 70 percent of Medicare beneficiaries have more than one chronic condition that may require outpatient therapy. Beneficiaries requiring extensive or multiple therapies can quickly exceed the therapy cap, and while an exceptions process is in place, it is only guaranteed through the end of the year. Therapy caps, he said, place "an arbitrary stopping point to therapy regardless of the medical necessity of the services." He requested that Congress repeal the therapy caps and replace them with a "thoughtful medical review policy."

Diabetic testing supplies. Christel Aprigliano, CEO of the Diabetes Patient Advocacy Coalitiontestified that the payment rate for diabetes test strips has decreased significantly since they were included in the DME competitive bidding program. However, beneficiary access to such supplies has been restricted, which can adversely affect beneficiaries’ health (see Report pokes around mail order diabetes supplies, June 24, 2014). She urged Congress to enact H.R. 3271, the "Protecting Access to Diabetes Supplies Act," which would strengthen the 50 percent rule and the anti-switching rule.

Companies: American Physical Therapy Association; Diabetes Patient Advocacy Coalition; Healthcare Leadership Council; National Association for the Support of Long Term Care

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