Baker Tilly healthcare update November 25, 2014

At the agencies

On November 7, the Centers for Medicare and Medicaid Services (CMS) announced the final methodology that it will utilize for its Dialysis Facility Compare (DFC) Star Ratings Program. CMS provided dialysis facilities that participate in Medicare with a preview of their ratings, which the facilities can review. The agency also announced that it expected to begin posting DFC ratings on its website in January of 2015.

On November 6, the Health Resources and Services Administration (HRSA), within the Department of Health and Human Services, announced that it had awarded $51.3 million in funding to 210 health centers across the country to provide behavioral health services, including hiring mental health professionals and expanding the provision mental health and substance abuse services.

On November 10, CMS issued a Proposed Decision Memo, in which it proposed to allow Medicare coverage for low-dose computed tomography (LDCT) scans on an annual basis for Medicare beneficiaries between 55 and 74 years of age who smoked a minimum of one package of cigarettes per day for 30 years.

On November 10, CMS said that it expected between 9 and 9.9 million individuals to enroll in ACA health coverage during the 2014-2015 open enrollment period—a figure that is 3 million individuals less than what was previously projected by the Congressional Budget Office. The lower figure is the result of a slower than expected movement from employer-sponsored and individual coverage outside of the federal exchange.

During the Medicare Payment Advisory Commission’s (MedPAC) most recent public meeting, the commissioners discussed recommending to Congress a per-beneficiary per month payment incentive for primary care providers. The incentive, which would be in the amount of $31 per month, would replace the current Medicare primary care incentive payment, which expires at the end of next year. MedPAC plans to vote on this recommendation at its December meeting.

On the Hill

With a new Congress, there will be a shift of committee leadership in both the House and the Senate. Of particular note for healthcare are changes to leadership at the Senate Health Education Labor and Pensions (HELP) Committee and the Senate Finance Committee. Retiring HELP Committee Chair Senator Tom Harkin (D-IA) is likely to be replaced by Senator Lamar Alexander (R-TN), who is currently the Ranking Member on the HELP committee. For the Senate Finance Committee, which also oversees healthcare policy, Senator Ron Wyden (D-OR) will likely be replaced by Senator Orrin Hatch (R-UT).

On November 18, a group of senators sent a letter to President Obama in which they voiced their opposition to a part of his 2015 budget proposal that would cut Medicare reimbursements for hospitals.  The letter, written by a bipartisan group of 27 senators, also expressed concern for provisions in the president’s 2015 budget proposal that would make it more difficult for rural hospitals to be designated as “critical access hospitals.” In the letter, the senators hail the importance of critical access hospitals for rural areas and request that the President’s 2016 budget proposal omit these provisions.

Some Capitol Hill staff members have recently reported that the end of this congressional session, known as a “lame duck” session, could present the best opportunity for repealing the sustainable growth rate (SGR) formula. Repealing the SGR, also known as a permanent “doc fix,” would require a new method for determining the correct physician fee schedule in a given year – and more challengingly, a way to pay for it. Although there has been continued congressional support for permanently repealing the SGR, there is no agreement on an offset for the cost of this repeal. Some in Congress have raised the idea of passing permanent repeal without an offset; however, other legislators and their staffs do not think this is a good strategy.

For more information on this topic, or to learn how Baker Tilly healthcare specialists can help, contact our team.