Legislative Activity

SGR Reform Negotiations

Staff negotiations on a package to overhaul the sustainable growth rate (SGR) formula are gaining steam as the Committees of jurisdiction tackle a significant hurdle left unaddressed to date: how to pay for reform. Last week, the Senate Finance Committee released a list of offset options including policies that would impact Medicare providers, manufacturers, medical education, exchange subsidies for high-income beneficiaries, and elements of the Medicaid and Medicare programs. The Committee did not specifically endorse the pay-fors, but the list identifies offsets under consideration. Sen. Max Baucus (D-MT) sat for a confirmation hearing with the Senate Foreign Relations Committee last week, and is widely expected to be approved in the coming weeks. While the current physician fee fix runs through the end of March, negotiators have expressed strong desire to complete work on the SGR reform bill prior to Sen. Baucus’ departure.

This Week’s Hearings:

  • Tuesday, February 4: The House Committee on Oversight and Government Reform Subcommittee on Government Operations will hold a hearing titled “Mixed Signals: The Administration’s Policy on Marijuana.” The House Committee on Ways and Means will hold a markup of the following bills:
    • H.R. 2575, the Save American Workers Act of 2013, and
    • H.R. 3979, the Protecting Volunteer Firefighters and Emergency Responders Act.
  • Wednesday, February 5: The House Committee on the Budget will hold a hearing on the Congressional Budget Office’s budget and economic outlook. The House Committee Energy and Commerce Subcommittee on Health has scheduled a hearing titled “Examining the Implementation of the Food Safety Modernization Act. The House Committee on Oversight and Government Reform will hold a hearing titled “ObamaCare: Why the Need for an Insurance Company Bailout? The House Committee on Oversight and Government Reform Subcommittees on Economic Growth, Job Creation and Regulatory Affairs and Energy Policy, Health Care and Entitlements will also hold a hearing titled “Health Insurance CO-Ops: Examining ObamaCare’s $2 Billion Loan Gamble.”

Regulatory Activity

CMS Two-Midnight Rule Inpatient Review Extension

The Centers for Medicare and Medicaid Services (CMS) posted an announcement to extend the “probe and educate” pre-payment review process related to implementation of the two-midnight inpatient hospital rule. The six-month extension will allow Medicare Administrative Contractors (MACs) to conduct pre-payment “probe and educate” reviews of a sample of Part A inpatient claims through September 30. MACs will also continue to conduct educational sessions with hospitals throughout the “audit free” period.

Home Health and Ambulance Provider Moratoria

The Centers for Medicare and Medicaid Services (CMS) announced new and extended temporary moratoria on enrollment of ambulances and home health agencies in designated geographic regions to prevent and combat fraud, waste and abuse. The moratorium on the Medicare enrollment of home health agencies will apply to designated counties in Florida, the Texas, and Michigan. The moratorium on Medicare Part B enrollment of ambulance suppliers will apply to designated counties in Pennsylvania.