House Passes Repeal of IPAB; Tell Your Senators to do the Same!

Originally published in the November 8th issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

Last week, the House of Representatives passed a bipartisan bill, the Protecting Seniors’ Access to Medicare Act (H.R. 849), to repeal the Independent Payment Advisory Board (IPAB) by a vote of 307–111. The IPAB is a cost containment tool created under the Affordable Care Act to convene if Medicare spending exceeds a particular limit. The board has draconian power to make changes to Medicare spending, leaving little-to-no room for recourse if IPAB-mandated payment cuts are triggered.

The fight to eliminate the IPAB is not yet over. The companion bill (S.260) to H.R. 849 now moves to the Senate; if it is successful there, it will advance to the President for his signature. Please join MGMA in urging the Senate to expeditiously pass this important legislation, before future actuary reports trigger the IPAB and activate payment reductions to Medicare providers. Contact your senators now via MGMA’s Advocacy Center to express support for IPAB repeal!

NCMGMA Survey: Medicare Advantage Organizations (MAOs) in NC

NCMGMA Member Survey
Medicare Advantage Organizations (MAOs) in NC

NCMGMA values your opinion. The NCMGMA leadership has a scheduled meeting with CMS leaders and this survey is intended to capture the extent and financial impact of improper sequestration by Medicare Advantage Organizations (MAOs) in North Carolina.

The results could be helpful to underscore MAO behavior and the responsibility of CMS to actively monitor – and respond to – complaints by providers about violations of CMS rules.

Please take a moment to complete our brief survey. If you have any questions, please email our offices at info@ncmgm.org.

https://www.surveymonkey.com/r/MAO_Survey17

Thank you and we appreciate your time!

House Passes Bipartisan Bill to Repeal IPAB

Washington, DC – November 2, 2017

The House of Representatives today passed H.R. 849, the Protecting Seniors Access to Medicare Act, by a vote of 307-111.

H.R. 849, authored by Rep. Phil Roe (R-TN) and Rep. Raul Ruiz (D-CA), would repeal the Independent Payment Advisory Board (IPAB), which was created under the Affordable Care Act with the objective of identifying savings by restricting access to health care for Medicare beneficiaries. If IPAB is triggered, even if the board has not been filled, the Secretary of Health and Human Services (HHS) has the authority to carry out cuts to vital services.

At a July #SubHealth hearing, Ms. Mary Grealy, President, Healthcare Leadership Council, testified in support of H.R. 849, saying, “Nearly 800 organizations representing patients, health care providers, seniors, employers, veterans, Americans with disabilities, and others are asking Congress to do away with the Independent Payment Advisory Board before harm is done to Medicare beneficiaries.”

“Repealing the threat of this powerful, unelected board has been a bipartisan effort for years,” said Health Subcommittee Chairman Michael C. Burgess, M.D. (R-TX). “Today, the House acted yet again to repeal this board and its unconstitutional relinquishment of Congressional authority. I urge the Senate to follow suit so we can return oversight of the future of the Medicare program where it belongs. We must prevent potential cuts from being implemented by this unelected board once and for all.”

Note from MGMA

Please visit the MGMA Advocacy Center to ask their Senators to vote YES to this IPAB repeal legislation.

North Carolina’s New “STOP Act” Creates Obligations for Prescribers and Dispensers of Opioids

2018 Alliance sponsor article courtesy of Medical Mutual

Jason Newton, Senior Vice President, Claims and Risk Management, and Associate General Counsel—Medical Mutual

A new opioid control law in North Carolina brings a nearly immediate effect on physicians and health care providers. Signed by Gov. Roy Cooper on June 29, the Strengthen Opioid Abuse Prevention (STOP) Act has major provisions that went into effect just two days later, on July 1.

The legislation applies to providers, prescribers, and their clinical and non-clinical team members, as well as dispensers. The key points for private practice providers who prescribe “target controlled substances” (Schedule II and III opioids and narcotics listed in NC Gen. Stat. § 90-90(1), (2) or 90-91(d)) to patients in North Carolina are as follows:

  1. Consultation Requirements for NPs and PAs. As of July 1, 2017, nurse practitioners and physician assistants must personally consult with their supervising physician if the patient is being treated at a facility that primarily engages in the treatment of pain by prescribing narcotic medications or advertises for any type of pain management services, and the therapeutic use of the prescription will, or is expected to, exceed 30 days. When continually prescribing the targeted controlled substance to the same patient in accordance with the above, the NP/PA must consult with the supervising physician at least once every 90 days to verify that the prescription remains medically appropriate.
  2. CSRS Not Yet Mandatory, but Should Be Used. Though the law does not make controlled substance reporting system (CSRS) use mandatory immediately (and does not provide a date for when it will be), Medical Mutual’s advice is that providers should not put off registering for and using CSRS for North Carolina patients. It is expected that, after confirming technical upgrades to CSRS, the North Carolina Department of Health and Human Services (NC DHHS) and the North Carolina Medical Board (NCMB) will broadcast when mandatory registration must occur, and that this likely will take place in early 2018.
    1. A patient’s data in CSRS for the prior 12 months must be reviewed before an initial prescription to that patient.
    2. For every three-month period of continued prescription, the practitioner must review the patient’s prior twelve-month history in CSRS and document the results in the EHR.
    3. If CSRS cannot be reviewed because of some technological failure, that inability should be documented in the patient’s chart, and the review should occur as soon as the systems problem is fixed.
    4. CSRS review is not mandatory for certain patients, including but not limited to those receiving the prescription as part of cancer treatment, or those in hospice or receiving palliative care.
  3. Clinical and Non-Clinical Delegates May Be Used to Query CSRS for Physicians. Prescribers may continue to use “delegates” to query the North Carolina Controlled Substance Reporting System. Delegates must work under the physician’s direction and supervision, and the delegation must be approved by NC DHHS. To register delegates, the licensee must register a master account first. The easiest way for a physician licensee to register his or her own account is through the NCMB’s website: https://wwwapps.ncmedboard.org/Clients/NCBOM/Private/MDProfileUpdate/MDProfile_Login.aspx. Delegates may include office nurses and non-clinical staff. The master registrant is responsible for each of his or her delegates. Delegate accounts must be updated annually, or they will become inactive.
  4. Limitations on Prescriptions for Acute Pain. As of January 1, 2018, practitioners must not prescribe more than a five-day supply upon initial consultation and treatment of a patient for acute pain, unless the prescription is for post-operative acute pain relief for immediate use following a surgical procedure, in which case the prescription cannot exceed a seven-day supply.
    1. Acute pain is defined as pain, whether resulting from disease, accident, intentional trauma, or other cause, that the practitioner reasonably expects to last for three months or less. It does not include chronic pain or pain being treated as part of cancer care, hospice care, palliative care, or medication-assisted treatment for substance use disorder.
    2. Chronic pain is defined as pain that typically lasts for longer than three months or that lasts beyond the time of normal tissue healing.
  5. Electronic Prescribing Required as of January 1, 2020. As a general rule, practitioners must electronically prescribe all targeted controlled substances.
  6. Hospice and Palliative Care Instructions. Effective July 1, 2017, Hospice and palliative care providers must share information regarding proper disposal of medications with patients and their families.

As a result of the above, Medical Mutual recommends that practitioners take the following steps:

  1. Enroll in CSRS, read the act, and immediately adopt the prescribing limitations in the act.
  2. Choose delegates carefully, ensuring delegates understand that they must only query CSRS upon the licensee’s request for a patient whose prescription options are being considered by the practitioner.
  3. Set up a process to revoke delegates’ access if those employees leave the practice.
  4. Update delegates’ accounts annually to maintain their access.
  5. Personally document (in the patient’s EHR) that CSRS was queried, what the results were (the prescription history should be added to the EHR), what prescribing decisions were made, and why they were made.
  6. Regularly audit their personal controlled substances prescribing history to ensure its accuracy.
  7. Understand that the DHHS likely will flag unusual prescribing habits evidenced by CSRS activity and share them with the NCMB.
  8. Ask for help with CSRS if needed (CSRS questions should be directed to the Division of Mental Health, Developmental Disabilities and Substance Abuse at [919] 733-7011).

The following resources may be helpful for those seeking more information about the new law:

Medical Mutual members can access opioid-specific resources, including a toolkit and CME-eligible webinars, here: https://www.medicalmutualgroup.com/mednotes-blog/opioid-epidemic-resources.

Act Now on Independent Payment Advisory Board Repeal Legislation

Act Now on Independent Payment Advisory Board (IPAB) Repeal Legislation that was Enacted under the Affordable Care Act

Tomorrow, the House Energy and Commerce Committee and Ways and Means Committee, two committees with jurisdiction over Medicare Part B, are holding hearings on H.R. 849, the Protecting Seniors’ Access to Medicare Act of 2017, which would repeal the Independent Payment Advisory Board (IPAB) created under the Affordable Care Act. Under current law, the IPAB will be triggered when the growth rate in Medicare exceeds target growth rates (as reported by CMS’ Office of the Actuary), and will be responsible for recommending to Congress spending reductions in the Medicare program in order to reduce growth below the target growth rate. Although there have been no members appointed to the IPAB, if the IPAB is triggered, the Secretary of HHS is required to stand in place of the board and submit a proposal for reducing Medicare spending. Any proposal, whether from IPAB or HHS, is subject to a “fast track” legislative implementation process with virtually no oversight, leaving little-to-no room for recourse once IPAB-mandated payment cuts are implemented.

It is paramount that members of Congress act now, before future actuary reports trigger the IPAB and activate payment reductions to Medicare providers. Given the timeliness of the House Committee meetings this week, MGMA has created a template message supporting IPAB repeal that can be found by visiting the MGMA Advocacy Center, where you can contact lawmakers and urge them to support this important legislation.

New and Revised Articles Posted to MLN Matters

New Articles

SE17031 – Updates to Medicare’s Cost Report Worksheet S-10 to Capture Uncompensated Care Data
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE17031.pdf

Revised Articles

MM9904 – Guidance on Implementing System Edits for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9904.pdf

MM10198 – New Waived Tests
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10198.pdf

MIPS 90-day reporting period deadline: Oct. 2

Group practices and eligible clinicians (ECs) seeking to earn a bonus in the Merit-Based Incentive Payment System (MIPS) in 2019 have until Oct. 2 to begin reporting one or more quality measures, improvement activities, or Advancing Care Information measures for the minimum 90 consecutive days. Conversely, group practices and ECs have through the end of the calendar year to avoid a 4% MIPS penalty in 2019 by reporting at least one quality measure on one patient. MGMA encourages practice executives to protect their practice from a Medicare payment cut by reporting more than one measure as an insurance policy in case the group encounters any data submission issues or inaccuracies. For resources to help your practice successfully participate in MIPS, visit MGMA.org/MACRA.