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!

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.

CNBC Interview With Anthem CEO

Click here to view an interview with the Anthem Blue Cross CEO Joseph Swedish regarding their future participation in Obamacare. This is interesting perspective from the carrier’s position about the affordable care act.

Palmetto GBA E-mail Update: Friday, June 16, 2017

Provider Enrollment Revalidation – Cycle 2
Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers/suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria. In an effort to streamline the revalidation process and reduce provider/supplier burden, CMS has implemented several revalidation processing improvements that are captured within this article. Make sure your staff is aware.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

Reminder of Advance Beneficiary Notice of Noncoverage (ABN) Renewal
The Centers for Medicare & Medicaid have renewed the Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131. Please note no changes have been made to the form itself; however, the newly incorporated expiration date is March 2020. Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

E/M Weekly Tip: General Documentation
You may only use one set of evaluation and management (E/M) guidelines when selecting the appropriate CPT code. Mixing or combining of the two sets of guidelines is not acceptable. Please share with appropriate staff.

Applies to:

  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Signatures, Credentials and Dates: They Are Important
Each entry in the patient’s medical record requires the acceptable signature of the person writing the note along with the date. Palmetto GBA also recommends the inclusion of the applicable credentials (e.g. P.A., D.O. or M.D.), especially when the services being billed are only coverable when performed by certain credentialed professionals. Please share with appropriate staff.

Applies to:

  • Railroad Medicare (RRB)//General – Railroad Medicare
  • JM Part A//General
  • JM Part B//General
  • JM Home Health and Hospice//General

American Health Care Act (AHCA) passes House, advances to Senate

Originally published on May 4, 2017 in MGMA’s Washington Connection
Reprinted with permission from MGMA

Today, the House of Representatives passed an amended version of the American Health Care Act (AHCA), H.R. 1628, by a vote of 217-213. This version of AHCA has not yet received a score from the Congressional Budget Office (CBO). In the previous version, CBO estimated that under the AHCA 14 million fewer people would have health insurance coverage in 2018 and 24 million fewer by 2026. Among other changes, this legislation would:

  • Repeal the Affordable Care Act tax credits and replace them with advanceable, refundable flat tax credits adjusted for age
  • Impose a 30% late enrollment penalty on premiums for individuals who have lapsed in consecutive coverage for 63 consecutive days or longer
  • Modify the age-rating limit, which would allow insurers to significantly raise premiums for older adults
  • Fund separate state high-risk pools for more expensive patients, which is intended to lower premiums
  • Incentivize the use and expansion of health savings accounts
  • Allow states to apply for waivers that would:
    • Redefine required coverage for mandated essential health benefits,
    • Further increase the age rating ratio, or
    • Eliminate the ban against significant increases in premiums for people with pre-existing conditions;
  • Repeal the Medicaid expansion program and phase out current enhanced federal matching rates, with certain exceptions
  • Permit states to institute a Medicaid work requirement
  • Allow states to choose between a Medicaid per capita allotment or flexible block grant federal financing structure

The legislation will now be sent to the Senate where it will be subject to debate. All Democratic and many Republican Senators have expressed significant reservations. If the Senate decides to advance the legislation, it is almost certain to be amended, which would require another House vote prior to final passage.

Last month, MGMA sent a letter to House leadership outlining concerns with the AHCA in the context of the Association’s healthcare reform principles. Stay tuned to the Washington Connection for updates.

New Administration signals significant policy shifts

Originally published in the January 25, 2017 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

On his first day in office, President Trump signed an executive order reaffirming his goal to “seek the prompt repeal” of the Affordable Care Act (ACA). The order compels federal agencies to take all actions consistent with law to minimize the economic and regulatory burdens of the ACA. The majority of relevant regulations that can be changed through rule-making, including minimum essential benefits requirements and the authority to institute waivers for insurance mandates, are governed by the Department of Health and Human Services (HHS). Accordingly, the magnitude of the order’s practical impact will be largely contingent on the future actions of Rep. Tom Price, MD (R-GA) and Seema Verma, MPH, the nominees for Secretary of HHS and Administrator of the Centers for Medicare & Medicaid Services (CMS), respectively. Both nominations will be considered for confirmation in the coming weeks.

Earlier this month, the House and Senate took the first step towards ACA repeal and replacement by passing a budget resolution instructing relevant congressional committees to develop legislation that would repeal critical budgetary elements of the ACA through an expedited process known as reconciliation. Details on the expected timeline and key elements of the replacement legislation remain unclear.

New Congress begins, starts process to repeal and replace the ACA

Originally published in the January 4, 2017 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

Members of the 115th Session of Congress were sworn in on Tuesday and introduced a budget resolution that would begin the process to repeal and replace parts of the Affordable Care Act (ACA). The budget resolution, which does not have the force of law, instructs certain congressional committees to develop legislation to repeal parts of the ACA through an intricate budgetary process known as reconciliation. The goal is for both the Senate and House of Representatives to complete action on the budget resolution by Jan. 20 when President-elect Trump is inaugurated. Then, development of the repeal legislation would begin. Under consideration is a plan to defer implementation of the repeal bill to allow congressional leadership and the Trump Administration time to develop a replacement package. However, the outcome of the process and any practical implication for medical group practices will remain unclear until more specificity is brought to the timeline and content of the legislative package.