2017 Medicare final rules could spur lame duck action
November 10, 2016
By Jill Rathbun
When Congress returns, members could be faced with a decision regarding whether to address a small health care policy piece of legislation during the lame duck session, or wait for the new Administration and the expiration of the Medicaid CHIP program and Medicare extenders on Sept. 30, 2017. With the expiration of the CHIP program and the Medicare extenders in 2017, this basically guarantees discussion of health care policy and potentially the development of a substantial piece of legislation next year. So, does Congress wait?
Well, it depends…The party that controls the different houses of Congress, and by how many seats, is going to make a difference. If the Senate majority changes, and along with it chairpersonships and the possible agenda, it may be that the Democrats decide it is in their best health care policy interest, and the Administration’s health care policy interest, to wait for next year.
There is only so much money in the health care payment system that will be available through policy changes, and there is going to be a sizable cost to continue the Medicaid CHIP program and the Medicare extenders, many of which relate to rural health care. The next party in charge of Congress may want to hold on to those policy changes for next year’s Medicare and Medicaid legislation. Or not…
The “or not…” is for those policy changes that are neither savers nor spenders. These are items that individual members of Congress, who are retiring, want to do, or that need to get done to help fix a process problem with a program. Or it may be pieces the party that is taking over in January just wants to get cleared off.
There is yet another “Or,” and that is that there is the legislation that may be catapulted into action by the 2017 Final Medicare Physician and Hospital Outpatient Fee schedules. And this is probably where the motivation lies and the “it depends” matters. 2017 Final Medicare Physician and Hospital Outpatient Fee schedules and the last of the current Administration’s proposed Medicare demonstration projects have the greatest probability of causing a piece of health care policy, which would be primarily Medicare policy, to materialize in the lame duck session.
This would then become a “vehicle” to add other policy proposals as well. I expect that by the time you are reading this the Final Medicare Physician and Hospital Outpatient Fee schedules will have been published in the Federal Register, as we expect them on or before Nov. 1, 2016. We may also have the final Medicare Part B Drug Costs Demonstration Project Rule as well. It is what is or is not in these two final rules that may be the catalyst for a health care package/piece of legislation in the lame duck.
Hospitals are still contemplating how to fix the problems in the original site-neutral legislation regarding the grandfathering of facilities under construction, to be paid under the hospital outpatient department fee schedule, versus the physician fee schedule. CMS has a very narrow interpretation regarding hospital services and facilities, including when the grandfather clause will be effective and when it won’t. In addition, CMS proposes that hospitals would have to find a way to re-register under the Medicare program as a physician office to continue to be paid in 2017 for their non-grandfathered outpatient services.
How the comments on the proposed rule are taken into consideration, and changes made in the final rule, could determine if the hospital community unifies around a position and goes to Congress for help in the lame duck. There is already legislation introduced to stop the Medicare Part B Drug Demonstration Program. Depending on how CMS adapts and changes that program based on comments regarding the proposed rule when it releases the final version, Congress could decide it needs to act. This would then provide a highly-motivated opportunity for other health care legislation to be added on.
Where does imaging fit into all of this and where should there be concern? First is the impact that the finalization of the site-neutral policies and the grandfathering of the outpatient facilities will have. How CMS makes changes could determine the ability of hospitals to expand imaging services. Second, whenever there is Medicare-related legislation that may cost money to enact, like the repeal of the Medicare Part B Drug Demonstration Project, imaging is often on the reimbursement reduction list to pay for some of the cost. This is something that the imaging community must guard against.
About the author: Jill Rathbun is managing partner at Galileo Consulting Group.
When Congress returns, members could be faced with a decision regarding whether to address a small health care policy piece of legislation during the lame duck session, or wait for the new Administration and the expiration of the Medicaid CHIP program and Medicare extenders on Sept. 30, 2017. With the expiration of the CHIP program and the Medicare extenders in 2017, this basically guarantees discussion of health care policy and potentially the development of a substantial piece of legislation next year. So, does Congress wait?
Well, it depends…The party that controls the different houses of Congress, and by how many seats, is going to make a difference. If the Senate majority changes, and along with it chairpersonships and the possible agenda, it may be that the Democrats decide it is in their best health care policy interest, and the Administration’s health care policy interest, to wait for next year.
There is only so much money in the health care payment system that will be available through policy changes, and there is going to be a sizable cost to continue the Medicaid CHIP program and the Medicare extenders, many of which relate to rural health care. The next party in charge of Congress may want to hold on to those policy changes for next year’s Medicare and Medicaid legislation. Or not…
The “or not…” is for those policy changes that are neither savers nor spenders. These are items that individual members of Congress, who are retiring, want to do, or that need to get done to help fix a process problem with a program. Or it may be pieces the party that is taking over in January just wants to get cleared off.
There is yet another “Or,” and that is that there is the legislation that may be catapulted into action by the 2017 Final Medicare Physician and Hospital Outpatient Fee schedules. And this is probably where the motivation lies and the “it depends” matters. 2017 Final Medicare Physician and Hospital Outpatient Fee schedules and the last of the current Administration’s proposed Medicare demonstration projects have the greatest probability of causing a piece of health care policy, which would be primarily Medicare policy, to materialize in the lame duck session.
This would then become a “vehicle” to add other policy proposals as well. I expect that by the time you are reading this the Final Medicare Physician and Hospital Outpatient Fee schedules will have been published in the Federal Register, as we expect them on or before Nov. 1, 2016. We may also have the final Medicare Part B Drug Costs Demonstration Project Rule as well. It is what is or is not in these two final rules that may be the catalyst for a health care package/piece of legislation in the lame duck.
Hospitals are still contemplating how to fix the problems in the original site-neutral legislation regarding the grandfathering of facilities under construction, to be paid under the hospital outpatient department fee schedule, versus the physician fee schedule. CMS has a very narrow interpretation regarding hospital services and facilities, including when the grandfather clause will be effective and when it won’t. In addition, CMS proposes that hospitals would have to find a way to re-register under the Medicare program as a physician office to continue to be paid in 2017 for their non-grandfathered outpatient services.
How the comments on the proposed rule are taken into consideration, and changes made in the final rule, could determine if the hospital community unifies around a position and goes to Congress for help in the lame duck. There is already legislation introduced to stop the Medicare Part B Drug Demonstration Program. Depending on how CMS adapts and changes that program based on comments regarding the proposed rule when it releases the final version, Congress could decide it needs to act. This would then provide a highly-motivated opportunity for other health care legislation to be added on.
Where does imaging fit into all of this and where should there be concern? First is the impact that the finalization of the site-neutral policies and the grandfathering of the outpatient facilities will have. How CMS makes changes could determine the ability of hospitals to expand imaging services. Second, whenever there is Medicare-related legislation that may cost money to enact, like the repeal of the Medicare Part B Drug Demonstration Project, imaging is often on the reimbursement reduction list to pay for some of the cost. This is something that the imaging community must guard against.
About the author: Jill Rathbun is managing partner at Galileo Consulting Group.