On March 26, 2015, the House passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) by an overwhelming vote of 392-37. This is a critical bill for health care providers and attorneys to monitor as it includes many major changes, most notably the modification of the sustainable growth rate (SGR) for physician payments. If signed into law, the new bill would eliminate the SGR formula for Medicare physician reimbursement, instead implementing a 0.5 percent rate increase starting in July 2015, with an additional annual 0.5 percent rate increase each January thereafter through 2019. The new reimbursement formula has been publicly endorsed by the American Medical Association, the American College of Cardiology, the American Congress of Obstetricians and Gynecologists, and the Association of American Medical Colleges.
The package also contains a set of Medicare fraud measures known as the Protecting the Integrity of Medicare Act 2015 (PIMA), including:
- Further delay enforcement of the so-called Medicare “two midnight rule” for inpatient admissions until September 20, 2015;
- Loosen existing restrictions on gainsharing with physicians, thereby permitting providers to give bonuses to doctors for reduced costs on services which were not medically necessary;
- Permit the Department of the Treasury to impose major levies of up to 100 percent on tax delinquent Medicare service providers;
- Require the Centers for Medicare & Medicaid Services (CMS) to stop using Social Security numbers on Medicare beneficiary cards; and
- Modify the face-to-face encounter requirement for durable medical equipment to permit nurse practitioners and physician assistants to perform the encounter if allowable under state law.
The Senate recessed for two weeks on Friday, March 27, without passing the legislation, but is expected to vote soon after returning. For more in-depth analysis, please read McDermott + Consulting’s March 2015 +Insights newsletter.