Repeal and Replacement of the Patient Protection and Affordable Care Act (ACA) On January 12 and 13, 2017, the 115th Congress set the stage for the Trump administration by passing a budget resolution to repeal major provisions of the ACA with a simple majority vote. On January 27, 2017, President Trump signed an executive order titled “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal,” to set in…

January 20, 2017 Memorandum from Reince Priebus On January 20, 2017, the White House issued a memorandum for the Heads of Executive Departments and Agencies. In the memorandum, Reince Priebus, Assistant to the President and Chief of Staff, provided a directive including the following: Do not send any regulations to the Office of the Federal Register (OFR) until a department or agency head or designee appointed by President Trump has reviewed and approved the regulation;…

Tom Price, Secretary of Health and Human Services (HHS) President Trump’s nominee for the Secretary of HHS, Tom Price (R-GA), was confirmed on February 10, 2017, by a 52-47 Senate vote. As a U.S. Representative, Tom Price had voted against the Affordable Care Act, and subsequently led efforts to repeal it. He also endorsed plans to limit the growth of Medicare and Medicaid through tax credits, use of health savings accounts, and federal funds for…

On November 1, 2016, CMS issued its Calendar Year (CY) 2017 Outpatient Prospective Payment System (OPPS) final rule with comment period. CMS also issued an interim final rule with comment period that establishes Medicare Physician Fee Schedule (MPFS) rates for certain items and services furnished by certain hospital off-campus outpatient departments. Significant provisions of the final rule are highlighted below. Site Neutral Payment Provisions under Section 603 Under the Bipartisan Budget Act of 2015, Section…

On October 14, 2016, CMS issued the “Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models” final rule with comment period. MIPS and Advanced APMs are the two ways for health care providers to participate in the CMS Quality Payment Program that rewards value and outcomes, as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA amended Title…

On July 6, 2016, CMS published its Calendar Year (CY) 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule. We provide a more detailed analysis of the significant proposals to our July 6 post below.…

On June 17, 2016, CMS published the “Medicare Clinical Diagnostic Laboratory Tests Payment System” final rule. Among the key changes in this final rule, CMS has revised the Medicare Clinical Laboratory Fee Schedule (CLFS) such that payment for clinical diagnostic laboratory tests (CDLTs) beginning January 1, 2018 will reflect the weighted median of private payor rates.…