Agreement to End Government Shutdown Contains Many Provisions Impacting Reimbursement

The recent bi-partisan budget package to keep the government funded does much more than simply keep the government open. The legislation makes a number of changes to the Medicare program as well as other health programs. The most notable are summarized below:

  • The scheduled 0.5 percent update to the Physician Fee Schedule slated to occur on January 1, 2019 is reduced to 0.25 percent.
  • Included in the budget package is language extending the mandatory 2 % Medicare sequestration cut enacted in 2013 until 2027.  Sequestration in its current form began on March 1, 2013, when President Obama, pursuant to the Budget Control Act of 2011, ordered cuts to federal spending effective April 1, 2013, after Congress and the President failed to reach a budget compromise.
  • The bill repeals the Independent Payment Advisory Board (IPAB), a committee which has never been formed or convened, with broad authority to institute Medicare payment cuts. The IPAB was created by the Affordable Care Act (ACA) and is unpopular among both Republicans and Democrats.
  • Congress will provide the Centers for Medicare and Medicaid Services (CMS) with increased flexibility to implement the Merit-based Incentive Payment System (MIPS). Congress is allowing CMS to set the performance threshold for performance years two through five. The original MACRA statute required CMS to use either the mean or the median Composite Performance Score (CPS) as the performance threshold beginning in year three of MIPS.
  • Eligible clinicians who score below the performance threshold will receive a negative payment adjustment for the corresponding performance year. This flexibility will allow CMS to gradually increase the performance threshold over time. CMS would be required to use the mean or median CPS beginning in the sixth year of MIPS.
  • The bill grants CMS discretion in how to weight the Resource Use (cost) performance category in MIPS for the second through fifth years of MIPS. Cost will account for 10% of each EC’s CPS score in the 2018 reporting year and is required by statute to represent 30 percent of an EC’s CPS score in the 2019 reporting year. CMS would still be required to maintain at least a weighting of 10% for the cost category. Further, CMS would not be allowed to factor improvement within this category into an EC’s CPS.
  • The bill increases civil and criminal penalties and increased sentences for Federal health care program fraud and abuse. The bill updates both the civil and criminal penalties for fraud and abuse in federal health programs that have largely remained static over the past 20 years.
  • The bill makes it easier for providers to obtain a hardship exemption from the Advancing Care Information (ACI) reporting category of MIPS and the EHR Meaningful Use Program.
  • The bill also removes a requirement that CMS make meaningful use standards more stringent over time, increasing the likelihood that providers will be able to comply with those standards.

As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.

Regards,
Lauren Sloan, MHA, RD, LD
Director of Regulatory Affairs