Medicare Physician Cut Set for April 1st

With the Senate failing to extend the Medicare SGR formula before Congress left for the 2-week recess, physicians again are faced with a 21.3% cut in Medicare reimbursement effective April 1st. The House already passed H.R. 4851, which includes an extension of the SGR Medicare formula, in addition to COBRA and unemployment benefits, but the Senate was not able to vote on this bill prior to recess. The Senate is planning to call for a cloture vote after recess, which if supported by 60 Senators, will allow the Senate to vote on the legislation. This is expected to occur April 12th. This means that there will most likely be a gap that will include the 21.3% reduction in Medicare reimbursement. The Center for Medicare and Medicaid (CMS) should be making an announcement soon discussing how they will handle this issue. Other policy sites are stating that judging on past experience, CMS will be forced to process claims at the reduced reimbursement rates for at least 10 days.

Health Reform & State Update

Well, as most everyone knows by now, the U.S. has undertaken the biggest social policy change since the 60's with the passage of the healthcare bill that President Obama signed into law on Tuesday. There is still a reconciliation bill that corrects a lot of (what I like to call) political garbage that was in the orginal bill that was passed. The Senate is ironing out the reconciliation bill and should be voting on it today or tomorrow. There has been some slight tweaks to the bill, so the House will have to vote on the bill again before being sent to the President to sign.

I've been frantic with other policy fun here at the state level this week and have not had time to fully digest what is in the health reform bill. I am including some links for you to follow if you'd like to read more about the health reform bill. I hope to have something posted that has some more in depth information next week.

National Rural Health Association
American Medical Association
Kaiser Health News

At the state level, HB10-1138 (Colorado Health Service Corps) is up for hearing today at 1:30 in SCR 356. You can listen online by clicking HERE. This is a bill CRHC is in support of as it will strengthen the state's ability to more efficiently and effectively administer the state loan repayment program. It does not have any opposition that I'm aware of, so should sail through the Senate Health & Human Services Committee without issue.

Also, the Long Bill (aka FY10-11 Budget) should be introduced next week. I will be dissecting what is in the budget in regards to rural healthcare services and posting that information here as soon as I'm able.

APN/PAs Spared 10% Cuts!

CRHC is pleased to announce that the Joint Budget Committee did not approve the Colorado Department of Health Care Policy and Financing recommendation to cut Medicaid reimbursement rates for Advance Practice Nurses and Physician Assistants (APN/PA) by 10% to help balance the state budget for FY10-11. Unfortunately due to the state’s fiscal situation, the JBC did support an across the board 1% Medicaid provider reimbursement cut. While CRHC does not support the idea of balancing the state budget on the backs of healthcare providers, CRHC considers the JBC actions regarding APN/PAs a victory for rural healthcare providers and patients.

Thanks to all of you who contacted the JBC and for your continued support of ensuring that rural Coloradans have access to quality, affordable healthcare services!

Health Reform????

Well folks, the end is near. Either we are about to see the culmination of the past year come forward with the passage of health reform or we are about to witness a huge political failure. As of this writing, sources say the House is still shy 3 votes of having the 216 votes needed. Regardless, the President has postponed his oversees trip and is hoping to have something signed before Easter recess on March 26th. The House is expected to vote on Sunday on the health reform bill, which now consits of the Senate bill that was passed on Christmas Eve along with a reconciliation bill that the House drafted to address some of the issues in the Senate bill.

Should be an interesting weekend folks, especially since we are expecting a big snowstorm to welcome in the offical beginning of Spring on the 20th!

One more thing......the House Committee on Energy & Commerce has detailed information on how the health reform bill will impact each of the 435 congressional districts in the country.
This is a great resource.

CMS Delays OPPS Rule for CAHs

The Centers for Medicare & Medicaid (CMS) issued a notice on Monday stating that the supervision requirement for Outpatient Therapeutic Services will not be enforced for Critical Access Hospitals (CAHs). This is good news as most CAHs were not able to comply with the recent outpatient prospective patient system rule of "direct supervision" for therapeutic services furnished in hospital outpatient departments. The "direct supervision" rule unfortunately still applies to rural hospitals who are not CAHs and who will still face a difficult time complying with the CMS rule. The delay in enforcement for CAHs is through the end of 2010. CRHC will be working with our CAHs and organizational partners to make permanent changes to this rule to ensure that CAHs and rural hospitals will be able to comply with future supervision requirements.

For a fact sheet on the OPPS rule, please click here.

To read the CMS notice, please click here.

Updated Bill Tracking List

As I mentioned last week, there aren't any new bills posted on the bill tracker, though most of the bills we are following have been scheduled for a hearing. Of note is HB10-1138: Colorado Health Service Corps. CRHC is supporting this bill, which is seeking to rebrand the state loan repayment program, expand eligible providers who have access to these funds, and also make some administrative changes so that the Primary Care Office can most efficiently and effectively operate the program. This bill has already passed out of the House and is scheduled to be heard in the Senate Health & Human Services Committee on Thursday, March 25th. I will post more information on this bill and contact information for the Senate HHS Committee in the upcoming days for those of you interested in contacting your Senator to urge their support of this bill.

We Need to Hear from CAHs

The Centers for Medicare & Medicaid (CMS) proposed rule changes to the 2010 Outpatient Prospective Payment System (OPPS) recently went into effect. There has been quite a bit of outreach from other state's in regards to this final rule especially in regards to the physician supervision requirements for outpatient therapeutic services. If you are a Critical Access Hospital (CAH) or rural hospital in Colorado and are concerned about this new ruling, we need to hear from you!

According to information gathered on a recent call with CMS:

• Although the CAH Conditions of Participation don’t require a CAH to have a physician on-site 24/7, the 2010 OPPS Final Rule does require a physician or non-physician practitioner (NPP) to be on-site and immediately available whenever the CAH is providing OP therapeutic services in order to bill for these services, including normal business hours, after hours/overnight. Having the physician or NPP on-call is not sufficient to meet the 2010 OPPS final rule billing requirements for these services. Observation services and IV treatments are included in OP therapeutic services.

• An ED physician or NPP could potentially provide direct supervision of OP therapeutic services (within their scope). It is up to the CAH’s discretion to determine if the ED physician can meet the “immediately available” criteria under the rule depending on their patient volume.

• “Immediately available” means the physician or NPP can be interrupted – for example, a surgeon performing an 8-hour surgery is not considered immediately available.

CMS has received many questions and comments since the 2010 OPPS rule went into effect. CRHC has been contacted by Senator Udall's office to inquire about how this rule will impact CAHs and if we should be actively trying to change this.

Please contact Terri Hurst, th@coruralhealth.org, and let CRHC know what sort of impact this rule has on your facility’s ability to provide OP therapeutic services. We’ll keep you informed of any additional guidance from CMS on this issue.

State & Federal Updates

I won't be posting the bill tracking list this week as there have been no real substantive changes since last week. We are anxiously awaiting the HCPF figure setting, which is set to occur on Tuesday, March 16th. We'll know then if the JBC is recommending the 10% cuts to APN/PAs or if they are willing to share the pain across all providers. It is bad policy to cut provider reimbursement rates to help balance the state's budget, but it is even worse policy to target specific provider types as a reason to cut reimbursement rates. Please see my post from March 2nd to learn more about this issue and how you can get involved.

At the federal level, the Senate passed H.R. 4213 Tax Extenders Act of 2009 (aka jobs bill) yesterday. This bill will extend a lot of expiring provisions which include extending the FMAP increase for an additional 6 months to June 30, 2011 and delaying Medicare physician cuts until October 1st 2010. The House passed a similar bill in December 2009. The two chambers will now have to reconcile the differences between the two bills before it is sent to President Obama. Currently, Medicare physician cuts are set to occur April 1st. Hopefully Congress can work through their differences and get this bill enacted prior to that time.

Federal Healthcare Reform Update

Well, it sounds like this is it folks. Either we are about to witness federal healthcare reform move forward or we will not see anything happen......Or at least, that is what every policy wonk is saying from D.C. to California. Here's the latest and greatest on what people are anticipating will happen the next couple of weeks:

The House will pass the Senate bill that was passed on Christmas Eve 2009. The pickle here is that the House will essentially be supporting all the "junk" in the Senate bill that the President has announced he wants out and has outlined in his "correction's" bill.

After and IF the House pass the Senate bill, the Senate will then have to pass the President's "correction's" bill through reconciliation, which will strip out some of the "junk" that is currently in the bill (ex: Federal government paying for all of Nebraska's Medicaid program AKA the Cornhusker kickback).

Then, the "correction's" bill will have to pass the House......and then, it would be sent to President Obama to sign.

Whew......

As of today, there are not enough votes in the House (218 are needed) to pass the Senate bill. There was talk of a vote by St. Patrick's Day (not sure why our Government has been using holidays as timelines....), but it now seems people are hoping for a vote by March 26th before the Congressional recess. Regardless, it seems that time is ticking and if something does not occur soon, then the past year of debates, discussions, and movement will be another example of a failed attempt by the feds to reform healthcare.

3.5.10 Updated Bill Tracker

Not a lot of new bills added this week. Seems like the hot button issues are still concerning the budget supplementals and medical marijuana. Stay tuned next week for HCPF figure setting by the JBC on Thursdsay, March 11th. Please see my post from March 2nd concerning APN/PA rate reductions.....

In federal health reform news, President Obama wants something passed and now we're just waiting to see when and how healthcare reform will move forward. Still a lot of talk of using the reconciliation process. Here is a link to an article on Time Magazine online that discusses how the reconciliation process works.

Have a great weekend!

Medicare Payments Extended 30 Days

Last night the Senate was able to pass the Temporary Extension Act of 2010, which will delay the 21.2% Medicare cut to physicians. In addition to postponing Medicare physician payment cuts, the bill extended a variety of other expiring programs including unemployment insurance and premium subsidies for COBRA continuation coverage for those whose employment was involuntarily terminated.

This now means that Congress has a month to either approve another short-term fix to the Medicare SGR or to finally address this payment methodology so that physicians are not constantly faced with the threat of substantial Medicare reimbursement cuts. With President Obama pushing healthcare reform, the SGR formula fix may be tied into that bill or we may see something completely seperate emerge.

Stay tuned as the fun never seems to stop!!!!

Call to Action: Contact the JBC!

The Joint Budget Committee (JBC) will be figure setting (creating the budget) for FY10-11 for the Department of Health Care Policy & Finance (HCPF) on Thursday, March 11th. Due to the budget shortfall, there will inevitably be cuts to the HCPF budget. Some of the proposed HCPF cuts for FY10-11 include:

A 4-week delay in Medicaid payments (meaning Medicaid providers will most likely get paid the first week of June 2011, but won't be paid again until after July 1, 2011);

$25.7 million cut from Amendment 35 funds, which will leave $17.3 million for prevention, early detection, and treatment programs; tobacco education; and health disparities programs;

Medicaid reimbursement cut of 1%; and

10% Medicaid cuts to Advance Practice Nurses(APN) and Physician Assistants(PA).

It is this last proposed cut that CRHC is urging the JBC to reconsider. Targeting APNs and PAs for reimbursement cuts would greatly impact rural healthcare delivery. APNs, in particular, practice independently in rural Colorado. In addition to the 5.5% Medicaid cuts that have taken place the past 2 years, an additional 10% cut to their reimbursement would cause many APNs and PAs to reduce or stop accepting Medicaid patients altogether. The state estimates that a 10% rate cut to APN/PAs will save the state approximately $600,000. Instead of targeting specific provider types, CRHC, along with some of our partner organizations, are asking for an additional .1% across the board cut for all providers. According to the Colorado Nurses Association, adding a .1% across the board cut to all providers would save the state approximately $900,000. This means more cost savings for the state and a more fair and equitable way to address the budget shortfall. It is unfortunate that healthcare providers are being targeted at all in helping to balance the state budget, but targeting provider types as a reason to reduce reimbursement rates is not fair nor good public policy.

CRHC encourages you to contact members of the JBC and ask them to avoid cutting APNs and PAs by 10% and instead spread the cuts across all providers by adding a .1% Medicaid reduction.

JBC Members:

Representative Jack Pommer: 303-866-2780
jack.pommer.house@state.co.us

Representative Mark Ferrandino: 303-866-2911
mferrandino@yahoo.com

Representative Kent Lambert: 303-866-2937
rep.kent.lambert@comcast.net

Senator Moe Keller: 303-866-2585
moe.keller.senate@state.co.us

Senator Abel Tapia: 303-866-2581
abel.tapia.senate@state.co.us

Senator Al White: 303-866-2586
al.white.senate@state.co.us

Medicare Rate Cuts for Physicians

Starting today, the Center for Medicare & Medicaid Services (CMS) will hold Medicare claims for 10 days in anticipation that Congress will act to avoid a 21.2% reimbursement cut to physciains. If Congress fails to address the Sustainable Growth Rate (SGR), which is the methodology used to determine Medicare payments, Medicare patients will be greatly impacted as physicians will inevitably stop accepting Medicare patients. These Medicare cuts will greatly impact rural residents as there is a larger portion of elderly living in our rural communities who are already faced with a provider shortage.

Now is the time to contact Colorado's Congressional leaders and encourage them to fix the SGR and avoid these cuts!

Senator Mark Udall: 202-224-5941; 303-650-7820
Senator Michael Bennet: 202-224-5852; 303-455-7600

Representative Diana DeGette: 202-225-4431; 303-844-4988
Representative Jared Polis: 202-225-4431; 303-484-9596
Representative John Salazar: 202-225-4761; 970-245-7107
Representative Betsy Markey: 202-225-4676; 970-221-7110
Representative Doug Lamborn: 202-225-4422; 719-520-0055
Representative Mike Coffman: 202-225-7882; 720-283-9772
Representative Ed Perlmutter: 202-225-2645; 303-274-7944