ACNP Legislative Update - April 30, 2012

Trustees Find Medicare Funding Adequate Until 2024

Medicare's Trust Fund will be solvent until 2024, the same as estimated last year, the program's trustees said April 23 in their annual report on the financial state of Medicare. The trust fund would have gone bankrupt in 2016 without the Medicare provisions in the Patient Protection and Affordable Care Act, according to the report, although many of those provisions have yet to be implemented. The law reduced projected Medicare spending more than $500 billion over 10 years.

Although Medicare will remain financially viable until 2024, the 285-page "2012 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds" said further reforms beyond those included in the health reform law will be needed to ensure the program's long-term solvency. "The sooner solutions are enacted, the more flexible and gradual they can be," Treasury Secretary and Medicare trustee Timothy F. Geithner said. "At the same time, adjustments to Social Security and Medicare must be balanced and evenhanded. We will not support proposals that sow the seeds of their destruction in the name of reform, or that shift the cost of health care to seniors in order to sustain tax cuts for the most fortunate Americans," he added, in an apparent reference to a proposal by House Budget Committee Chairman Paul Ryan (R-WI) that would convert Medicare into a voucher program.

Senate Passes Postal Reforms Without Workers Comp Changes

The Senate approved legislation (S. 1789) last Wednesday that would help the U.S. Postal Service shore up its shaky finances, putting pressure on the House to act on its alternative bill before a mid-May deadline for the Post Office to begin cutting back services and closing facilities.

However, Senators voted 46 to 53 to reject an amendment offered by Senator Daniel Akaka (D-HI) that would have allowed nurse practitioners, physician assistants, and other advanced practice nurses to diagnose and treat federal employees with job-related traumatic injuries during the first 45-day continuation of pay period.  The House passed legislation (H.R. 2465) last November that included the provisions of the Akaka amendment, and the issue could resurface in conference negotiations between the House and the Senate.

FDA User Fee Bills Advance in Senate, Stall in House

The Senate Health Education Labor and Pensions Committee approved bipartisan legislation to reauthorize the Prescription Drug User Fee Act (PDUFA) user fee bill passed out of committee easily Wednesday, but votes on a House companion bill were delayed when a draft released by the Energy and Commerce Health Subcommittee leadership drew sharp opposition from Democrats in both chambers.

With a week-long congressional recess starting last Friday evening, House leaders postponed a scheduled markup of their reauthorization bill until May 8 to give members and staff more time to iron out problems. The full Senate is expected to take up the HELP Committee bill in May.

Negotiators in the House have been tight-lipped about their concerns, but a potential sticking point is how generously to craft incentives for antibiotic drug makers. Both Senate and House bills are expected to include provision to permanently reauthorize research incentives for development of drugs for children.

House Panel Votes to Cut $115 Billion in Health Spending

The House Energy and Commerce Committee voted Wednesday to approve a package of $115 billion in health care savings as its contribution to reconciling revenue and spending under the House-passed budget plan for fiscal year 2013. The proposal, which unlikely to be considered in the Senate, would completely repeal the Prevention and Public Health Fund and the Medicaid "maintenance of effort" requirement in the Affordable Care Act as well as bonus payments to states for finding and enrolling eligible children.

Five other House committees have sent similar spending reduction plans to the House Budget Committee, which will combine them into a single budget reconciliation bill that the full House is likely to debate in May. Senate leaders do not intend to consider a reconciliation bill for fiscal year 2013, but the House may use the proposed cuts as negotiating positions in budget talks later this year.

CMS Proposes 2013 Hospital Payment Policies

The Centers for Medicare and Medicaid Services (CMS) released proposed regulations Tuesday setting fiscal year 2013 Medicare payment policies and rates for inpatient stays in general acute-care and long-term care hospitals, signaling that it will not enforce the looming "25 percent" rule that hospitals have been trying to avoid. However, the proposed rule includes a separate pay cut, called the "budget neutrality adjustment," that some observers expected CMS to delay another year.

CMS proposes to increase fiscal 2013 pay rates 2.3 percent for acute-care hospitals that report quality data. Facilities that don't participate in the Hospital Inpatient Quality Reporting (IQR) Program would get a mere 0.3 percent increase. Long-term care hospitals would get a 1.9 percent boost in pay, but CMS will cut that LTCH pay rate by 1.3 percent starting at the end of the year with the budget neutrality adjustment. The rule also includes key elements of the Affordable Care Act's value-based purchasing program and the hospital readmissions reduction program.

The proposed rule is scheduled to be published in the May 11 Federal Register and the deadline for public comments is June 25.

Expanded Role For Providers Added to PCORI Draft Research Agenda

The governing board of the Patient-Centered Outcomes Research Institute (PCORI) voted Wednesday to amend PCORI's draft research agenda in response to 15 major themes that emerged from more than 470 public comments on its proposed agenda released in February. Language was added on the importance of studying new and expanded roles for the full range of healthcare providers and emphasizing the importance of care coordination.  The board did not recommend any changes in the quasi-governmental agency's National Priorities for Research, saying the public comments did not identify significant gaps in the five proposed priorities. A full final version of the National Priorities and Research Agenda, including accepted revisions, will be released May 21 after final Board review and approval at its next public meeting in Denver.

The board also authorized $30 million in funding over two years for a slate of 50 pilot projects that will address a broad range of questions about methods for engaging patients in various aspects of the research and dissemination process.

CMS Provider and Supplier Enrollment Rule Finalized

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on April 24, 2012 called the "Medicare and Medicaid Programs: Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements." The final rule requires all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs. It also requires health care professionals who are permitted to order and certify covered items and services for Medicare beneficiaries to be enrolled in Medicare.  It also requires document retention and provision requirements on providers and supplier that order and certify items and services for Medicare beneficiaries. Those who fail to meet the requirements may find their provider's enrollment in federal health care programs suspended for up to a year.