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Written by: Darlene D'Altorio-Jones (1959-2015) on Wednesday, April 2, 2014 Posted in: Outpatient Rehab

A Statement Delay of Enormous Proportion: H.R. 4302

If ever a bill held substance that directly impacts rehabilitation management of issues we now face, this could be the one. Don’t pass up your chance to read and understand it a bit better. H.R. 4302 pushed quickly to address an impasse on Senate Bill 2110; this bill includes several extended mandates and even a twist – another delay to ICD-10! And the kicker – final signature and passage occurred on April Fool’s Day. Is this an impending statement? You decide!

Why is it important you review this bill? What affects you, the rehabilitation provider? Let me carve out just a few of the sections that impact you TODAY, perhaps in the same way as yesterday or slightly different!

Title I—Medicare Extenders – 3 Items highlighted

Sec. 101. Physician payment update – Fee schedule adjustment that doesn’t repair the SGR formula as originally intended but continues to patch the formula 17 times in the past 11 years. When CMS realized final signature would extend to the beginning of April, Medicare had forewarned MACs to ‘delay’ processing of April services payments for at least 10 days to allow adjustment for the final law making mandates to be determined. The end result is that Medicare payments will NOT be hit with the 24.4 percent cut as intended. Instead, the 12 month patch of extending the 0.5 percent update through the end of this year and then holding future payments at 0.0 percent until addressed permanently is the most likely solution.

Sec. 103. Extension of therapy cap exceptions process. It has been extended through March 31, 2015. (Present status quo, only dates were changed through March 2015.)

Sec. 109. Extension of funding for quality measure endorsement, input and selection. (Quality transparency and continuous alignment for comparative values supported to continue crossing that ‘quality chasm’ described to hold health care accountable to outcomes for payment!)

·         For purposes of carrying out this section and section 1890A (other than subsections (e) and (f)), the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841, in such proportion as the Secretary determines appropriate, to the Centers for Medicare & Medicaid Services Program Management Account of $5,000,000 for fiscal year 2014 and $15,000,000 for the first 6 months of fiscal year 2015. Amounts transferred under the preceding sentence shall remain available until expended.

Sec. 111. Extension of two-midnight rule (important observation status definition & audit activity).

·         (a)Continuation of certain medical review activities. The Secretary of Health and Human Services may continue medical review activities described in the notice entitled Selecting Hospital Claims for Patient Status Reviews: Admissions On or After Oct.1, 2013, posted on the Internet website of the Centers for Medicare & Medicaid Services, through the first six months of fiscal year 2015 for such additional hospital claims as the Secretary determines appropriate.

·         (b) Limitation. The Secretary of Health and Human Services shall not conduct patient status reviews (as described in such notice) on a post-payment review basis through recovery audit contractors under section 1893(h) of the Social Security Act (42 U.S.C. 1395ddd(h)) for inpatient claims with dates of admission Oct. 1, 2013, through March 31, 2015, unless there is evidence of systematic gaming, fraud, abuse, or delays in the provision of care by a provider of services (as defined in section 1861(u) of such Act (42 U.S.C. 1395x(u))).

Title II—Other Health Provisions – 3 items highlighted

Sec. 212. Delay in transition from ICD–9 to ICD–10 code sets.

·         The Secretary of Health and Human Services may not, prior to Oct. 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, Code of Federal Regulations.

Sec. 213. Elimination of limitation on deductibles for employer-sponsored health plans.

Sec. 215. Skilled nursing facility value-based purchasing. (Accountability to outcomes and reduction of 20 percent return to acute within 30 days of discharge as presently experiencing. Two steps are addressed!)

·         Skilled nursing facility readmission measure

(1)Readmission measure: Not later than Oct. 1, 2015, the Secretary shall specify a skilled nursing facility all-cause all-condition hospital readmission measure (or any successor to such a measure).

(2)Resource use measure: Not later than Oct. 1, 2016, the Secretary shall specify a measure to reflect an all-condition risk-adjusted potentially preventable hospital readmission rate for skilled nursing facilities.

(C)Timing: Such procedures shall provide that the information described in subparagraph (A) is made publicly available beginning not later than Oct. 1, 2017.


·         SNF VBP – incentive payments

(1) Establishment (A) In general: Subject to the succeeding provisions of this subsection, the Secretary shall establish a skilled nursing facility value-based purchasing program (in this subsection referred to as the SNF VBP Program) under which value-based incentive payments are made in a fiscal year to skilled nursing facilities.

(B) Program to begin in fiscal year 2019.

The SNF VBP Program shall apply to payments for services furnished on or after Oct. 1, 2018.

(Extensive discussion – go to the bill to read more.)

Of course many more areas were highlighted in the bill that was signed. Please review to what extent these other areas will affect your lines of service!

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