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NAHC Report: Issue# 2367, 2/6/2014
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House and Senate Committees Reach Agreement on SGR Bill
HHS OIG Releases 2014 Work Plan
For Your Information: CMS’ Hospice Item Set Training Videos Available Online
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House and Senate Committees Reach Agreement on SGR Bill
Compromise bill does not address offsets or payment methods

Negotiators from the House Energy and Commerce and Ways and Means Committees as well as the Senate Finance Committee reached an agreement earlier today on a bill to replace the flawed Medicare physician payment formula known as “SGR” – incorporating aspects from the three competing versions. The compromise  agreement does not include any language on extending certain Medicare policies, known as “extenders,” nor on offsets to pay for the legislation. 

Congressional leaders are hoping for congressional action on this bill before the most recent SGR patch - which was approved last month - expires on March 31, but the effort to find offsets promises to be daunting.

Key changes that were incorporated into the final SGR repeal bill include:

  • 0.5 percent increase in physician payments for 5 years before the alternative physician payment models take effect
  • Making the targets in the incentive-based program more clear
  • Allowing podiatrists, optometrists, and chiropractors to participate in the first year of the alternative payment models
  • Provides $40 million in each of 5 years for technical assistance to offices with 15 or fewer professionals
  • Capping of the payment adjustment at 9 percent instead of 12 percent

The compromise SGR bill did not include any offsets to pay for the SGR replacement, though staff from both committees indicated that they will continue to have discussions on offsets and Medicare extenders, including the non-SGR amendments that were accepted during the markup of Senate Finance Committee late last year.

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HHS OIG Releases 2014 Work Plan

On January 31, U.S. Department of Health and Human Services Office of the Inspector General (HHS OIG) released its Work Plan for Fiscal Year 2014 (the Work Plan).  The National Council on Medicaid Home Care – a NAHC affiliate - reports on the focus areas and objectives of the Work Plan in the Medicaid home care space, found on pages 36 through 38 of the Work Plan.  These focus areas and objectives are virtually identical to objectives from the Work Plan for Fiscal Year 2013.  However, while the 2013 Work Plan contains twelve (12) focus areas and objectives relating to Medicaid home care, the 2014 Work Plan contains only five (5).  Standards and contextual information from the 2014 Work Plan provide: 

Billing and Payments

  1. Home Health Services: Provider and Beneficiary Eligibility

[HHS OIG] will review HHA claims to State Medicaid programs to determine whether the billing providers met applicable criteria to provide home health services to Medicaid beneficiaries. [HHS OIG] will also determine whether the beneficiaries met the criteria to receive such services.

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CMS’ Hospice Item Set Training Videos Available Online

CMS has posted videos of its recent Hospice Item Set trainings that occurred February 4 and 5 in Baltimore, MD.

To access the most recent training videos, please click here.

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