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Congress Bills H. Add to List. Save your opinion on this bill on a six-point scale from strongly oppose to strongly support. Add Note All Positions » Shared on panel. About Ads Hide These Ads. Widget for your website Get a bill status widget ». Ransom Disclosure Act would require companies disclose ransom payments to Department of Homeland…. Save Note. About the bill Source: Wikipedia. This law contained the first revision to policy covering Medicare Part D.
Continue reading ». Jun 20, th Congress — Enacted — Veto Overridden on Jul 15, This bill was enacted after a congressional override of the President's veto on July 15, History Jun 20, Passed House Senate next. Failed Cloture in the Senate. No later than two years after the demonstration's implementation date, ORHP in coordination with CMS, will submit a status report to Congress with initial recommendations.
A final report with recommendations for legislation and for administrative action is due no later than one year after the project's completion. These reclassifications were subsequently extended to September 30, MMSEA extended certain hospital reclassifications made through the Secretary's authority to make exceptions and adjustments during the FY rulemaking process until September 30, This provision extends the Section and the special exception reclassifications until September 30, In order to receive Medicare payments, Medicare providers and suppliers must meet certain health and safety requirements specified in statute.
Alternatively, a provider can be deemed to meet these requirements if it has been accredited by an approved national accreditation body. Hospitals, like other Medicare provider entities, will be accredited by national accrediting organizations approved by the Secretary. This provision will take effect 24 months after the legislation is enacted and will not affect those hospitals currently being accredited or under accreditation by JCAHO.
The provision does not remove the unique authority granted the American Osteopathic Association AOA to accredit provider entities for participation in the program. Medicare payments for services of physicians and certain nonphysician practitioners are made on the basis of a fee schedule.
The fee schedule assigns relative values to services that reflect physician work i. The relative values are adjusted for geographic variation in costs. The adjusted relative values are then converted into a dollar payment amounts by a conversion factor. The law specifies a formula for calculating the annual update to the conversion factors.
This formula would have resulted in a The update formula would have required a reduction in the conversion factor of This provision averts this reduction and extends the 0. For , the update to the conversion factor will be 1. The conversion factor for and subsequent years will be computed as if this modification had never applied.
The physician quality reporting system, which currently runs only through , is extended through Eligible professionals who provide covered professional services will be eligible for the incentive payment if 1 there are quality measures that have been established under the physician reporting system that are applicable to any services furnished by such professional for the reporting period; and 2 the eligible professional satisfactorily submits data to the Secretary on the quality measures.
These providers, in addition to the amount otherwise paid under Medicare, will also be paid an incentive payment equal to 1. The provision also defines satisfactory reporting of measures for group practices and includes qualified audiologists as eligible professionals for purposes of Medicare payment, beginning in MedPAC asserts that physicians would be able to assess their practice styles, evaluate whether they tend to use more resources than their peers or what evidence-based research if available recommends, and revise practice styles as appropriate.
MedPAC notes that in certain instances, the private sector use of feedback has led to a small downward trend in resource use. The GAO noted that certain public and private health care purchasers routinely evaluate physicians in their networks using measures of efficiency and other factors and that the purchasers it studied linked their evaluation results to a range of incentives to encourage efficiency.
This provision of MIPPA will establish a physician feedback program with the intent to improve efficiency and to control costs. Under the Physician Feedback Program, to be implemented by January 1, , the Secretary will use Medicare claims data to provide confidential reports to physicians that measure the resources involved in furnishing care to Medicare beneficiaries.
The resources to be considered in this program may be measured on an episode basis, on a per capita basis, or on both an episode and a per capita basis.
The GAO will conduct a study of the Physician Feedback Program as described above, including the implementation of the Program, and will submit a report to Congress by March 1, containing the results of the study, together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate. Finally, the provision requires the Secretary of Health and Human Services to develop a plan to transition to a value-based purchasing program for payment under the Medicare program for covered professional services.
Not later than May 1, , the Secretary of Health and Human Services will submit a report to Congress containing the plan, together with recommendations for such legislation and administrative action as the Secretary determines appropriate.
The provision establishes incentives for electronic prescribing in the Medicare program. For through , Medicare professionals providing covered services to Medicare beneficiaries and who are successful electronic prescribers will receive an incentive payment of 2.
Providers who do not have a sufficient volume of qualifying services will be excluded from the program, as will those for whom the Secretary determines that compliance would be a significant hardship such as for an eligible professional who practices in a rural area without sufficient Internet access. Not later than September 1, , the GAO will submit to Congress a report on the implementation of the incentives for electronic prescribing established by this section.
The provision gives the Secretary the authority to expand the duration and scope of the Medical Home Demonstration Project if the expansion will meet either of the following conditions: 1 the expansion of the project is expected to improve the quality of patient care without increasing spending under Medicare, or 2 the expansion of the project is expected to reduce spending under the Medicare program without reducing the quality of patient care.
The provision changes the application of the budget-neutrality adjustor used in the calculation of Medicare physician fee schedule reimbursement from the relative value units to the conversion factor, beginning with Medicare makes payment for physician services under the fee schedule.
Three factors enter into the calculation of the fee schedule payment amount: the relative value for the service, a geographic adjustment and a national dollar conversion factor.
The geographic adjustments are indexes that reflect cost differences among areas compared to the national average in a "market basket" of goods. A value of 1. The law placed a temporary floor of 1. The provision extends, through December, , the period that the floor is set at 1. In addition, beginning January 1, , it raises the work geographic adjustment to 1. The provision specifies that beginning January 1, , payment may only be made under the physician fee schedule for the technical component of advanced diagnostic imaging services furnished by a supplier if such supplier is accredited by an accreditation organization.
Advanced diagnostic imaging services are defined as including diagnostic magnetic resonance imaging, computed tomography, and certain other services as specified by the Secretary in consultation with physician specialty organizations and other stakeholders. The accreditation organization must be designated by the Secretary who will be required to consider specified factors both in designating an accreditation organization and in reviewing and modifying the list of designated organizations.
The Secretary will be required to establish procedures to ensure that the criteria used by an accreditation organization to evaluate a supplier that furnishes the technical component of advanced diagnostic imaging services is specific to each imaging modality. The provision requires the Secretary to establish a two-year demonstration project using specified models to collect data regarding physician compliance with appropriateness criteria for advanced diagnostic imaging services.
The Secretary may focus the demonstration project, such as on services that account for a large amount of Medicare expenditures, services that have recently experienced a high rate of growth, or services for which appropriateness criteria exist.
The Secretary, in consultation with medical specialty societies and other stakeholders, will select criteria with respect to the clinical appropriateness of advanced diagnostic imaging for use in the demonstration. The Secretary will develop mechanisms to provide feedback reports to physicians participating in the project. In addition, the Secretary is required to evaluate the demonstration project and submit a report to Congress containing the results of the evaluation together with recommendations for legislative and administrative action.
The GAO is required to conduct a study by imaging modality of the new accreditation requirement and any other relevant questions involving access to and the value of advanced diagnostic imaging services for beneficiaries. Legislation enacted in specified that independent labs that had agreements with hospitals on July 22, to bill directly for the technical component of pathology services could continue to do so in and The provision has been periodically extended, most recently through June 30, Medicare payment may be made to a physician for services furnished by a second physician to patients of the first physician, provided certain conditions are met.
In general, the services cannot be provided by the second physician for more than 60 days. The law permits, for services provided prior to June 30, , reciprocal billing over a longer period in cases where the first physician was called or ordered to active duty as a member of a reserve component of the Armed Forces. The provision will make the accommodation permanent.
Medicare pays for mental health services under the physician fee schedule. Anesthesia services may be personally performed by the anesthesiologist or the anesthesiologist may medically direct up to four concurrent anesthesia cases. The provision establishes a special payment rule with respect to physicians' services furnished on or after January 1, This payment provision will only apply if 1 the teaching anesthesiologist was present during all critical or key portions of the anesthesia service or procedure involved; and 2 the teaching anesthesiologist or another anesthesiologist with whom the teaching anesthesiologist had entered into an arrangement was immediately available to furnish anesthesia services during the entire procedure.
Further, the provision requires the Secretary to make appropriate payment adjustments for items and services furnished by teaching certified registered nurse anesthetists.
The law places annual per beneficiary payment limits for all outpatient therapy services provided by non-hospital providers. There are two beneficiary limits. The law required the Secretary to implement an exceptions process for , , and the first half of for cases in which the provision of additional therapy services was determined to be medically necessary.
The provision extends the exceptions process through MMA required Medicare's outpatient prospective payment system to make separate payments for specified brachytherapy sources. Subsequent legislation established that the separate payment would be made using hospitals' charges adjusted to their costs until January 1, MMSEA extended this payment method for brachytherapy services until July 1, and established these type of payments for therapeutic radiopharmaceuticals for services provided on or after January 1, , and before July 1, This provision extends cost reimbursement for brachytherapy and therapeutic radiopharmaceuticals until January 1, The provision establishes a separate definition for outpatient speech-language pathology services and permits speech-language pathologists practicing independently to bill Part B subject to the same conditions applicable to physical and occupational therapists in independent practice.
The provision is effective July 1, The provision will include, within the definition of covered medical and other health services, items and services furnished under a cardiac rehabilitation program or under a pulmonary rehabilitation program, subject to specified conditions. The provision will be effective January 1, This provision repeals the requirement that medical equipment suppliers transfer the title for oxygen equipment to the beneficiary after a 36 months rental period, effective January 1, ; suppliers will retain ownership of the equipment but will continue to furnish the equipment to the beneficiary during the period of medical need.
The provision repeals the requirement for competitive bidding for clinical laboratory services. In addition, it specifies that the clinical laboratory fee schedule update, otherwise slated to occur each year, will be reduced each year from through by 0. The provision also specifies that any area designated as rural for the purposes of making payments for air ambulance services on December 31, , will be treated as rural for the purpose of making air ambulance payments during the period July 1, December 31, Small rural hospitals with no more than beds that are not sole community hospitals SCHs can receive additional Medicare payments if their outpatient prospective payment system OPPS payments are less than those under the prior reimbursement system.
Medicare outpatient clinical laboratory services are generally paid based on a fee schedule. Clinical laboratory services provided by CAHs to those who are not patients are paid on the basis of the Medicare fee schedule. In no instance are Medicare beneficiaries liable for any coinsurance or deductible amounts.
Originating sites are defined as the site where a Medicare provider delivers the telehealth service to the patient. The following are qualified as originating sites: 1 office of a physician or physician practitioner; 2 a critical access hospital; 3 a rural health clinic; 4 a federally qualified health center, and 5 a hospital.
The provision adds: 1 a hospital-based or critical access hospital based renal dialysis center including satellites , 2 a skilled nursing facility, and 3 a community health center to the list of originating sites for payment of telehealth services, effective on January 1, The Medicare Payment Advisory Commission MedPAC will be required to conduct a study and provide a report to Congress no later than June 15, , on the feasibility and advisability of establishing a Medicare Chronic Care Practice Research Network to serve as a standing network of providers testing new models of care coordination and other care approaches for chronically ill beneficiaries, including the initiation, operation, evaluation, and if appropriate, expansion of such models to the broader Medicare patient population.
They will also be required to make recommendations for appropriate legislative and administrative action. In subsequent years the previous year's amount will be increased by the increase in the Medicare economic index MEI. A new section is added to the Public Health Service Act, allowing the Secretary to establish pilot projects for chronic kidney disease to 1 increase awareness; 2 increase screening; and 3 enhance surveillance systems to better assess prevalence and incidence.
The Secretary will select at least 3 states in which to conduct pilot projects, for no longer than five years, beginning on January 1, GAO will conduct an evaluation and report to Congress not later than 12 months after completion of the pilot projects. There are authorized to be appropriated such sums as may be necessary to carry out this provision.
Medicare coverage is expanded to include coverage for kidney disease education services, defined as education services 1 for an individual with stage IV chronic kidney disease who requires dialysis or a kidney transplant; 2 furnished upon the referral of the physician managing the individual's kidney condition or by a qualified person; 3 designed to provide comprehensive information regarding managing co-morbidities, including delaying the need for dialysis, prevention of uremic complications, and options for renal replacement therapy; and 4 designed to meet an individual's needs and provide an opportunity to participate in the choice of therapy.
The Secretary will set standards for the educational services. Individuals will be eligible for no more than six sessions of kidney disease education services, effective for services furnished on or after January 1, Beginning January 1, , the payment rate for dialysis services will be "site neutral" and in applying the geographic index to providers of services, the labor share will be based on the labor share otherwise applied for renal dialysis facilities.
Adjustments will no longer be made to the composite rate for hospital-based dialysis facilities to reflect higher overhead costs. The term "renal dialysis services" will include 1 items and services which were included in the composite rate as of December 31, ; 2 erythropoiesis stimulating agents ESAs or any other oral form of such agents furnished to individuals for the treatment of End Stage Renal Disease ESRD ; 3 other drugs and biologicals for which payment was made separately before bundling , and any oral equivalent form of such drug or biological; and 4 diagnostic laboratory tests and other items and services furnished to individuals for the treatment of ESRD.
The term "renal dialysis services" will not include vaccines. The bundled payments system will be phased-in equally over four years, fully implemented by January 1, A provider of dialysis services or facility will be allowed to make a one-time election to be excluded from the phase-in and be paid entirely based on the bundled payment system.
Estimated total payments during the phase-in will equal the estimated total payments that would otherwise occur. Beginning in , the Secretary will annually increase the bundled payment amounts by an ESRD market basket increase factor appropriate for a bundled payment system for renal dialysis minus 1 percentage point.
For the portion of the payment based on the old composite rate system, the composite rate will be updated by the ESRD market basket increase factor minus 1 percentage point. The requirements will include measures on 1 anemia management and dialysis adequacy; 2 to the extent feasible, patient satisfaction; and 3 other areas.
The Secretary will develop a methodology to assess the total performance of each provider or facility, referred to as the "total performance score. The Secretary will make performance information available to the public, provide certificates to be displayed in patient areas, and will allow the provider or facility the opportunity to review the information, prior to it being made public. Two courses are available related to benefits access and enrollment.
The module also provides key referral resources for additional program information and enrollment assistance. Benefits Outreach and Enrollment for Older Adults and Persons with Disabilities: The Role of State and Local Organizations describes the role of state and local practices in benefits outreach and enrollment for older adults and individuals with disabilities.
This course provides the opportunity for participants to learn about core benefit programs and challenges to accessing benefits. This course also describes sources of information trusted by older adults and persons with disabilities and identifies effective outreach strategies using those information channels. Additionally, participants will learn about state and local practices for ensuring individuals are connected to potential benefits, as well as opportunities to adjust benefits outreach and enrollment during crises and emergencies.
The program must be implemented by January 1, The Secretary may focus the program on specific areas, such as: high-cost specialties; physicians who treat high-cost or high-volume conditions; physicians who use a high amount of resources compared to other physicians; physicians practicing in certain geographic areas; or physicians who treat a minimum number of Medicare patients.
To the extent possible, the data should be adjusted to account for variations in health status and other patient characteristics. Finally, MIPPA requires the Secretary to submit a plan to Congress by May 1, regarding transition to a value-based purchasing program for Medicare physician services.
The bonus payment for electronic prescribing will be 2. In determining eligibility for bonus payments, MIPPA directs the Secretary to consider to the extent possible whether professionals use e-prescribing systems that comply with federal standards.
Beginning in , Medicare physician fee schedule payments to physicians who are not successful prescribers will be reduced by up to 2 percent. Specifically, payments will be reduced by 1 percent in , by 1. MIPPA requires non-hospital advanced diagnostic imaging providers to be accredited by an accreditation organization designated by the Secretary by January 1, , or Medicare will not make a payment for the technical component of the service under the physician fee schedule.
Advanced diagnostic imaging services covered by the provision include: diagnostic magnetic resonance imaging, computed tomography, and nuclear medicine including positron emission tomography , and other diagnostic imaging services excluding X-ray, ultrasound, and fluoroscopy specified by the Secretary in consultation with physician specialty organizations and other stakeholders.
The Secretary must designate the accreditation organizations by January 1, based on a number of factors enumerated in the law. The accreditation organizations must evaluate the supplier of the technical component of advanced diagnostic imaging services based on criteria established by the Secretary that is specific to each imaging modality. Such criteria must include standards for:. In a related provision, MIPPA requires the Secretary to establish, by January 1, , a two-year, voluntary demonstration program to test the use of appropriateness criteria for advanced diagnostic imaging services.
The demonstration could be limited to imaging services that account for high Medicare expenditures, fast-growing services, or those for which appropriateness criteria exists. The Secretary is directed to consult with medical specialty societies and other stakeholders to select appropriate criteria, which must developed or endorsed by a medical specialty society and developed in adherence with principles developed by a consensus organization.
MIPPA specifies the models that the Secretary must use to collect data regarding physician compliance with the appropriateness criteria, and prevents the use of prior authorization to collect data under the demonstration.
Participating physicians will receive feedback reports on their compliance compared to their peers. The Secretary is required to evaluate the demonstration and report to Congress on its findings, including its assessment of whether the use of appropriateness criteria should be expanded.
MIPPA also requires the GAO to conduct a study on the impact of accreditation and other issues related to access to and the value of advanced diagnostic imaging services. Although enforcement of the caps has been suspended periodically, the caps are currently in place. Under this process, a Medicare enrollee or person acting on behalf of the enrollee could request an exception from the therapy caps. The individual could obtain an exception if the provision of services was determined medically necessary; CMS established an automatic process to facilitate exceptions.
MIPPA establishes a statutory definition for outpatient speech-language pathology services, separate from the definition of outpatient physical therapy services. The law also allows outpatient speech-language pathologists to bill Medicare directly for their services subject to the same conditions as physical therapists, beginning July 1, MIPPA specifies that this provision may not be construed to affect existing CMS regulations or policies that require physician oversight of care as a condition of Medicare Part B payment for speech-language pathology services.
MIPPA provides Medicare coverage of certain items and services furnished under an intensive cardiac rehabilitation program or pulmonary rehabilitation program meeting specified criteria, effective January 1, Covered services include, among other things: physician-prescribed exercise; education; psychosocial assessment; outcomes assessment; and other reasonable and necessary items identified by the Secretary.
The services must be part of a physician-supervised program and meet certain performance standards. The law sets forth specific criteria for intensive cardiac rehabilitation services, including beneficiary eligibility standards, authorization of a total of 72 one-hour sessions, and payment under the physician fee schedule based on the OPPS payment for certain cardiac rehabilitation codes. In addition, the new law repeals a provision of the DRA that required medical equipment suppliers to transfer the title for oxygen equipment to the beneficiary after 36 months of rental.
While the supplier retains the title to the equipment, the supplier must continue to furnish the equipment to the beneficiary during the period of medical need for the remainder of the reasonable useful life of the equipment. As under the DRA, separate rental payments still will be made for the oxygen contents, and maintenance and servicing payments will be made if determined by the Secretary to be reasonable and necessary and not otherwise covered under warranty.
This provision is effective January 1, The MMA required the Secretary to institute a competitive bidding demonstration program for Medicare Part B clinical laboratory services. In October , CMS announced that it intended to launch the first Medicare clinical laboratory demonstration in the San Diego-Carlsbad-San Marcos, California metropolitan statistical area in early Implementation initially was blocked by a court injunction, however.
MIPPA repeals the statutory authority for the Secretary to conduct the clinical laboratory competitive bidding demonstration project. Separately, MIPPA clarifies that clinical diagnostic laboratory services furnished by a CAH will be treated as being furnished as part of outpatient critical access service and reimbursed based on reasonable cost , regardless of whether the beneficiary is physically present in the CAH or in a CAH-operated SNF or clinic at the time the specimen is collected.
This provision is effective for services furnished on or after July 1, Specifically, payments are increased by 3 percent in rural areas and 2 percent in other areas for services furnished on or after July 1, and before January 1, The law also provides an month hold harmless payment provision for air ambulance regions recently reclassified from rural to urban, and it clarifies the medical review standard for air ambulance services.
MIPPA extends through December 31, , a statutory provision allowing certain small rural hospitals to receive additional Medicare payments if their OPPS payments are less than under the prior reimbursement system.
In and , these hospitals will receive 85 percent of the difference between the payment under OPPS and under the prior reimbursement system. MIPPA also extends this provision to sole community hospitals with fewer than beds. MIPPA provides that additional types of entities can be considered as originating sites for Medicare payment of telehealth services.
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