Congress steps closer to Medicare regulatory relief

Last week, the House Energy and Commerce Committee Health Subcommittee unanimously passed a Medicare regulatory relief bill that targets the program’s complex regulatory system by improving communication between it and providers, creating an expedited process for appeals to claim denials and improving education and training for Medicare contractors. That comes just weeks after the House Ways and Means Health Subcommittee passed a similar measure.

Mary Grealy, president of the Healthcare Leadership Council, gives the bill good odds. "It was extraordinary to see this done in a bipartisan way," she says. Health care representatives would like to see a bill that goes even further, she adds. But eliminating the more controversial provisions has improved the bill’s chances by getting both sides of the aisle on board behind the bill. The reforms also are championed by Centers for Medicare and Medicaid Services (CMS) Administrator Tom Scully.

Vicki Riley, a spokeswoman for the Commerce Committee, says talks have commenced between that committee and the House Ways and Means Health Subcommittee to hammer out differences between the two versions. In addition, she reports that talks already are under way with the Senate Finance Committee. "We want to get something passed this year," she asserts. "CMS agrees this is an issue that really needs to be taken care of now," she adds. "I think it has a pretty good chance of passing."

According to Grealy, changes to the current provider appeals process are critical. Any reforms to overpayment review and how Medicare contractors deal with payment errors and audits also would be extremely welcome, she adds. "Anything you do to simplify this program is going to make it easier for providers to spend less time on paperwork and more resources on patient care," she says.

Here is a rundown of some of the key reforms included in the House Commerce legislation:

  • Requires final regulations be issued no later than 12 months after an interim final regulation has been released.
  • Ensures that substantive regulation or policy changes take effect at least 30 days after the Secretary of Health and Human Services has issued such a change.
  • Provides for the designation and training of Medicare-only Administrative Law Judges.
  • Creates an expedited process for providers to obtain judicial review of appeals for denied claims.
  • Requires the secretary to expedite proceedings when termination of participation or other immediate sanctions have been imposed.
  • Increases Medicare Integrity Program funding for provider education and training by $35 million.
  • Requires Medicare contractors to provide general written responses to beneficiary and provider written inquiries within 45 business days.
  • Requires the secretary to develop standards for repayment plans, taking into account a provider’s reliance on guidance and financial hardship.
  • Directs the secretary to establish a methodology for Medicare contractors to review questionable billing patterns.