Latest Continuing Resolution Sweetened with Medicare Extenders Package
February 7, 2018
 
Congress is again facing another deadline to either pass another stopgap continuing resolution (CR) or shutdown the government; the current CR expires on February 8. At press time, work was already underway to avert another shutdown. The House passed a CR that would fund the nondefense functions of the government through March 23 and provide full funding for the Department of the Defense. The funding for the Department of Defense exceeds the sequestered FY 2018 cap of $549 billion for defense, so the measure includes language to waive sequestration.
The Senate is expected to make changes to the House-passed measure, specifically removing the full funding for the Department of Defense. It is also rumored that the Senate may add a provision to raise the budget caps for both FY 2018 and FY 2019. A deal on the budget caps would allow appropriators to begin working the final FY 2018 funding bills. If the Senate makes any changes to the House-passed version, the House will be forced to vote on the revised CR.

Attached to the CR is the long-awaited Medicare extenders package. Of note, the package includes a two-year extension for Community Health Center funding that expired last year; the National Health Service Corps also received an additional two years of funding. The Teaching Health Center Graduate Medical Education program that trains primary care residents in community settings rather than hospitals was also extended for two years at an annual level of $126.5 million, more than doubling the current funding for the program.

The extenders package also makes several technical corrections to the Quality Payment Program (QPP) that was authorized by the Medicare Access and CHIP Reauthorization Act (MACRA). These changes would fix errors in the statute and provide the Centers for Medicare and Medicaid Services (CMS) with greater flexibility in implementing the QPP:

  • Excluding Medicare Part B drug costs from the Merit-Based Incentive Payment System (MIPS) payment adjustments;
  • Eliminating improvement scoring for the MIPS cost performance category for years 2 through 5 of the program;
  • Allowing CMS to reweight the cost performance category to not less than 10 percent for years 2 through 5 of the program. Without this change, the weight of the cost category would be required to increase to 30 percent in year 3;
  • Granting CMS the flexibility to set the performance threshold for years 2 through 5 to provide a gradual and incremental transition; and
  • Allowing the Physician Focused Payment Model Technical Advisory Committee to provide initial feedback on proposed models regarding the extent to which they meet the committee’s model criteria.

Several telehealth provisions, some of which were in the Senate CHRONIC Care Act, were included as well. If finalized, Medicare Advantage plans will be authorized to offer additional telehealth benefits in its annual bid amount beyond the services that are reimbursed under Part B beginning in 2020. It would remove the geographic restrictions on the provision of telehealth services delivered in certain ACOs. The legislation also would remove the geographic restrictions for Medicare beneficiaries who require telehealth consultation services for the diagnosis, evaluation, or treatment of acute stroke symptoms.

Despite all the positive policy changes included in the Medicare extenders package, some of the spending offsets included are concerning. One offset extends the misvalued code provision for one additional year, which would require CMS to reallocate 0.5 percent of fee schedule spending from overvalued services. If this 0.5 percent target is not met, all physician fee schedule services would be reduced by the difference. Since this provision’s implementation, the target has not been met and is not expected be met in 2019 if this extension is finalized. Another offset includes reductions in the Prevention and Public Health Fund, which has supplemented funding for the Centers of Disease Control of Prevention, potentially undermining critical public health programs.

SGIM will continue to closely monitor all these issues and keep you informed on upcoming developments.  For more information about SGIM's advocacy efforts, please visit the advocacy website .
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