WASHINGTON WIRE
August 1, 2008
Issue 179
Senate Fails to Act on Bill Including Party Compromise, Advocates Look to September
CMS Finalizes IPPS, IRF, SNF and Hospice Wage Index Rules
OIG Says Surgeon Group/Hospital Corporation Ownership Arrangement with ASC OK Under Stark Law
Grassley Bill Would Tighten Oversight of Self Referral and Imaging Services
Hearings
Top Story
Senate Fails to Act on Bill Including Parity Compromise, Advocates Look to September
The Senate has pushed action on a mental health parity compromise into September, which is likely to be a very busy month for Congress. On Wednesday, July 30, the Senate failed by nine votes to end a filibuster and move to consideration of energy and tax legislation containing the House and Senate parity compromise. The Senate will likely take the issue up again after August recess and before the beginning of October, by which time Congress hopes to adjourn.
The House and Senate reached a deal on parity provisions in mid-June. The House approved its parity bill (H.R. 1424) in March, and the Senate approved parity legislation (S. 558) in September of last year. Over the August recess, mental health advocates will be encouraging lawmakers to wrap up loose ends, including how to pay for the provisions, so that the legislation is ready in September.
The Senate is poised to mark up a second economic stimulus package after recess. Whether that bill will be the vehicle for mental health parity is unclear. It also remains to be seen whether the House will wait for the Senate to take up the compromise or move ahead before Senate action.
The parity bills would require health plans offering mental health coverage to provide the same benefits for mental illness as they do for other medical conditions.
Health Care News
CMS Finalizes IPPS, IRF, SNF and Hospice Wage Index Rules
On July 31, CMS finalized four rules: the FY 2009 inpatient prospective payment system (IPPS) rule, the final inpatient rehabilitation facility (IRF) rule, the skilled nursing facility (SNF) payment final rule, and the 2009 hospice wage index.
In the final IPPS rule, which will be released in the Federal Register August 19, CMS identifies three out of a proposed nine "never events" for which the agency will discontinue payment: surgical site infections following certain elective procedures, including certain orthopedic surgeries; some manifestations of poor control of blood sugar levels; and deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures.
The IPPS rule also increases payments to acute care hospitals by about $4.75 billion, the agency said.
The SNF rule replaces a proposed payment reduction with a 3.4 percent market basket increase. CMS said it would continue to consider a cut for the future. The proposed cut was meant to counteract an unintended increase in Medicare expenditures that resulted from the expansion of the Resource Utilization Groups in 2005.
The IRF rule will cut aggregate payments by $40 million, or 0.7 percent, for FY 2009. The decrease is $20 million more than predicted in the proposed rule. CMS is setting the outlier threshold for FY 2009 at $10,250, as opposed to the amount given in the proposal: $9,191.
The final rule will be effective beginning Oct. 1.
The hospice wage index rule gives hospices a 2.5 percent increase for 2009. The 3.6 percent increase in the market basket update is hampered by a 1.1 percent decrease in payments to hospices; CMS is phasing out a budget neutrality adjustment factor to the hospice wage index.
OIG Says Surgeon Group/Hospital Corporation Ownership Arrangement with ASC OK Under Stark Law
On July 25, HHS' Office of Inspector General said it would not impose penalties on a proposed arrangement involving ownership of an ambulatory surgery center by a group of orthopedic surgeons and a hospital corporation.
OIG found that although the arrangement had potential for fraud, the arrangement had installed sufficient safeguards to protect against improper referrals.
Under the arrangement, the surgeons would own 70 percent of the ambulatory surgery center and the hospital corporation would own 30 percent.
Grassley Bill Would Tighten Oversight of Self Referral and Imaging Services
Sen. Chuck Grassley (R-IA), ranking member on the Senate Finance Committee, wants to tighten self referral laws related to imaging procedures. Grassley's Medicare Imaging Disclosure Sunshine Act (S. 3343) would require physicians billing Medicare for imaging procedure referrals to disclose financial interests in certain imaging equipment.
The Stark law allows for exceptions to a general ban on doctors billing Medicare for services performed at entities in which they have financial interests. S. 3343, introduced July 28, would alter one such exception that allows doctors to bill Medicare for imaging procedures performed in their offices.
Besides disclosure of ownership interests in certain imaging services, the bill would also require physicians to give patients a list of other suppliers that provide those imaging services.
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