While the Capitol Hill spotlight is focused on the Senate debate on legislation to repeal or revise the Affordable Care Act, the House of Representatives quietly approved by voice vote HR 3178, the Medicare Part B Improvement Act of 2017. The bipartisan bill would impact a number of Medicare policies, including the Stark physician self-referral law, home infusion therapy and dialysis service policies, and documentation requirements for orthotics and prosthetics. In particular, the bill would:

  • Codify certain technical changes to Medicare physician self-referral rules pertaining to lease arrangements and signature requirements that CMS adopted as part of the 2016 Medicare physician fee schedule update. The legislation specifies that written compensation arrangement requirements may “be satisfied by such means as determined by the Secretary,” which includes “a collection of documents, including contemporaneous documents evidencing the course of conduct between the parties involved.” Furthermore, missing signatures may be obtained within 90 calendar days. The legislation also codifies CMS’s policy permitting indefinite (rather than 6-month) “holdovers” of certain space and equipment rentals and personal services arrangements after an existing arrangement expires if the arrangements continue on the same terms and conditions as the original agreements and otherwise continue to satisfy the applicable exception.
  • Establish a temporary transitional Medicare payment methodology for home infusion therapy services beginning in 2019 until related provisions of the 21st Century Cures Act go into effect January 1, 2021.
  • Extend the Medicare Patient IVIG Access Demonstration Project through 2020.
  • Provide that documentation created by an orthotist or prosthetist is considered part of the individual’s medical record to support determinations of the medical necessity of orthotics and prosthetics.
  • Allow dialysis facilities to be surveyed and accredited by a CMS-approved independent accreditation agency.
  • Allow end-stage renal disease providers to utilize telehealth for home dialysis patient monitoring beginning in 2019.

The legislation now awaits Senate consideration.