The House Energy and Commerce Committee is seeking input on Section 603 of the Bipartisan Budget Act of 2015, which established a site-neutral payment policy for newly-acquired, provider-based, off campus hospital outpatient departments (HOPD) after November 2, 2016. In an open letter to the health care community, the Committee explains the origins of the policy, noting that it was enacted as a result of concerns that the Medicare hospital outpatient prospective payment system paid more for the same services provided at HOPDs than in other settings, such as an ambulatory surgery center, physician office, or community outpatient facility. The letter discusses evidence the Committee considered in establishing this policy, but notes that the Committee has received significant feedback on this provision since enactment, with concerns raised about the provision’s potential impact on hospitals, beneficiaries, and providers. The Committee has received a range of recommendations from the public, with stakeholders urging the Committee to:
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Bipartisan Budget Act
Bipartisan Budget Law Extends Medicare Sequestration, Includes Medicaid Drug Rebate, Off-Campus Hospital Outpatient Department, CMP Inflation Policies
By Debra A. McCurdy on
On November 2, 2015, President Obama signed into law H.R. 1314, the “Bipartisan Budget Act of 2015” (BBA). The two-year, $80 billion budget/debt-ceiling deal is funded in part by several significant Medicare and Medicaid policies, including an extension of Medicare sequestration, changes to Medicare payment for services provided in “new” off-campus hospital outpatient departments (OPDs), and extension of inflation-based Medicaid drug rebates to generic drugs.
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Bipartisan Budget Act Jacks Up Civil Monetary Penalties Under the Social Security Act and False Claims Act Penalties
By Susan Edwards on
The Bipartisan Budget Act of 2015 (H.R. 1314), signed into law by President Obama November 2, 2015, will increase the civil monetary penalties (CMPs) imposed under the Social Security Act (SSA) in addition to False Claims Act (FCA) penalties (among other civil penalties). Under an innocuous-sounding provision, entitled “Civil monetary penalty inflation adjustments,” the budget deal removed an inflation update exclusion that previously applied to the SSA as well as the Occupational Safety and Health Act (OSHA). The budget deal also requires that federal agencies implement a “catch up” penalty update through interim rulemaking no later than August 1, 2016, along with annual penalty updates thereafter. Pursuant to the provision requiring penalty “catch up” adjustments, agencies must update penalties to reflect Consumer Price Index (CPI) updates for each CMP from October of the calendar year during which the amount of such CMP was established or last adjusted under a provision of law other than the Federal Civil Penalties Inflation Adjustment Act of 1990. However, such “catch up” adjustment are capped at 150% of the current penalty amount. For example, a penalty now set at $10,000 may not increase to more than $25,000. Under this “catch up” methodology, per day CMPs imposed on nursing facilities under the SSA, currently capped at $10,000, will likely increase to approximately $20,000 no later than August 1, 2016. The nursing facility CMP update to approximately $20,000 would reflect the inflation updates since the establishment of these CMPs in 1987. After the initial, “catch up” update, annual adjustments will be made consistent with CPI cost-of-living updates.
Continue Reading Bipartisan Budget Act Jacks Up Civil Monetary Penalties Under the Social Security Act and False Claims Act Penalties