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A look at the new year for rural providers

By Brock Slabach posted 12-18-2013 03:10 PM

  

At the close of a year it’s often helpful to look back and take stock of the year that just ended and plan the start of a brand new year. NRHA had many victories on key pieces of legislation, for which we’re very thankful. So, as we look forward to 2014, here is a recap of the issues that may impact you next year:

  • SGR Fix. The Murray-Ryan bipartisan budget deal contains a temporary moratorium on the implementation of the sustainable growth rate (SGR) formula to the physician fee schedule through March 31, 2014. This means your physicians paid on the Medicare physician fee schedule will not receive a reduction on January 1, 2014. The bad news is we’ll be back in 2014 re-hashing this whole debate with another deadline.
  • Sequestration. The 2% reduction in Medicare payments to providers will continue in 2014, even though defense and education received a reduction in their sequestration cuts.
  • ACA. The affordable Care Act (ACA) will be implemented fully in 2014 as the Marketplace exchange insurance policies become effective on January 1, in addition to Medicaid expansion in close to 25 states. Rural providers will need to ensure their inclusion in the networks of insurance companies being sold on the Marketplace exchanges.
  • MDH and LVH. The Murray-Ryan budget deal restores the Medicare Dependent Hospital (MDH) and the Low Volume Hospital (LVH) adjustment from September 30, 2013 through March 31, 2014. This is a huge win for rural providers that NRHA worked hard to achieve. The bad news is that we’ll be in the trenches again in 2014 to get these provisions restored after March 31, 2014.
  • Physician Supervision. CMS had placed a moratorium on the implementation of onerous physician supervision regulations for the last two years. That moratorium WILL END on December, 31, 2013. Starting January 1, 2014, all therapeutic outpatient procedures that were not explicitly moved to general level supervision by the Hospital Outpatient Payment (HOP) Panel will require practitioner supervision. This applies to all providers, both CAH and PPS.
  • Rehabilitation Therapy Caps. CMS outlined in final regulations in November, 2013 that CAH’s will be subjected to outpatient therapy caps on Medicare patients. NRHA provided an analysis of these regulations and recommendations on how CAH’s can comply starting January 1, 2014. The Permanent SGR Fix bill recently marked in the Senate Finance Committee contains provisions to move all outpatient therapeutic supervision levels to general supervision and to remove the therapy caps on CAH’s. NRHA will be advocating for these provisions to be contained in the “must-pass” SGR Fix legislation that is necessary on or before March 31, 2014.
  • Meaningful Use. On December 6, 2013, CMS and the Office of National Coordinator proposed a new meaningful use timeline that will allow providers to focus on the successful implementation of Stage 2 and use data from this interoperability and patient engagement stage to inform policy decisions for Stage 3. Stage 2 will be extended through 2016 (its start date will NOT be delayed) and Stage 3 will begin in 2017 for those who have completed at least two years in Stage 2.

NRHA is committed to continue to work on these important issues on your behalf. Our Annual Policy Institute is February 4-6, 2014 in Washington, DC, which is a perfect opportunity to learn how you can impact legislation and regulation on these and other key issues on Capitol Hill. We value your membership and appreciate the support you provide through your effective grassroots advocacy. It has and will continue to make all of the difference for us next year!

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