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Federal Legislative Update from AANP

Posted about 5 years ago by Michelle Rampersad

April 8, 2013  

MedPAC Examines Barriers to NP Services in Medicare In a wide-ranging initial discussion on April 5th, the Medicare Payment Advisory Commission (MedPAC), an independent 15-member panel, questioned policies that discount payments to NPs for the same Medicare services provided by physicians and that create uneven rules for certification and documentation of care.  The commission also expressed concern that “incident-to” billing of services provided by NPs under physicians’ provider numbers makes it difficult to track NP services.  AANP and other NP groups raised similar concerns in a February meeting with MedPAC staff.

This preliminary discussion will guide MedPAC’s staff in analyzing current policies and possibly drafting recommendations to Congress. The commission could consider policy changes as soon as next fall.  Although its proposals often guide decisions on future Medicare policies, legislators are not bound to consider or adopt the commission’s recommendations.

President's Budget Renews 2014 Deficit Reduction Debate This week President Barack Obama will submit his fiscal year 2014 budget to Capitol Hill.  The President’s plan is expected to kick off negotiations on spending, tax, and entitlement changes that could ultimately include raising the federal debt limit, which will be reached this summer.

Upon official release on April 10th, the President’s budget is expected to propose cutting the deficit by $1.8 trillion over 10 years by reducing spending, trimming entitlement programs, and raising revenue.  Nurse practitioners would be affected by the roughly $400 billion in health care cuts specified in last year’s deficit reduction offer. This included Medicaid drug rebates to low-income Part D enrollees, cutting Medicare bad debt payments, and capping Medicaid durable medical equipment payments at Medicare competitive bidding rates.  The 2014 budget may propose even deeper Medicare cuts since the White House has said that savings from Medicaid are off the table as it tries to encourage states to expand Medicaid eligibility.

House Committees Expand Medicare Payment Proposal Last week two key House committees released an expanded second draft of their strategy for repealing the Medicare “sustainable growth rate” formula, shifting fee-for-service payments to quality based measures and creating incentives for alternative payment structures.  The outline circulated on April 3rd by Republican staff for the House Energy and Commerce and Ways and Means Committees also raises the possibility of separating non-physician providers into an alternative incentive program if the one developed for physicians does not apply. In essence, the committee’s intention is to stabilize fee-for-service payments while developing performance measures on which a portion of payments will be based. Questions remain about how the quality and performance measures will be designed and financed.

AANP will provide comments to the committees and continue to engage in a dialogue with them as they prepare to craft legislation that will hopefully be voted on this summer.

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