Medicare Regulatory Relief Bill Comparison

 

 

 

 

House Energy and Commerce (HR 3046)

As reported by full committee

 

House Ways and Means (HR 2768)

As reported by full committee

 

Senate Finance

 

 

Issuance of Regulations

(Regulations)

 

Proposed or final regulations would be issued only on one business day of every month. The Secretary along with the Director of OMB, would establish a regular timeline for the publication of final regulations. (Sec. 101)

 

Reads the same as Energy and Commerce bill. (Sec. 2)

 

 

 

Compliance with Changes in Regulations and Policies

(Regulations)

 

Substantial changes in regulations would not be applied retroactively. A change would not take effect until 30 days after issuance. (Sec. 102)

 

This bill reads the same as in Energy and Commerce. (Sec. 3)

 

 

 

Report on Regulatory Burdens and SGR

(Regulations)

 

Every two years, the Secretary would submit a report to Congress about areas of confusion, inconsistency and conflict. The Comptroller General would study the accuracy of the sustainable growth rate system 18 months after enactment. (Sec. 103-104)

 

Not included in bill.

 

 

 

Dental Claims

(Regulations)

 

A study would be submitted by the GAO to understand how Medicare can make it easier for dentists and other health providers to obtain Medicare denials of claims so they can receive payment from prior insurers. (Sec. 105)

 

Not included.

 

 

 

Provider Appeals

(Appeals)

 

A plan would be developed in which administrative law judges, responsible for hearing cases, would be transferred from the responsibility of the Social Security Administration to the Department of Health and Human Services. The plan would address workload, cost projections, transition timetable, regulations, case tracking, feasibility of precedential authority and access to law judges. Funds to increase the number of judges would be provided (“such sums as necessary for FY’03"). (Sec. 201)

 

A plan would be developed in which administrative law judges, responsible for hearing cases, would be transferred from the responsibility of the Social Security Administration to the Department of Health and Human Services. Authorization of funds would increase to increase the number of judges and improve education and training for judges and staff. $5 million for FY’03. (Sec. 8)

 

 

 

Expedited Access to Judicial Review

(Appeals)

 

A review panel would have to answer a request in writing within 60 days after the date such review panel receives the request. (Sec. 202)

 

Reads the same as Energy and Commerce bill. (Sec. 8)

 

 

 

Revisions to Appeals Process (Appeals)

 

The deadline for filing documentation and holding a hearing to complete the record would be 90 days after an appeal is requested. (Sec. 204)

 

Not included.

 

 

 

Requiring Full and Early Presentation of Evidence

(Appeals)

 

Not included.

 

A service provider would not be allowed to introduce evidence in any appeal that was not presented at the reconsideration by the qualified independent contractor. (Sec. 8)

 

 

 

 

 

 

 

 

 

Hearing Rights

(Appeals)

 

In cases of denial or non-renewal, the Secretary would establish regulations allowing service providers, physicians and practitioners to appeal when their enrollment applications are denied. Deadlines for applications and consideration would apply. (Sec. 205)

 

Not included.

 

 

 

Exceptions to National Coverage Determinations Under Specific Medical Circumstances

(Appeals)

 

Would establish a process whereby a beneficiary may submit a request for a determination that would otherwise not be applicable under a national coverage determination, which has the effect of denying coverage for the treatment of a serious or life-threatening condition. (Sec. 207)

 

Not included.

 

 

 

Increased Flexibility in Medicare Administration

(Contracting)

 

The Secretary would renew a contract if the contractor has met or exceeded the performance requirements. The Secretary would not require that the contractor match data obtained from other non-Medicare activities. No officer would be held liable in the absence of gross negligence or intent to defraud. Contractors would be held liable if acted with gross negligence. (Sec. 301)

 

Reads the same as Energy and Commerce. (Sec. 4)

 

 

 

Requirements for Information Study

(Contracting)

 

Contractors would be required to develop contractor-wide information security programs for their Medicare-related business. (Sec. 302)

 

Not included.

 

 

 

Provider Education and Technical Assistance

(Education)

 

The Secretary would coordinate funding for educational activities in order to maximize the effectiveness to expand educational efforts for providers, physicians, practitioners and suppliers by Oct. 1, 2002.  In order to give contractors an incentive to implement education programs, a methodology would be developed to measure the specific claims payment error rates of such contractors in the processing or reviewing of claims. Funding for education and training programs would be increased by $35 million. Special consideration would be given to small providers/suppliers. (Sec.401)

 

Contains all the provisions of Energy and Commerce bill but does not include a numerical value. The Secretary would identify best practices developed by contractors for educating providers of services and would then encourage use of these practices nationwide. (Sec. 5)

 

 

 

Response to Inquires

(Education)

 

Contractors would be required to respond with a written response within 45 business days. A toll-free telephone line would be implemented. A system would be required by each contractor to follow in order to monitor inquiries. (Sec. 402)

 

The contractor would have a responsibility to respond  in an effective manor to the inquiries of providers and suppliers (ex. toll-free telephone number). A monitoring system would also be implemented.  (Sec. 5)

 

 

 

Small Provider Technical Assistance

(Education)

 

Not included.

 

A demonstration program would be established whereby technical assistance would be provided, on a voluntary basis, to small service providers to evaluate billing and related systems to ensure compliance with requirements. $1 million would be authorized for FY’03 and $6 million for FY’04. (Sec. 7)

 

 

 

Medicare Ombudsman

(Education)

 

The Secretary would appoint an individual responsible for responding to complaints and grievances from providers, physicians, practitioners and suppliers concerning inconsistent information or inconsistent responses.(Sec. 404)

 

The Secretary would appoint an Ombudsman to provide assistance, on a confidential basis, to providers with respect to complaints, grievances and requests for information and would respond accordingly. The Ombudsman would submit recommendations for medicare improvement. The toll-free number is specified as 1-800-MEDICARE. (Sec. 7)

 

 

 

 

 

Policy Development Regarding Evaluation and Management

(Education)

 

No new guidelines for evaluation and management physician services would be implemented until the guidelines underwent various measures to ensure their success in the cross-over. (Sec. 405)

 

Reads the same as Energy and Commerce. (Sec. 11)

 

 

 

Beneficiary Outreach Demonstration Program

(Education)

 

A program would be established whereby Medicare specialists would provide advice and assistance to Medicare beneficiaries at six selected social security offices. At least two rural areas must be selected. (Sec. 406)

 

Reads the same as Energy and Commerce. (Sec. 10)

 

 

 

Enrollment Process

(Education)

 

 

The Secretary would establish, by regulation, deadlines for application for enrollment. Medicare contractors would be monitored to ensure deadlines are met. (Sec. 407)

 

A regulated process would be established for the enrollment of service providers. The process would include a method by which providers, whose application to enroll are denied, are provided a way to appeal in a timely manor. Minor errors do not need to go through appeals process. (Sec. 9)

 

 

 

Repayments

(Review/Recovery)

 

If the repayment would constitute a hardship, the Secretary would be required to enter into a plan for offset or repayment for at least 1 year and no more than 3. (Sec. 501-502)

 

If the repayment would constitute a hardship, the Secretary would enter into a plan with the service provider for offset or repayment of an overpayment over a period of 3 years (5 years if under extreme hardship). (Sec. 9)

 

 

 

Standardization of Prepayment Review

(Review/Recovery)

 

A contractor would be able to conduct random prepayment review only in accordance with a standard protocol developed by the Secretary. (Sec. 501)

 

A contractor would be able to conduct random prepayment review only to develop contractor-wide or program-wide claims payment error rates. A contractor would not be allowed to use extrapolation to determine overpayment amounts to be recovered by recoupment. (Sec. 9)

 

 

 

Non-Random Prepayment Review

(Review/Recovery)

 

A contractor may not initiate non-random prepayment reviews of a service provider based on the initial identification of an improper billing. Regulations relating to termination, including termination dates, of non-random prepayment review will be established by the Secretary. (Sec. 501)

 

Reads the same as Energy and Commerce. (Sec. 9)

 

 

 

Limitation on Recoupment

(Review/Recovery)

 

If a service provider is determined to have received an overpayment and seeks a hearing by an administrative law judge, the Secretary would not be able to take any action to recoup overpayments until the decision is of the hearing is ordered. (Sec. 502)

 

Reads the same as Energy and Commerce.  (Sec. 9)

 

 

 

Consent Settlements

(Review/Recovery)

 

The Secretary would be allowed to use a consent settlement to settle projected overpayments at his discretion. (Sec. 502)

 

Reads the same as Energy and Commerce. (Sec. 9)

 

 

 

Correcting without going through appeals process

(Review/Recovery)

 

The Secretary would develop a process under which claims that have incomplete or missing information would not be processed. It would be returned to the provider and may be resubmitted without having to appeal.(Sec. 503)

 

Not included.

 

 

 

Authority to Waive Program Exclusion

(Review/Recovery)

 

The ability to waive authority applicable to mandatory program exclusions would be expanded, permitting waivers in cases where a Federal health care program believes that the subject is a sole community physician and that the exclusion would impose a hardship on the program’s beneficiaries. (Sec. 504)

 

Not included.

 

 

 

 

Improvement in Oversight of Technology and Coverage

(Miscellaneous)

 

Not Included.

 

A Council for Technology and Innovation would be established within CMS that would coordinate the activities of coverage, coding, and payment process with respect to new technologies and procedures, including new drug therapies, and would coordinate the exchange of information on new technologies between CMS and other entities that make similar decisions. Also, public hospitals would be required to follow OSHA standards on bloodborne pathogens. (Sec.12)

 

 

 

EMTALA Task Force

 

An Emergency Medical Treatment and Active Labor Act Task Force would be established that would review EMTALA regulations, provide advice and recommendations, solicit comments and recommendations and would disseminate information on the application of regulations to hospitals, physicians and the public. (Sec. 602) 

 

Not included.

 

 

 

Laboratory Diagnostic Test

(Miscellaneous)

 

A procedure would be established to help determine the basis for payment for any clinical diagnostic laboratory test with respect to which a new HCPCS code is assigned after January 1, 20003. (Sec 701)

 

Hospitals would not be required to ask questions in the case of reference laboratory services (clinical laboratory diagnostic tests). (Sec. 13)

 

 

 

Lock-In Procedures

(Miscellaneous)

 

Would delay, for one year, a Medicare+Choice rule scheduled to take effect in 2002 that would lock-in beneficiaries for one year once they chose a managed care plan. (Sec. 702)

 

Not included.