Nurse Practitioners celebrate a long-awaited victory with the bipartisan passage of H.R.2 known as Medicare Access and CHIP Reauthorization Act of 2015 by the US House March 26 and the subsequent passage by the US Senate April 14, 2015. The resolution was signed into law by the President on April 16, 2015.
H.R.2 includes 5 titles and accomplishes a number of objectives pertinent to NP practice by amending Title XVIII (Medicare). A full rendering of the text of the bill can be found at the following URL: https://www.congress.gov/bill/114th-congress/house-bill/2. Some of the major effects of each of the 5 titles are included below.
- Title I – Repeals the current sustainable growth rate (SGR) formula beginning in 2026 and creates a bridge for conversion factors for reimbursement until 2026, directs for the development of quality measures to assess professionals and to make available items and services furnished to Medicare beneficiaries on an annual basis, expands the possible uses of Medicare data for quality improvement activities, declares a national objective for the widespread exchange of personal health information through electronic health records by December 31, 2018, and directs for study of telehealth and remote patient monitoring services.
- Title II – Subtitle A extends current Medicare programs, including state health insurance programs, provides an extension for insurances who have contracted for Medicare Advantage plans under Part C, extends increased payment for certain low-volume hospitals and EMS services, extends until 2017 the opportunity for patients to apply for extension on dollar limits for PT/OT and speech-language pathology services, extends payment increases for rural home health services.
Subtitle B makes the current policy of states paying the Part B premiums for low income (120-135% federal poverty level) permanent and extends federal funding for such individuals through 2016 and makes the work-related transitional medical assistance program permanent which requires states to provide 6-12 months additional Medicaid coverage to families who lose eligibility because of increase hours of work or increased income. The law also extends financial support for various programs for sexual education, special needs child education, graduate medical education, and other programs.
- Title III – Extends funding for CHIP through 2017 and provides for collection and reporting of information regarding the utilization and eligibility for state-based Medicaid and CHIP programs.
- Title IV – Denies Medigap policies that would have covered Medicare Part B deductibles to beneficiaries becoming eligible after January 1, 2020, adjusts income threshold for Part B premiums beginning 2018, and limits reimbursement increases to 1% annually for LTAC hospitals, hospice, and other groups, and amends inpatient hospital payment rates for discharges occurring between fiscal year 2018-2023.
- Title V – Social Security Numbers will no longer appear on beneficiary cards, provides for processes to reduce fraudulent payments to incarcerated or deceased individuals and to those not living in the USA, requires the use of Medicare smart cards, removes the physician specific language for documenting face-to-face encounters to order DME and includes NPs, revises HIPAA to encourage greater participation in reporting fraud and abuse in Medicare, extends the two-midnight rule for inpatient hospital care.
As with any new law, more is included that anyone anticipates and the above points are only a brief and not a comprehensive summary of the new law. Other key points of the law are the inclusion of NPs in the first year of Merit-based Incentive Payment Systems and ensuring NP-led medical homes may receive incentive payments for the management of patients with chronic illnesses.
Some state and federal organizations such as AANP have touted the law as evidence of recognition of NPs as equal or full partners in the Medicare program. While the law does remove long-standing obstacles to providing care, particularly to seniors and those who require DME as well as those with chronic illness, it does not fully recognize NPs as equal or full partners in a longstanding federal program which discriminates against NPs and perpetuates unequal pay for equal work. Utah Nurse Practitioners celebrates this historic victory with NPs around the nation and simultaneously calls on NPs and national NP organizations, including AANP, to lobby for true equality and true full partnership in Medicare by advocating for equal pay for equal work.
Written by Jared Johnson, DNP, ACNP-BC, Immediate Past President