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House Releases final 21st Century Cures and CMS Releases CY2016 In- and Outpatient Hospital Stay Rules

Posted on 7/3/2015 by NTOCC ® in Public Policy Updates

Today, the Energy and Commerce Committee released the final language for the 21st Century Cures Initiative. This bill is similar to what was reported unanimously out of the Energy and Commerce Committee in June 2015. A few changes include reducing the new NIH funding increase from $10 billion to $8.75 billion in mandatory spending over the next five years and finalizing the interoperability language. We expect a vote in the full House of Representatives as early as next Thursday.

To read the final version, please click here.

The Centers for Medicare and Medicaid (CMS) also released a proposed rule this week that covered in- and outpatient hospital stays. In the rule, CMS proposed several major changes to the current Medicare “two midnight” rule that determines how hospitals are paid for patients who have shorter stays. The change would make it easier to get an exception to the rule and is an attempt to satisfy groups who have taken issue with the policy and advocated for it to be withdrawn. The agency proposed keeping in place the .2 percent payment reduction tied to the two-midnight rule.  Hospitals will also be affected by next year’s outpatient payment rate, with a CMS proposal that includes an overall net reduction of .2 percent as well, which the agency estimates will bring in $43 million in Medicare savings.

This proposed rule also provides clarification to the chronic care management (CCM) payment code, which covers non face-to-face care management services for Medicare beneficiaries who have multiple chronic conditions. CMS also clarifies the role of hospitals in furnishing CCM services and defines the scope of service elements for the hospital outpatient setting that are comparable to the scope of service elements finalized as billing requirements.

You can read text of the Medicare hospital outpatient prospective payment system here.