NAPGCM Public Policy E-Newsletter: Protecting Access to Medicare Act of 2014

Protecting Access to Medicare Act of 2014
Released to NAPGCM Membership on April 2, 2014

The House and Senate have passed and the President signed into law yesterday, the "Protecting Access to Medicare Act of 2014," which postpones the imminent Medicare physician payment cut for 12 months until March 31, 2015. In addition to the sustainable growth rate (SGR) fix, the measure includes a number of provisions of interest to NAPGCM, which are summarized briefly below.

  • Extension of Therapy Cap Process. Extends the Medicare therapy cap exceptions process until March 31, 2015.
  • Postponement of Two-Midnight Rule. Postpones the Two-Midnight Rule and continues to allow provider education instead through the first six months of 2015. The Two-Midnight Rule clarifies the Contractor review of inpatient hospital and critical access hospital admissions for payment purposes. Under this rule, surgical procedures, diagnostic tests, and other treatments are appropriate for inpatient hospital admission when the physician expects the beneficiary to require a stay that crosses at least two midnights and admits the beneficiary to the hospital based upon that expectation. This provision suspends the Recovery Audit Program (RAC) post-payment audits under the policy through March 31, 2015.
  • Extension of the Qualifying Individual (QI) Program. Extends the QI program through March 31, 2015, allocating $285 million for the second half of fiscal year 2014 and $250 million for January through March, 2015.

Extension of Funding Outreach and Assistance for Low-Income Programs. Extends funding for insurance outreach and assistance programs that help low-income Medicare beneficiaries and their families. Funding is extended through March 31, 2015 for the various entities that provide these services such as State Health Insurance Counseling Programs.