Congress Passes Patient Access and Medicare Protection Act

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FinerfrockBy Bill Finerfrock and Matt Reiter, Capitol Associates

On Friday December 18th, Congress passed S. 2425, the Patient Access and Medicare Protection Act by unanimous consent in both chambers. The bill is still awaiting the President’s signature. S. 2425 is comprised of several technical Medicare provisions.

The bill extends the deadline for providers to obtain a hardship exemption from Meaningful Use (MU) penalties for the 2015 reporting year to March 15, 2016. A similar bill had been proposed that would have granted a blanket hardship exemption for providers and hospitals from the MU penalties. Rather than use that language, under this bill, CMS is given the ability to implement a blanket hardship exemption, but until/unless it does, hardship exemption requests will still be determined on a case-by-case basis.

Additionally, the bill seeks to reduce improper Medicare payments at the Medicare Administrative Contractor (MAC) level with new “incentives” for the MACs. According to the bill, these incentives:

  1. May include a sliding scale of award fee payments and additional incentives to MACs that either reduce the improper payment rates in their jurisdictions to certain thresholds, as determined by the Secretary, or accomplish tasks, as determined by the Secretary, that further improve payment accuracy; and
  2. May include substantial reductions in award fee payments under cost-plus-award-fee contracts, for MACs that reach an upper end improper payment rate threshold or other threshold as determined by the Secretary, or fail to accomplish tasks, as determined by the Secretary, that further improve payment accuracy.

These incentives would take effect with new or renewed MAC contracts three years after the bill becomes law. CMS would be allowed to apply these incentives to existing contracts at its discretion for when its practicable to do so.

The bill also address Medicare and Medicaid identity theft by creating harsher penalties for those convicted of doing so. Under this provision in the bill, individuals or corporations would face up to a $500,000 or $1,000,000 fine respectively and could face up to ten years in jail if convicted of the theft or usage of illegally obtained Medicare or Medicaid identity information.

Bill Finerfrock is the president and owner of Capitol Associates, a government relations/consulting firm. Prior to assuming ownership of Capitol Associates, Bill was a senior vice president in the company for more than 20 years. Capitol Associates was recently selected to work with AHRA on their regulatory affairs issues. Bill specializes in health care financing, health systems reform, health workforce and rural health. He can be reached at

Matt Reiter has been an associate with Capitol Associates since 2014. Matt focuses on Federal issues relating to the health care revenue cycle, medical specialties as well as the Affordable Care Act. He provides analysis of legislation and regulatory policies for the firm’s clients and represents clients before Congress, Federal Agencies and at industry functions.

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