Medicare is the federal program that pays for covered health care services of qualified beneficiaries, which include individuals age 65 or older as well as those permanently disabled under the age of 65. In FY2017, the program will cover approximately 58 million people (49 million aged and 9 million disabled) at a total cost of $715 billion.
Medicare Part A covers inpatient hospital services, skilled nursing care, hospice, and some health services. Medicare Part B covers physician services, outpatient services, and some home health and preventive services like clinical research, ambulatory, durable medical equipment, mental health, second opinions, and limited outpatient prescription drugs.
H.R. 3178 amends title XVIII of the Social Security Act to improve the delivery of home infusion therapy and dialysis as well as the application of the Stark rule under the Medicare program. Specifically, the bill expands access to treatments for patients, and includes the following provisions reflected in other legislation:
- Creation of a temporary transition payment related to home infusion therapies for Medicare beneficiaries to ensure there are no gaps in care (H.R. 3163)
- Extension of an ongoing intravenous immunoglobulin (IVIG) demonstration that allows Medicare beneficiaries with weakened immune systems to receive care in their homes (H.R. 3172)
- Streamlining of rules to protect access to orthotics and prosthetics for Medicare beneficiaries who need them (H.R. 3171)
- Improvement of the accreditation process for dialysis facilities so Medicare beneficiaries with chronic kidney disease can more easily access the treatments they need (H.R. 3166)
- Expansion of the use of telehealth technologies for Medicare beneficiaries receiving dialysis in their homes (H.R. 3164)
- Codification of regulations to modernize Medicare’s physician self-referral laws, known as “Stark laws” (Sections of H.R. 3173)
The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on Jul 25, 2017.
Medicare Part B Improvement Act of 2017
TITLE I--IMPROVEMENTS IN PROVISION OF HOME INFUSION THERAPY
(Sec. 101) This bill amends title XVIII (Medicare) of the Social Security Act to temporarily provide for transitional Medicare payment with respect to certain home infusion services furnished on or after January 1, 2019. Under current law, the Center for Medicare & Medicaid Services (CMS) is required to establish a permanent payment system with respect to such services furnished on or after January 1, 2021.
(Sec. 102) The bill extends the Medicare Intravenous Immune Globulin demonstration project through 2020, subject to the availability of funds. A Medicare beneficiary who is enrolled in the project on September 30, 2017, shall be automatically reenrolled, subject to an existing cap on project participants.
(Sec. 103) Documentation created by an orthotist or prosthetist shall be considered part of a Medicare beneficiary's medical record for purposes of determining the reasonableness and medical necessity of orthotics and prosthetics.
TITLE II--IMPROVEMENTS IN DIALYSIS SERVICES
(Sec. 201) The bill allows renal dialysis facilities to be accredited by a CMS-approved accreditation body for participation in the Medicare program. The bill also establishes a time frame with respect to initial surveys of renal dialysis facilities.
(Sec. 202) A Medicare beneficiary who has end-stage renal disease (ESRD) and is receiving home dialysis may choose to receive monthly ESRD-related visits via telehealth, provided that the beneficiary also receives face-to-face visits periodically. Specified facility fees and geographic requirements shall not apply with respect to the provision of such services via telehealth.
The Government Accountability Office must study and report to Congress on the further expansion of Medicare coverage of renal dialysis services furnished via telehealth.
TITLE III--IMPROVEMENTS IN APPLICATION OF STARK RULE
(Sec. 301) The bill codifies certain CMS rules regarding signature requirements and holdover arrangements as they relate to prohibitions against physician self-referrals.
(Sec. 302) The bill reduces annual funding available to the Medicare Improvement Fund beginning in FY2021.