August 10, 2001

Health Subcommittee Proposes Regulatory Relief and Provider Protections

Legislation introduced by House Ways and Means Health Subcommittee Chair Nancy Johnson (R-Conn.) would offer regulatory relief, as well as new protections for Medicare providers who are accused of receiving overpayments. Co-sponsored by the subcommittee's ranking member, Rep. Pete Stark (D-Calif.), the "Medicare Regulatory and Contracting Reform Act of 2001" (H.R. 2768) was introduced in response to earlier legislation, (H.R. 868) the "Medicare Education and Regulatory Fairness Act of 2001" (MERFA). H.R. 2768 limits the use of extrapolation in determining overpayments and offers protections for providers who commit billing errors due to inaccurate guidance. It also outlines new repayment options and limits the duration of prepayment reviews. The legislation includes a competitive process for selecting Medicare contractors and creates minimum performance requirements for those entities.

The bill establishes new policies for developing and implementing evaluation and management (E&M) guidelines and requires pilot projects for testing any modifications. At least one pilot project would have to occur within a teaching setting. Before implementing any E&M modifications, HHS would have to demonstrate that the changes would decrease the level of non-pertinent or burdensome documentation. The bill also would disallow the use of any pilot-related data as the basis for audits or repayment demands.

Information: Christiane Mitchell, AAMC Office of Governmental Relations, 202-828-0526.