Changes in Medicare

New Bipartisian Budget Act of 2018 Provisions

By: Wyn Staheli, Director of Research

On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law. There were some changes which will affect Medicare payments. The following is a brief summary, for a more comprehensive summary see the References.

Therapy Caps: Some therapy caps (e.g., occupational, physical therapy, speech-language pathology) were discontinued. However, modifier KX will be required to indicated the services are medically necessary and there will be medical reviews when services exceed $3,000 per year.

Geographic Practice Cost Index (GPCI): The work portion of the GPCI has a floor of 1.000 through December 31, 2019. This may affect your payments if you were in an area with a lower work ‘floor’. Find-A-Code has the updated fee calculations (see the [Fees] section for each individual code.) If you haven’t done a fee analysis for the year, perhaps now would be a good time to use our Compare-A-Fee tool.

Ambulance Services: Two provisions were extended – fee and base rate increases. Also non-emergency ESRD payment rates were reduced.

Low-Volume Hospitals: Extension of the law which allows qualifying low-volume hospitals to receive add-on payments based on their number of discharges and their distance from the nearest hospital.

Medicare-Dependent Hospital (MDH) Program: Extension of the MDH program which enhances payments to qualifying small rural hospitals.

Home Health: Extension of the 3 percent payment add on (in 2018) for home health services provided in a rural area. For 2019, the add on will vary by the location and the type of services provided.

Skilled Nursing Facilities: The payment update portion is holding for an estimated market basket update. Watch for further proposed rulemakings on SNF payments.

References:

Summary of Medicare Expired Legislative Provisions Extended and Other Bipartisan Budget Act of 2018 Provisions