AANEM News Express

AANEM News Express

Congress Features AANEM Concerns in Appropriations Bill

4/9/2018
 
Once Congress had reached a budget deal for fiscal year (FY) 2018 and FY 2019, lawmakers were able to pass an omnibus spending package at the end of March 2018 to fund all federal programs for FY 2018. The $1.3 trillion package included (and excluded) any number of additional non-spending policy initiatives. Most notably absent was the bipartisan individual health insurance market stabilization proposal, which would have reinstated Cost Sharing Reduction payments and established a health reinsurance program to reduce premiums and subsidize insurers. Disagreements over language for coverage of abortion services derailed this effort. Other non-spending poison pill policy riders, designed to make political statements, were removed from the legislation, making the package much easier to pass. The legislation did include significant new investments in research and public health activities to address the opioid crisis, consistent with congressional and administration priorities. 
 
In addition to making meaningful investments in medical research and patient care activities, the FY 2018 appropriations effort continued to advance policy discussions regarding quality patient care, including fraud and abuse in electrodiagnostic (EDX) medicine. A summary of key items is included below:  
  • $37.08 billion for the National Institutes of Health (NIH), an increase of $3 billion over FY 2017.
  • $74.7 billion for the Veterans Health Administration, an increase of $6.23 billion over FY 2017. 
  • $34.43 billion for Defense Health Program, an increase of $650 million over FY 2017. 
  • $745 million for Fraud and Abuse Control Activities at the Centers for Medicare and Medicaid Services (CMS), an increase of $20 million over FY 2017. 
The FY 2018 appropriations process also included the guidance and instructions below from Congress to CMS regarding EDX medicine. CMS is expected to respond to these requests for information during the second session of the 115th Congress and the FY 2019 appropriations process. 
  • Electrodiagnostic (EDX) Tests – The Committee appreciates that CMS provided additional guidance regarding the recommendations in the 2014 OIG Report: “Questionable Billing for Medicare Electrodiagnostic Tests.” The Committee notes that utilization of codes for EDX testing continues to increase and remains interested in comprehensive solutions that advance quality care and cost savings ensuring patients do not receive unnecessary EDX tests. 
  • Electrodiagnostic (EDX) Patient Care – The Committee thanks CMS for providing additional guidance on actions taken in response to the recommendations in the 2014 OIG Report: Questionable Billing for Medicare Electrodiagnostic Tests. The Committee notes that utilization of the codes for EDX testing continue to increase and that identified efforts to curb rampant fraud and abuse are exclusively focused on physicians with high utilization rates, and do not capture the full scope of the problem. The Committee remains interested in comprehensive solutions from CMS that advance quality care and cost savings by ensuring patients do not receive inadequate or unnecessary EDX tests. 
 


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