2021 GI Outlook (GO) Conference (On-Demand) | November 2021-Legislative and Regulatory Hot Topics

Pdf Summary

The document highlights several legislative and regulatory hot topics related to healthcare. National Health Expenditures are projected to increase from $3.6 trillion in 2018 to $6.2 trillion in 2028, with Medicare expenditures also rising significantly. Medicare sequestration, a budgetary enforcement mechanism, is set to resume at 2% next year along with an additional 4% sequestration. The American Rescue Plan will trigger PAY-GO statute reductions in Medicare spending of 4% next year, totaling $36 billion. The No Surprises Act, which protects patients from surprise medical bills, went into effect on January 1, 2022.<br /><br />Other hot topics include ASC cost reporting, ownership and price transparency, site-neutral payment policies, surprise billing restrictions, utilization controls and prior authorization, and site-neutral payment policies. The document discusses the need for transparency and ownership information for private equity deals and addresses concerns related to undercapitalization and risky behaviors. Prior authorization and step therapy protocols are also discussed, including the Safe Step Act and Improving Seniors Timely Access to Care Act. The document also mentions the Medicare Appropriate Use Criteria (AUC) program, which requires ordering clinicians to consult AUC before ordering advanced diagnostic imaging tests.<br /><br />Site-neutral payment policies are another topic of concern, with a recent CMS rule reducing the Medicare rate for hospital outpatient clinic visits at off-campus provider-based departments. The American Hospital Association challenged this rule but lost in a Supreme Court appeal. The document also mentions declining reimbursement, administrative burden, consolidation, and practice acquisition, as well as the growth of health service volume and expenditures.<br /><br />Overall, the document provides a comprehensive overview of various legislative and regulatory hot topics in the healthcare industry.

Asset Subtitle

Camille S Bonta, MHS

Keywords

legislative

regulatory

healthcare

Medicare

No Surprises Act

site-neutral payment policies

surprise billing restrictions

prior authorization

private equity deals

Medicare Appropriate Use Criteria (AUC)