$10 Million for O&P Outcomes Research Included in the Cromnibus Bill, and RAC Concerns Addressed


Great news for O&P outcomes research! The $1.1 trillion combined continuing resolution and omnibus appropriations bill (the “cromnibus” bill) enacted December 13 to keep the government running includes a Department of Defense (DoD) section with an additional $10 million for O&P outcomes research funding.  This was also included in last year’s budget and we are especially grateful for AOPA lobbyist Catriona Macdonald, who has done such a spectacular job in transitioning this from a one-time item to being multi-year, and hopefully a mainstay of the federal budget! This is another good win for AOPA and its members. This news was especially impressive given how many cuts and other programs were squeezed out of the DoD portion of the bill.

Legislators also signaled that the efforts of AOPA and many others have been successful in raising very significant concern regarding the Medicare RAC audits, and the unconscionably long (and illegal) delays in allowing providers to access an Administrative Law Judge (ALJ) hearing.  Although there is no substantive fix included, an additional $5 million was added to ALJ funding. Greater help, while by no means certain, could come in new Medicare legislation in 2015. The good news is that Congress did ‘put down a marker’ on their concern in the following language included in the bill:

Recovery Audit Contractors (RACs). There is concern that the CMS RAC program has created incentives for RACs to take overly aggressive actions. Information received from the Office of Medicare Hearings and Appeals (OMHA) indicates that about 50 percent of the estimated 43,000 appeals were fully or partially overturned at its level. The fiscal year 2015 budget request should include a plan with a timeline, goals, and measurable objectives to improve the RAC process. In addition, CMS is expected to work with Congress and stakeholders to identify challenges and additional reforms. Further, CMS should establish a systematic feedback process with the OMHA, CMS programs, and the RACs to prevent the appearance that RACs are selecting determinations to increase their fees. The CMS is urged to stay focused on improvements to all “operations” that prevent improper payments in lieu of chasing dollars after the fact.