Saturday, December 17, 2011

Health Provisions of Reid-McConnell Payroll/UI Substitute

Sens. Reid and McConnell have introduced a substitute amendment for H.R. 3630, the House passed payroll tax bill.  Among other things, the substitute includes a two-month extension of Medicare payment provisions, which would prevent a 27 percent reduction in physician payments scheduled to take effect on January 1.  Per the unanimous consent request entered into yesterday evening, the vote on this payroll tax agreement will take place at 9 AM TODAY, subject to a 60-vote affirmative threshold.

The legislation provides a zero percent update in physician reimbursement levels for January and February 2012, and stipulates that the payment increase shall be disregarded for purposes of calculating SGR rates for future periods.  The bill also includes several two month extensions of expiring Medicare provisions (which are usually extended with the SGR).  The entire bill is paid for through non-health savings, namely an increase in guarantee fees for Fannie Mae and Freddie Mac mortgages.

A summary follows below.  Per CBO, the two month doc fix costs $3.6 billion over ten years, the other Medicare extenders cost $510 million, and this $4.1 billion in spending is offset by non-health provisions elsewhere in the bill, making the product fully paid for…

 

Medicare Physician Payment:  Provides for a 0 percent update in reimbursement levels for January and February 2012.  Provides that the payment update shall not be considered when calculating the Sustainable Growth Rate (SGR) reimbursement levels in future periods.

Medicare “Extenders:”  Extends for two months a series of Medicare and health-related provisions, all of which would expire at the end of the calendar year unless otherwise noted:

  • Section 508 hospital reclassifications;
  • Geographic floor for work;
  • Therapy caps exception process;
  • Technical component of certain physician pathology services;
  • Reimbursement raises for ambulance services;
  • Mental health reimbursements (5% increase);
  • Outpatient hold harmless provision;
  • Minimum payment for bone mass measurement;
  • Qualifying Individual (QI) program, assistance to low-income seniors in paying Medicare premiums; and
  • Transitional Medical Assistance, which provides Medicaid benefits for low-income families transitioning from welfare to work.