Summary of Health Provisions in “Jobs” Package
As you may know, Senators Baucus and Grassley released draft language on a jobs bill earlier today, the text of which can be found online here. A CBO score is not yet available, but will be forthcoming.
In addition to the jobs provisions, the bill includes several health and Medicare-related provisions. The package of health provisions are paid for by a draw-down of $8 billion from the Medicare Improvement Fund. Health-related provisions in the bill include the following:
COBRA Subsidies: Extends eligibility for subsidies to those laid off through May 31, 2010—a three month extension of the current deadline of February 28, 2010. Subsidies would last for up to 15 months (this was extended from nine months in the Department of Defense appropriations bill, P.L. 111-118, in December.) The bill also clarifies that individuals whose hours were reduced prior to being laid off entirely would become eligible for COBRA subsidies upon loss of employment.
“Doc Fix:” Extends the current Sustainable Growth Rate (SGR) fix through September 30, 2010—a seven month extension. Note that as the bill amends the Department of Defense appropriations bill, it also therefore incorporates the DoD bill’s funding “cliff,” such that this year’s fix will be disregarded for the purposes of determining payment levels beyond October 1, 2010. This provision would therefore result in a payment cut of at least 21% as of October 1 absent further Congressional action.
The bill also addresses various “Medicare extenders” that (unlike the doc fix and COBRA subsidies) were not included in the DoD appropriations package back in December, and therefore expired effective January 1. These include:
Therapy Caps: Provides a full-year extension to the Medicare therapy caps exception process, through December 31, 2010.
Durable Medical Equipment: Waives accreditation requirements through January 2011 for certain pharmacies, and provides an alternative form of accreditation for pharmacies whose sales of DME constitute less than 5% of overall revenues. (A three-month waiver of the accreditation requirements was enacted in October as P.L. 111-72 and expired on January 1, 2010.)
One Year Medicare Payment Extensions (all of which would expire at the end of December 2010 unless otherwise noted):
- Mental health reimbursements (5% increase);
- Reimbursement raises for ambulance services;
- Geographic floor for work;
- Technical component of certain physician pathology services;
- Outpatient hold harmless provision;
- Reimbursement for Part B services provided at Indian hospitals and clinics;
- Payment rules for long-term care services through July 2011 (and a moratorium on the establishment of facilities);
- Rural hospital flexibility program (expires at the end of Fiscal Year 2011);
- Section 508 hospital reclassifications (expires at the end of Fiscal Year 2010);
- Medicare Advantage plans for special needs individuals; and
- Reasonable cost contracts.
Other Provisions: The bill includes clarifications to the definition of electronic health records, amending the “stimulus” bill’s language to allow clinic-based physicians who bill through hospitals to receive bonus payments. The bill includes technical corrections related to critical access hospitals and the waiver policy for employer group Medicare Advantage plans. The bill extends the continuing care retirement community program and family-to-family health information centers through 2011, and provides several million dollars of additional funding related to low-income programs, as well as another $100 million to CMS to implement the legislation.