Medicare Bill Moves To
Pres, Veto Expected
Editor’s Note:
The following is an AMA-prepared summary of the Medicare Bill
averting 10.6 percent cuts. The bill was passed by Congress and sent
to the president, who is expected to veto it. House deliberations
could begin as early as Tuesday on a veto override, according to AMA
sources.
HIGHLIGHTS
H.R. 6331,
“Medicare Improvements for Patients and Providers Act of 2008” As
Passed by the Senate on July 9, 2008
•
Provides 18-month
Medicare physician payment fix, stopping the 10.6 percent Medicare
physician payment cut on July 1, 2008, and the 5.4 percent cut on
Jan. 1, 2009, extending the June 2008 rates through Dec. 31, 2008,
and providing an additional 1.1 percent update for 2009.
•
According to CBO
cost estimates, a 1 percent update for 2009 funded in a way that
produces no budgetary effects after 2009 would lead to a 21 percent
cut in January 2010. Establishes a Medicare Improvement Fund and
deposits $19.9 billion for use in 2014-17.
•
Requires that
budget neutrality adjustments for 2007 and 2008 relative value
changes be applied to the conversion factor, instead of work
relative values, effective in 2009.
•
Extends work GPCI
floor through 2009 and provides a 1.5 work GPCI for Alaska starting
in 2009.
•
Extends PQRI
reporting for two years and provides a 2 percent bonus payment for
reporting.
•
Adds new funding
and expanded authority for the Medical Home Demonstration Project.
•
Provides a 5
percent pay increase for certain mental health services from July 1,
2008, through Dec. 1, 2009.
•
Provides teaching
anesthesiologists 100 percent payment for two concurrent cases
starting in 2010.
•
Extends the
exceptions process for therapy caps through December 31, 2009.
•
Allows
independent laboratories to bill for pathology services furnished to
hospital patients through 2009.
•
Permanently
extends the accommodation for physicians ordered to active duty in
the armed services so that they can engage in substitute billing
arrangements for more than 60 days.
•
Delays Medicare
durable medical equipment (DMEPOS) competitive bidding program for
18 months (offset with reduced DMEPOS payments). Allows HHS to
permanently exempt physician suppliers of DMEPOS from DME
accreditation.
•
Increases asset
limits for beneficiaries to qualify for Part D low-income subsidy.
•
Expands coverage
of Medicare preventive services, including the “Welcome to Medicare”
visit.
•
Provides Medicare
coverage of cardiac and pulmonary rehabilitation services.
•
Phases in a
reduction in copays for mental health to the same level as other
outpatient services (20 percent).
•
Allows Part D
coverage of benzodiazepines and barbiturates.
•
Provides the same
standard for off-label drug coverage under Part D as under Part B.
•
Phases out double
payment to MA plans for indirect medical education.
•
Establishes
prohibited federal marketing practices and confers states with
authority to regulate MA and Part D marketing abuses. Prohibitions
include no marketing activities in physician offices.
•
Eliminates the
ability of MA private fee-for-service (PFFS) plans to “deem”
physicians where there are two or more MA HMO or PPO plans in an
area, beginning in 2011.
•
Provides a 2
percent bonus in 2009 and 2010 for e-prescribing by eligible
physicians, reduced to 1 percent in 2011 and 2012 and 0.5 percent in
2013. If eligible physicians do not e-prescribe, imposes penalties
of -1 percent in 2012, -1.5 percent in 2013, and -2 percent in 2014
and beyond. Provides hardship exceptions.
•
Requires
physicians and other suppliers that furnish advanced diagnostic
imaging services (MRI, CT, and nuclear medicine/PET) to meet
Medicare accreditation standards by January 1, 2012.
•
Extends the
Federal Payment Levy program to Medicare providers. This is an IRS
program to collect revenues from federal contractors who fail to pay
their taxes.
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