Today, March 25, the Medicare physician payment reform legislation was modified to include budget offsets, policy extenders, and other provisions and reintroduced by Rep. Michael Burgess, MD (R-TX) as H.R. 2, the “Medicare and CHIP Reauthorization Act” (MACRA). A section-by-section analysis prepared by staff of the House committees of jurisdiction is attached.
The new bill (which replaces H.R. 1470, introduced last week) builds on the bipartisan, bicameral SGR replacement policy negotiated last year. Additional provisions of interest include the following:
• The work GPCI floor was extended through 2017.
• The therapy caps exceptions process was extended through 2017.
• The Qualifying Individual (QI) program that provides Part B premium support for low-income Medicare beneficiaries was extended permanently, as was the Transitional Medical Assistance (TMA) program that allows Medicaid recipients to maintain coverage for a year as they transition from welfare to work.
• Funds for Community Health Centers and the National Health Service Corps and the Teaching Health Center GME Payment Program were all extended through 2017.
• The Children’s Health Insurance Program (CHIP) was extended through 2017.
• For new enrollees beginning in 2020, Medigap plan coverage will be limited to costs above the amount of the Part B deductible.
• Income-related premiums for Medicare Part B and D under current law have been readjusted; those with incomes between $133,501 and $160,000 will increase from 50 percent to 65 percent, those with incomes at $160,001 and above will increase from 65 percent to 80 percent.
• The decision by the Centers for Medicare and Medicaid Services (CMS) to eliminate bundled payments for 10-day and 90-day global surgical services has been reversed; instead, CMS will collect data on these services beginning in 2017 to determine the accuracy of payment rates.
The bill is scheduled for consideration by the House Rules Committee on Wednesday afternoon. Floor debate is expected to occur Thursday morning, with a vote taking place early Thursday afternoon. The House is scheduled to adjourn Thursday night for its two-week April recess.
On Thursday, the Senate will be voting on amendments to the FY 2015 budget resolution, which cannot be interrupted for other business. The budget votes are expected to continue well into the night, after which some action could occur regarding H.R. 2. The possibility of passing H.R. 2 before the Senate adjourns for the April recess should be more clear on Thursday—watch your email for updates.
It is vitally important for medicine to secure a strong House vote to maintain momentum that can carry the bill through the Senate. All physician groups are asked to maintain grassroots pressure on House members, while also engaging Senators.
Since H.R. 2 is originating in the House, the breadth of support in the Senate is less certain. Again, it is vitally important for medicine to express its support to all Senators, and physician groups should be prepared for a strong grassroots push on the Senate Thursday afternoon, after the House has acted.
If the Senate fails to pass the bill before adjourning for the two-week recess, a 21 percent Medicare physician payment cut will technically take effect on April 1. Because Medicare is required by law to hold claims for two weeks prior to issuing payment, physicians would not actually experience any cuts before April 14—the day after Congress returns. The AMA will, of course, be monitoring the situation closely and will keep the Federation apprised of any developments.
In the meantime, we continue to update material on the web site FixMedicareNow.org, which provides a gateway you may use to send email and social media messages to your legislators. Or, you may use our toll-free grassroots hotline, 1-800-833-6354.
Help us maintain the momentum so medicine can be done with the SGR once and for all!