by Heather Foster
For the fourth time this year, a bill will be sent to President Obama delaying a scheduled 25 percent cut to Medicare physician payments, known as the “doc fix.” The measure was passed by unanimous consent in the Senate on Wednesday, December 8th and passed in the House 409 to 2 (with 22 Members not voting) on Thursday, December 9th .
It is anticipated that the President will quickly sign the Medicare and Medicaid Extenders Act, which will not only stave off Medicare physician fee cuts for one year but also extend Medicare and Medicaid provisions set to expire in the coming weeks and make several very technical corrections to previously enacted legislation. The legislation is paid for by “recapturing” tax subsidies that will go to individuals to purchase health insurance coverage in the new state-based Exchanges beginning in 2014. In particular, fees will be increased on those individuals receiving tax subsidies through the new exchanges starting in 2014 who misstate their income or whose income significantly increases over the course of the year, thereby changing the amount they are eligible for under the tax credit.
While the scheduled fee cut would not have had an impact on health center providers (given health centers separate reimbursement methodology), NACHC had worked very hard to see our Medicaid health information technology (HIT) incentive payment fix included given that this bill is likely the last remaining health bill to move during the 111th Congress. The HIT incentive payment fix is one we have previously blogged about; it would require State Medicaid Agencies to make the HIT incentive payments called for in ARRA directly to health centers for each eligible provider who practices predominantly in an FQHC. Without the fix, health centers will need to work with all eligible providers in order to ensure that the payments are assigned to the health center. For technical assistance on reassigning payments, please see the issue brief put together by NACHC earlier this year.
Although there were no significant policy objections to our fix raised by those on the Hill assembling the package, ultimately the provision was not included because it did not fit within the narrow constraints of the package’s framework. During negotiations between Senate Democrats and Republicans, a decision was made to develop a package that could get unanimous consent (that is, agreement of every senator). Within that construct, the negotiators strictly limited the package to the “doc fix,” imminently expiring provisions that have previously been extended, and a small set of very technical corrections previously approved by the House in HR 5712 this past July. No new “fixes” were “on the table” for inclusion.
We will continue to work toward a legislative fix early in the 112th Congress, but do strongly recommend that all health centers review our NACHC issue brief on this topic as some states will soon be ready to get these payments out the door.