By Lupita Salazar Letscher
Last Thursday Congress passed a short-term legislative fix in an attempt to avoid a scheduled 21.2 percent cut to Medicare physician payments. The cut, which is mandated by the flawed sustainable growth rate (SGR) formula, were originally scheduled to go into effect on January 1, 2010. Congress has repeatedly delayed the cuts as it attempts to find a longer-term fix to the SGR problem.
As one might expect, the bill has become a “must-pass” vehicle for other important legislative priorities as well. One of these provisions is the temporary extension of the 2009 Federal Poverty Level (FPL) guidelines through the end of May. The extension of the 2009 FPL guidelines is extremely important to health centers across the country, each of which use the guidelines to formulate their sliding fee scale. The guidelines are also used by states to determine eligibility for Medicaid, so the extension will impact that program as well. It is understandably the intent of Congress to minimize any unintended consequences the proposed 2010 FPL guidelines (which would reduce the poverty level) would impose on communities with high unemployment and uninsurance rates.
Fortunately for health centers, the SGR fix may prove to be a vehicle to clarify the American Recovery and Reinvestment Act of 2009 (ARRA) section on Medicaid Health IT Incentives. Currently, ARRA provides incentive payments for five different provider types in order to promote, adopt, and meaningfully use interoperable health information technology. These Medicaid incentives may mean that nearly $1 billion in new resources will flow to health centers. However, there remain two technical issues that require clarification in order for health centers to fully realize the original intent of the legislation. First, the legislation needs to make clear that the State Medicaid agencies can make payments directly to Health Centers; the legislation currently authorizes payments directly to providers only. Second, the legislation needs to be revised to reflect that the “PA-led” requirement for incentives to apply to PAs should not apply to health centers – which are by definition community led.
The Medicaid incentives provided in ARRA offer a transformational opportunity to further customize the care health centers provide in over 7,000 communities across the country. We are working to make sure the next legislative vehicle addressing the SGR fix also recognizes the importance of clarifying the Health IT provisions for health centers as well.