Pay for Medicare Extensions

Senators voted 54 to 45 on Wednesday against an amendment I offered to make sure Medicare provisions in a tax-extenders bill are paid for in the federal budget.

I fought for my amendment to make sure the cost of important Medicare provisions wasn’t added to the federal deficit, but the Majority Leader worked to block it. Unfortunately for taxpayers, he succeeded. As a result, billions more will be spent by Congress without being paid for, even while congressional leaders say they are for pay-as-you-go. These extensions in Medicare policy are important to many beneficiaries, and they should be handled in a fiscally responsible way.

My amendment would have applied to a number of Medicare policies which expired at the end of 2009, as well as a two-month physician payment update that expired at the end of February, to make sure Medicare beneficiaries can access doctors. It also applied to the cap on physical therapy for Medicare beneficiaries needing additional treatment. These two provisions have been temporarily extended for March, but other critical Medicare provisions remain expired as of the end of last year.

For months now, these health care items have been managed irresponsibly by congressional leaders. Partisan political games have been played at the expense of seniors’ access to physicians and access to medical care for stroke victims and others with debilitating injuries. Even mental health counseling for veterans was jeopardized by Congress failing to pass even a short-term extension of additional payment for mental health services that expired at the end of 2009.

I offered a bipartisan proposal in February to extend a number of expiring tax provisions, along with these Medicare policies. The Senate Majority Leader, Senator Reid, rejected it, too. Instead, he’s put forward two partisan proposals, and neither of those is offset under federal budget rules.

Below is a list of the Medicare and other health-care related provisions that I worked to pay for in the federal budget.

Medicare Part A

Extension of Certain Payment Rules for Long-Term Care Hospital Services and of Moratorium on the Establishment of Certain Hospitals and Facilities. Extends Sections 114 (c) and (d) of the Medicare, Medicaid and SCHIP Extension Act of 2007 by one year. 

Extension of the Medicare Rural Hospital Flexibility Program.  Extends the authorization for the Flex Grant program through FY2011. 

Section 508 Hospital Wage Index Program.  Extends hospital reclassifications under section 508 of the Medicare Modernization Act (P.L 108-173) through the end of FY2010. 

Technical Correction Related to Critical Access Hospitals (CAHs).  Makes a technical correction to clarify that CAHs are eligible to receive 101 percent of reasonable costs for providing outpatient care regardless of eligible billing method the facility uses and for providing qualifying ambulance services. 

Medicare Part B

Outpatient Hospital Hold Harmless. Extends the existing hospital outpatient hold harmless provision for small rural hospitals under 100 beds through December 31, 2010.  Applies hospital outpatient hold harmless provision to sole community hospitals over 100 beds through December 31, 2010. 

Sustainable Growth Rate (SGR) Extension.  As of March 1, 2010, the sustainable growth rate update formula requires a 21 percent reduction in physician payments.  The provision would delay this payment reduction by 10 months through December 31, 2010, effective as of March 1, 2010. 

Extension of Exceptions Process for Medicare Therapy Caps.  Current law places annual per beneficiary payment limits for all outpatient therapy services provided by non-hospital providers.  The Secretary was required to implement an exceptions process for cases in which the provision of additional therapy services was determined to be medically necessary and this process expired on December 31, 2009.  The provision would extend, through December 31, 2010, the therapy caps exception process. 

Extension of Physician Fee Schedule Mental Health Add-On.  The provision would extend, through December 31, 2010, the 5 percent increase in payments for certain Medicare mental health services that expired on December 31, 2009. 

Extension of Ambulance Add-On.  The provision would extend, through December 31, 2010, the increased Medicare rates for ambulance services, including in super rural areas that expired on December 31, 2009. 

Extension of the 1.0 Floor on the Work Geographic Practice Cost Index (GPCI).  The provision would extend, through December 31, 2010, the existing 1.0 floor on the work geographic adjustment that expired on December 31, 2009. 

Extension of Payments for the Technical Component of Certain Physician Pathology Services.  The provision would extend, through December 31, 2010, the ability of independent laboratories to receive direct payments for the technical component for certain pathology services that expired on December 31, 2009.

Extension of Direct Billing for Indian Health Service Providers.  The provision would extend, through December 31, 2010, the authorization for Indian Health Service providers to be directly reimbursed by Medicare Part B. 

Accreditation Exemption for Certain Pharmacies that Furnish Durable Medical Equipment.  Under current law, suppliers of durable medical equipment, prosthetics, orthotics, and other supplies (DMEPOS) must prove their compliance with quality standards by being accredited.  Certain eligible professionals are specifically exempted from the accreditation requirement.  The provision would make pharmacies eligible for an exemption from the accreditation requirements under certain circumstances. 

Electronic Health Record Clarification.  The provision clarifies the health information technology provision in current law that allows non-hospital-based physicians and other health professionals who bill Medicare and Medicaid through a hospital to receive electronic health record incentives. 

Reduction in the Medicare Improvement Fund.  The Medicare Improvement Fund (MIF) contains funds that are available to the Secretary to make improvements to the original fee-for-service program under Parts A and B of Medicare. Under current law, approximately $20.7 billion is available.  The provision reduces the funding available in the MIF by approximately $17.9 billion. 

Medicare Part C

Medicare Advantage Changes. The bill extends the authority of certain types of private plans to offer coverage under Medicare Advantage for one year, 2011. Those plan types are special needs plans, cost plans, and senior housing programs.  The bill also includes a technical fix for existing employer-sponsored private fee-for-service plans.  Finally, it provides $20 million in added funds for State Health Insurance Assistance Programs and similar organizations that assist beneficiaries with Medicare benefits. 

Other Health Extenders

Court Improvement Programs. Extends funding for court improvement and handling of court proceedings relating to foster care and adoption programs through FY 2011, originally authorized in the Deficit Reduction Act of 2005. 

Family to Family Centers. Extends funding for the development and support of Family to Family Health Information Centers through FY 2011, which helps families of children with disabilities or special health care needs make informed decisions about health care.  The policy was first authorized in the Deficit Reduction Act of 2005. 

Extends Gainsharing Demonstration for another 21 months. The demonstration was authorized in the Deficit Reduction Act of 2005 and under current law was to end on December 31, 2009.