WASHINGTON --- Senators today voted 54 to 45 against an amendment offered by Senator Chuck Grassley 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 and, 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,” Grassley said. “These extensions in Medicare policy are important to many beneficiaries, and they should be handled in a fiscally responsible way.”
Grassley’s amendment would have applied to a number of Medicare policies which expired at the end of February, including a physician payment adjustment to make sure Medicare beneficiaries can access doctors and exceptions to the cap on physical therapy for Medicare beneficiaries needing additional treatment. Last night, Congress voted to prevent these cuts from taking place for another 30 days, but they will expire again at the end of March. Other provisions, including payment for mental health services, ambulance payments, and improved payments for rural and other hospitals were not temporarily extended.
Beyond the fiscal issues, Grassley said all of these health care items have been managed in an irresponsible way by congressional leaders. “Political games were played at the expense of seniors’ access to physicians and access to medical care for stroke victims and others with debilitating injuries,” he said. “Even mental health counseling for veterans was jeopardized by Congress passing a short-term extension at the end of 2009, and then failing to pass a more responsible extension in February.”
Last month, Grassley offered a bipartisan proposal with Senator Max Baucus to extend a number of expiring tax provisions, along with these Medicare policies. The Senate Majority Leader, Senator Reid, rejected their effort and instead has put forward two partisan proposals, the second of which is much larger in scope. Neither Reid bill has been offset under federal budget rules.
Grassley is the Ranking Member and Baucus is the Chairman of the Senate Committee on Finance, which is responsible for tax and Medicare legislation.
Below is a list of the Medicare and other health-care related provisions included in H.S. 4213, the Tax Extenders bill. The legislative text of Grassley’s amendment is attached. A floor statement by Grassley from this morning’s debate on the amendment follows the list of provisions.
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.
Floor Statement of Senator Chuck Grassley
Ranking Member of the Committee on Finance
Failure to Enact Medicare Health Extenders Harms Beneficiaries
Wednesday, March 3. 2010
Mr. President, as I stated before, I had worked in early February to put together a bipartisan package with my colleague, Finance Committee Chairman Baucus, to address some time-sensitive matters that need to be considered.
I find it surprising that we are taking up a package this week that, like last week’s exercise, solely belongs to the Senate Democratic Leadership.
We are not taking up the bipartisan package that I put together with Finance Committee Chairman Baucus.
The Senate Democratic Leadership arbitrarily decided to replace the Baucus-Grassley bipartisan bill with one that is dramatically different. Their package is almost three times the size and significantly greater in cost than the bipartisan bill we announced on February 11.
It's unfortunate that the Democratic Leadership failed to ensure that these critically-needed Medicare provisions were extended at the end of last year.
Then they failed to extend the provisions that had expired in 2009 for over two months.
Today, I am offering an amendment that would ensure that the Medicare provisions are fully offset. And my amendment would also extend the physician update through the end of this year.
These provisions are essential to the health and well being of Medicare beneficiaries.
And this is the fiscally responsible way to extend them--by paying for them.
These Medicare provisions have been routinely supported by both sides, fully offset, and passed repeatedly in recent years.
Now it is the 3rd of March.
Medicare beneficiaries around the country are suffering from the Senate Democratic Leader’s decision to abandon the Baucus-Grassley bipartisan package that my colleague and I had worked out weeks ago.
First, there is the urgently needed physician payment update, known as the “doc fix”.
A two-month extension that was passed in December expired on February 28th so, as of March 1st, physicians, nurses, and other health care professionals were subject to severe payment cuts of 21 percent.
Now with the 30-day extension having passed last night, physician payments will be in place until the end of March. But we should not be running Medicare on a month-to-month basis.
These cuts to physician payment cannot be allowed to occur. And as damaging as these would be to beneficiary access to care anywhere, these cuts are even more disastrous for access to care in rural states, like Iowa, where Medicare reimbursement is already at least 30 percent lower than in other areas.
I am appalled that seniors’ access to physicians and needed medical care has been handled this way because of the political games that are being played by the Senate Democratic Leadership.
Should these cuts remain in place, they will have a truly devastating effect on the ability of seniors to find physicians who take Medicare patients.
Many beneficiaries have already been affected by Medicare provisions that the Senate Democratic Leadership allowed to expire last December.
One of the most urgent situations involves limitations that Medicare places on the amount of certain kinds of treatments for beneficiaries.
Medicare places annual limits on the amount of outpatient physical therapy, speech-language pathology therapy and occupational therapy that a beneficiary can receive.
In 2005, the law was changed to provide for an exceptions process to these therapy caps for situations when additional therapy is medically necessary. But that needed protection for beneficiaries expired at the end of 2009.
Medicare beneficiaries who have suffered strokes or serious debilitating injuries, such as a hip fracture, have significant rehabilitation needs. Some have already exceeded the caps for 2010.
Those with the greatest need for therapy will be the hardest hit. Here again, with the 30-day extensions bill having passed last night, this problem has been temporarily fixed.
But this is another case where this Congress is playing political games with Medicare. These should have all been taken care of at the end of last year. And they could already have been resolved even now if the Senate had taken up the original Baucus-Grassley bill.
Other essential provisions include additional payments for mental health services. This benefits Medicare beneficiaries in need of mental health counseling as well as veterans suffering from post-traumatic stress and other disorders since TRICARE is based on Medicare rates.
Another issue concerns additional payments for ambulance services that many ambulance providers need to keep their doors open. Those provisions also expired at the end of last year and they were not extended in the 30-day bill voted on last night.
Another important issue affects community pharmacies. Pharmacies that have not gone through an accreditation process will soon be forced to turn away Medicare beneficiaries.
A provision in my amendment would ensure that beneficiaries who need vital medical supplies like diabetic test strips, canes, nebulizers, and wound care products can continue to have access to these products at local pharmacies.
Many eligible professionals, such as physicians, nurse practitioners, physical therapists, and others have been specifically exempted from this requirement. This provision would also exempt community pharmacies under certain conditions.
A number of other expired provisions are extended in this package. These include improved payments for hospitals, especially rural hospitals that rely on these provisions to keep their doors open. And like many others, these problems were not fixed in the 30-day bill passed last night. These problems still remain.
The impact of a hospital shutting its doors would be especially hard on rural and underserved areas where hospitals offer the only access to health care.
We need to pass this critically-needed and fiscally responsible amendment now. And I urge my colleagues to support it.
I yield the floor.