The has introduced its substitute to H.R. 4213. Unfortunately the preliminary CBO tables do not include a breakout of specific sections’ budgetary impact; however, the health subtitle as a whole would increase the deficit by $93.4 billion over five years and $81.5 over ten years. A summary of the health provisions follows; bill text can be found in Subtitle B of Title V (pages 304-67).
Medicare Physician Payment: Provides a 1.3% increase in reimbursement levels for June-December of 2010, and a 1% increase for 2011. For 2012 and 2013, implements a target rate funding policy allowing Medicare physician spending for evaluation and management codes, as well as preventive care, to rise at one level (GDP plus 2%), while all other spending would rise at a lower level (GDP plus 1%). Note however that this approach would still allow for Medicare payment cuts in future years, if physician spending exceeds target levels—so the problems inherent in the SGR target mechanism would NOT be fixed, just delayed. While the bill does state that no negative updates would be provided during the 2010-2013 period, it also guarantees a further funding “cliff” in January 2014. The new Medicare spending would be exempt for PAYGO purposes, but it would increase the deficit regardless. Increases the deficit by $64.9 billion over five and ten years.
Medicaid Funding: Includes a six-month extension (through June 30, 2011) of increased federal Medicaid funding provided in the “stimulus,” which is designated as emergency spending for PAYGO purposes. The bill clarifies that states with Section 1115 waivers covering childless adults in effect as of December 31, 2009 qualify for meeting the “stimulus” bill’s maintenance of effort requirements. The bill also includes a new provision requiring that to obtain the additional six months of federal funding, state chief executive officers must certify “that the state will request and use such additional funds” – language which some may view as a politically motivated stunt.
COBRA Subsidies: Extends for seven months eligibility for COBRA subsidies for individuals laid off through December 31, 2010. The bill does not extend the length of the subsidy program beyond the current-law 15 months. The bill designates this spending as emergency appropriations for PAYGO purposes, although it will still add to the deficit.
IRS Data Match: Includes provisions allowing the IRS and CMS to co-ordinate data matching efforts with regard to delinquent tax debts owed by Medicare providers, and to take such information into account when releasing reimbursement payments and accepting new providers. These provisions were originally included in Section 1303 of the substitute amendment for the reconciliation bill (H.R. 4872), but were stripped out at the House Rules Committee due to Byrd rule concerns.
340B Program: Adds inpatient drugs to the 340B outpatient discount program, and maintains childrens hospitals’ ability to participate in the 340B discount program with respect to orphan drugs.
Health Law Clarifications: Repeals the health law’s delay of the revised skilled nursing facility prospective payment system, as well as the law’s extension of reasonable cost payments for certain laboratory services. Repeals section 6502 of the law, which requires states to exclude certain providers from Medicaid and SCHIP. Includes other clarifying amendments with respect to drafting errors in the health care law.
Other Provisions: Extends for an additional year (through September 30, 2011) the Section 508 hospital reclassification program. Provides $175 million in mandatory appropriations to CMS to implement the act’s provisions. Includes clarifying provisions regarding eligibility for Medicaid health IT funding provided in the “stimulus.” Adjusts Medicare fee schedule localities in California, and includes clarifying language preventing Medicare providers from un-bundling reimbursement requests.