The Medicare Improvements for Patients and Providers Act
On June 24, 2008, the House passed the Medicare Improvements for Patients and Providers Act, H.R. 6331. This legislation prevents the pending 10 percent payment reduction for physicians in Medicare, enhances Medicare preventive and mental health benefits, improves and extends programs for low-income Medicare beneficiaries, and extends expiring provisions for rural and other providers. On July 15, the President vetoed this legislation, and the House voted to override the President's veto and pass the Medicare Improvements Act.
Watch Speaker Pelosi speak in support of overriding the President's veto>>
Key provisions of H.R. 6331 include:
Physicians
- The bill eliminates the pending 10 percent cut in Medicare payments to physicians for the remainder of 2008 and provides a 1.1 percent update in Medicare physician payments for 2009.
- The bill provides a 2 percent quality reporting bonus for doctors who report on quality measures through 2010 and provides financial incentives to providers to encourage the use of electronic prescribing technology.
Beneficiaries
- The bill extends and improves low-income assistance programs for Medicare beneficiaries whose income is below $14,040. This includes the “Qualified Individual” program which pays part B premiums for low-income beneficiaries with incomes of $12,480 to $14,040 a year.
- It would increase the amount of assets that low-income beneficiaries can have and still qualify for financial help with Medicare costs.
- The bill adds new preventive benefits to the Medicare program and reduces beneficiary out of pocket costs for mental health care.
Pharmacies
- The bill requires Medicare Advantage plans to:
- pay pharmacies promptly (within 14 days); and
- update the prices they will reimburse for prescription medicines at least weekly so the pharmacies know what they should get paid.
- The bill also delays the new Medicaid payment rule which changes Medicaid’s payment limits for pharmacies to be based on the Average Manufacturer Price (AMP). The rule would be delayed through September 2009.
Medicare Advantage
- The bill takes modest steps to reduce Medicare payments to private plans which are being paid more than 100 percent of the cost to treat a beneficiary in fee-for-service Medicare by:
- phasing out the Indirect Medical Education (IME) double-payment (hospitals would continue to be get paid, Medicare Advantage plans would not);
- eliminating the Medicare Advantage “slush” fund, which is a fund that the Secretary may use to further increase payments to private plans; and
- ensuring Private Fee-for-Service (PFFS) plans comply with quality requirements that other Medicare Advantage plans must meet and ensuring beneficiaries in PFFS plans have adequate access to providers.
- The bill also includes new prohibitions and limitations on marketing activities under Medicare Advantage and prescription drug plans.
Hospitals
- The bill protects access to care in rural America by extending and building upon expiring provisions, including:
- Improving payments for sole community hospitals, critical access hospitals, and ambulances;
- Extending expiring provisions that preserve payment equity for rural physicians and rural hospitals that run clinical laboratories;
- Increasing access to tele-health services and speech-language therapy;
- Retaining access to Medicare Advantage by ensuring private-fee-for-service plans in rural areas can continue to operate as they do today, if there are fewer than two plan options.
Other
H.R. 6331 makes a number of other modest changes to Medicare payments, including:
- Protecting access to therapy services by extending the exceptions process to the limits on therapy visits for beneficiaries in nursing homes; and
- Postponing the Durable Medical Equipment (DME) competitive bidding program and repealing the clinical laboratory competitive bidding program.