H.J.Res. 59 - Amendment 2: Amendment #2 to H.J.Res.59, Continuing Appropriations Resolution, 2014

H.J.Res. 59

Amendment #2 to H.J.Res.59, Continuing Appropriations Resolution, 2014

Sponsor
Rep. Hal Rogers

Date
December 12, 2013 (113th Congress, 1st Session)

Staff Contact
Communications

Floor Situation

On Thursday, December 12, 2013, the House will consider two amendments to H.J.Res.59, under a rule. 

Bill Summary

AMENDMENT #2 SUMMARY

(SUSTAINABALE GROWTH RATE and EXTENDERS)

Amendment #2 addresses the expiration of the current reimbursement rate for physicians treating Medicare patients. The amendment prevents a 20.1 percent cut in reimbursements currently set for January 1, 2014 and replaces it with a .5 percent increase until April 1, 2014. 

In addition, the amendment extends certain medical provisions that expire at the end of the year as well as makes certain policy changes to reduce spending, including the following:

Extends until April 1, 2014, the Medicare Work Geographic Practice Cost Index that allows CMS to determine the allowable payments to physicians for medical procedures.

Extends through March 31, 2014, the therapy cap exceptions process, which allows providers to seek and waive caps on the amount of expenses that patients can accrue for outpatient therapy services in a given year.

Extends through March 31, 2014, the increased Medicare rates for ambulance services currently in place, including those in rural areas of the country.

Extends for five months, the Medicare low volume hospital payment adjustment that allows CMS to provide an additional payment to hospitals for the higher costs associated with operating a hospital with a low-volume of discharged patients.

Extends the Medicare-Dependent Hospital Program for another five months. The MDH program was established in 197 to support smaller, more rural hospitals for which Medicare patients are a significant portion.

Extends the Medicare Advantage Special Needs Plan (SNP) for one year. The SNP is limited to those seniors that have specific diseases or characteristics and provide benefits, provider choices, and drug formularies tailored to meet the specific needs of the groups they serve.

Allows Medicare cost plans to continue through December 31, 2014 in areas where at least two Medicare Advantage coordinated care plans operate. Cost plans are private plans that operate much like MA plans. However, plans with cost contracts provide Medicare services on a reasonable per person amount based on the actual cost of services.

Extends the funding for the National Quality Forum until funds currently available expire.

Extends through March 31, 2014, the State Health Insurance Counseling Programs, Area Agencies on Aging (AAA), Aging and Disability Resource Centers (ADRCs), and the National Center for Benefits Outreach and Enrollment.

Extends for three months, the qualifying individual program. The QI program allows Medicaid to pay the Medicare Part B premium for low income Medicare beneficiaries with incomes between 120 percent and 135 percent of poverty.

Extends the Transitional Medical Assistance program for an additional three months. The TMA program allows low-income families to maintain their Medicaid coverage as they transition into employment and increase their earnings.

Extends for three months the Family-to-Health Information Centers to assist families of children/youth with special health care needs in making informed choices about health care in order to promote good treatment decisions, cost effectiveness, and improved health outcomes.

Relieves safety net provides of the Medicaid Disproportionate Share Hospital (DSH) reductions in 2014 and delays the scheduled 2015 DSH payment for a year. The provision also provides that the FY 2013 payments will be based on the FY 2022 levels.

Realigns the Medicare sequester in 2023 without increasing the overall effect of the sequester on Medicare providers.

Establishes new criteria for patients admitted to Long Term Care Hospitals (LTCH) in order for LTCHs to receive the increased LTCH rate. Specifically, the provisions provide that patients with stays longer than three days in an intensive care unit or are on a ventilator, qualify for the higher payment rate. All other cases are reimbursed at the equivalent of a stay in an inpatient facility. The provision also delays the application of the 25 percent rule for three years.

Background

The sustainable growth rate is a formula enacted in 1997 that creates annual spending targets for physician services under Medicare. The SGR policy flaws have compelled Congress to override the formula driven cuts for more than a decade.  On December 31, 2013, the one year SGR patch and other extenders included in the American Taxpayer Relief Act will expire.  

Cost

According to CBO, enactment of Amendment #2 will reduce direct spending by $300 million over ten years. For more information, click here.

Additional Information

For questions or further information contact the GOP Conference at 5-5107.