On Thursday, March 26, 2015, the House will consider of H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, under a rule. H.R. 2 was introduced on March 24, 2015 by Rep. Michael Burgess (R-TX).
H.R. 2 repeals the Medicare Sustainable Growth Rate (SGR) formula and replaces it with a formula that returns stability to Medicare physician payments. The proposal would institute a 0.5 percent payment update every year for five years, and would improve the fee-for-service system by streamlining Medicare’s existing web of quality assurance programs into one value-based performance program, (moving away from the current volume-based system). The Medicare Payment Advisory Commission (MedPAC) is required to submit reports to Congress in 2019 evaluating the impact that the 2015-2019 payment updates have on beneficiary access and quality of care. The report to Congress is required to include recommendations regarding further updates. A full summary of the SGR repeal and replace package can be found here.
This legislation also extends all of the extenders included in the Protecting Access to Medicare (PAMA) Act of 2014, and provides funding for Community Health Centers through 2017.[1] The bill also extends the existing Geographic Practice Cost Index (GPCI) floor until January 1, 2018, in order to boost payments for physicians in areas where labor costs are lower than the national average.[2] H.R. 2 also extends the add-on payment for ground ambulance services, including in super-rural areas, until January 1, 2018, and also extends the three percent add-on to payments made for home health services provided to patients in rural areas until January 1, 2018.[3] Additionally, this legislation extends permanently the Qualifying Individual (QI) program, which helps low-income seniors pay their premiums, and permanently extends the Transitional Medical Assistance Program (TMA), which helps families on Medicaid maintain their coverage for one year as they transition from welfare to work.[4]
This legislation also extends full funding for the Children’s Health Insurance Program (CHIP) through Fiscal Year 2017.[5] Moreover, this legislation requires the HHS Inspector General to study program integrity related to the Express Lane Eligibility Program and report to Congress within 18 months.[6]
There are a number of policies included in this legislation that reduce its cost, including:
This legislation also includes two bipartisan Medicare reform bills. The first, H.R. 284, the Medicare DMEPOS Competitive Bidding Improvement Act (passed March 16, 2015 by voice vote), makes modifications to the Medicare durable medical equipment, prosthetics, orthotics, and supplies competitive acquisition program. The other, H.R. 1021, the Protecting Integrity in Medicare Act, strengthens Medicare’s ability to fight fraud and builds upon program integrity policies. H.R. 2 also delays CMS’ auditing enforcement of the “two-midnight” policy, which requires a patient stay two-midnights in a hospital to qualify for inpatient status, through September 30, 2015.[13] H.R. 2 also reverses the CMS decision to eliminate the bundled payment for surgical services that span a 10 and 90-day period, and requires CMS to periodically collect information on the services that surgeons furnish during these global periods beginning not later than 2017 (and use that information to ensure that the bundled payment amounts are accurate). Finally, H.R. 2 provides a two-year extension of the Secure Rural Schools and Community Self-Determination Act of 2000 through FY 2015. This program allows for payments to mitigate the impacts on counties containing national forests with declining timber revenues.
A full section-by-section analysis of H.R. 2 can be found here.
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[1] See Section-by-Section, at 2.
[2] See Id.
[3] Id. at 2-3.
[4] Id.
[5] Id. at 4.
[6] The Express Lane Eligibility Program (ELE) permits states to rely on findings from another program (like SNAP, TANF, Head Start, WIC, etc.) to gather information on factors like income and household size in order to facilitate enrollment in healthcare coverage.
[7] See Section-by-Section, at 5.
[8] Id. at 5.
[9] Id. at 5.
[10] Id. at 5.
[11] Id. at 5.
[12] Id. at 5.
[13] Id. at 6.
The Sustainable Growth Rate (SGR) is a formula that was enacted in the Balanced Budget Act of 1997 to control Medicare spending on physician services. However, the SGR policy flaws have compelled Congress to override the formula-driven cuts for more than a decade. In fact, since 2003, Congress has spent nearly $170 billion in short-term patches to avoid these unsustainable cuts. The most recent patch will expire on March 31, 2015. H.R. 2 repeals the SGR, averting a 21 percent SGR-induced cut scheduled for April 1, 2015.
The Children’s Health Insurance Program (CHIP) covers more than 8 million children and pregnant women in families that earn income above Medicaid eligibility levels. CHIP prevents millions of children from being uninsured, while keeping them in private coverage models. Although CHIP is authorized through 2019, no new funding is available after FY 2015. H.R. 2 fully funds CHIP through FY 2017.
CBO estimates that enacting H.R. 2 would increase direct spending by a total of $141 billion over the 2015-2025 period. In addition, CBO conducted three supplemental analyses:
For questions or further information contact the GOP Conference at 5-5107.