H.R. 4302: Protecting Access to Medicare Act of 2014

H.R. 4302

Protecting Access to Medicare Act of 2014

Sponsor
Rep. Joe Pitts

Date
March 27, 2014 (113th Congress, 2nd Session)

Staff Contact
Communications

Floor Situation

On Thursday, March 27, 2014, the House will consider H.R. 4302, the Protecting Access to Medicare Act of 2014, under a suspension of the rules.  H.R. 4302 was introduced on March 26, 2014 by Representative Joe Pitts (R-PA), Chairman, Energy and Commerce Subcommittee on Health.

Bill Summary

H.R. 4302 repeals the current 24 percent cut in reimbursements for physicians treating Medicare patients set to take effect on April 1, 2014 and replaces it with a .5 percent update through December 31, 2014 and a zero percent update from January 1, 2015 through March 31, 2015.

In addition, the bill will extend: the Medicare Geographic Cost Price Index (GPCI) floor through March 31, 2015; the Medicare therapy cap exceptions process through March 31, 2015; the increased Medicare rates for ambulances services, including those in super rural areas, through March 31, 2015; Medicare low volume hospital payments and Medicare-dependent hospital payments for one year; Medicare Advantage Special Needs Plans (SNP) for one year; funding for the National Quality Forum (NQF) through March 31, 2015; outreach and assistance for low income programs including the State Health Insurance Counseling programs, Area Agencies on Aging, Aging and Disability Resource Centers, and the National Center for Benefits outreach and enrollment, and the CMS “probe and educate” program. H.R. 4302 allows Medicare cost contracts to continue to operate through December 31, 2015 in an area where at least two Medicare Advantage coordinated care plans operate, and makes technical corrections to the long term acute care hospitals (LTCH).

The bill extends by one year the following: the qualified individual (QI) program; transitional medical assistance (which allows low income families to maintain Medicaid coverage as they transition to employment); the Medicaid and CHIP express lane option; the Special Diabetes Program; abstinence education; the personal responsibility education program (PREP); the family to family health information centers; and the health workforce demo for low income individuals.  In addition, the bill provides funding for maternal infant and early child home visiting program and the development of pediatric quality measures.  The bill also delays for one year the transition from ICD 9 to ICD 10 under the Medicare program; delays enactment of the Medicaid Third Party Liability provision for two years; and repeals Section 1302(c)(2) of the Patient Protection and Affordable Care Act, thereby eliminating the deductible limitations on small group plans.

H.R. 4302 requires a GAO report on Children’s Hospital GME support program implementation; establishes a skilled nursing facility (SNF) value based purchasing program by October 1, 2019; reforms the current Medicare lab fee schedule by adopting market-based private sector payment rates; makes changes to the Medicare per-dialysis treatment bundled payment rate through 2024; establishes  CT equipment standards for purposes of payment under the Medicare program in order to protect the health and welfare of beneficiaries; uses $2.3 billion in funding set aside by the Bipartisan Budget Act; allows the Secretary of Health and Human Services to use information received from medical providers and other sources to adjust code pricing to address mis-valued codes used under the Medicare Physician Fee Schedule, and addresses GPCI payment locality irregularities; delays reductions in payments to Disproportionate Share Hospitals by one year and then makes additional reductions through 2024; realigns the Medicare sequester in 2024; and authorizes grants to states to implement assisted outpatient treatment programs for individuals with serious mental illness, including an eight state demonstration program to incentivize community mental health providers to offer a broad range of mental health services. 

Background

The sustainable growth rate is a formula that was enacted in 1997 to control physician spending under Medicare.  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 $150 billion in short term patches. On March 31, 2014, the most recent three month patch included in the Bipartisan Budget Act will expire.[1]  As a result, physicians will see an approximately 24 percent cut in reimbursement rates if left unaddressed.  


[1] See http://www.gpo.gov/fdsys/pkg/BILLS-113hjres59enr/pdf/BILLS-113hjres59enr.pdf.

Cost

CBO estimates that enacting H.R. 4302 would decrease direct spending by $1.2 billion over the 2014-2024 window.

Additional Information

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