H.R. 5712: H.R. 5712 - Veterans’, Seniors’, and Children’s Health Technical Corrections Act of 2010

H.R. 5712

H.R. 5712 - Veterans’, Seniors’, and Children’s Health Technical Corrections Act of 2010

Sponsor
Rep. Sander M. Levin

Date
November 29, 2010 (111th Congress, 2nd Session)

Staff Contact
Communications

Floor Situation

H.R.5712 is expected to be considered on the floor on November 29, 2010, under suspension of the rules, which requires two-thirds majority vote.  Rep. Levin (D-MI) introduced H.R.5712 on July 13, 2010, and it was referred to the Committee on Ways and Means, the Committee on Energy and Commerce, the Committee on the Budget.

Bill Summary

H.R.5712 makes several changes to Veterans’, Medicare, Medicaid, and CHIP.

Extension of Hospital Wage Rate Reclassifications: This provision extends the “Section 508” reclassifications through September 30, 2011.  

Funding for Claims Reprocessing: This provision provides $100 million in taxpayer money for CMS to reprocess claims to physicians, outpatient therapy services, and other providers. 

Graduate Medical Education (GME):  This provision allows CMS to examine the relationship between affiliated hospitals that share an aggregate number of residency slots before redistributing the slots. 

Part B Enrollment for TRICARE Beneficiaries:  This provision clarifies that Medicare Part B’s special enrollment period (SEP) policy became effective on the day H.R. 3590 was enacted (March 23, 2010), so Veterans can enroll in Part B and keep their TRICARE eligibility. 

Repeal Skilled Nursing Facility (SNF) Payment Delay:  This provision repeals a one-year delay of the implementation of the Resource Utilization Group Version Four (RUG-IV), an updated payment system for skilled nursing facilities. 

Inclusion of Orphan Drugs:  This provision clarifies that orphan drugs will continue to be covered at children’s hospitals under the 340B drug discount program.   

Repeal Section 6502 of Public Law 111-114, the Patient Protection and Affordable Care Act

 

Medicaid Eligibility:  Beginning on January 1, 2014, this provision makes children eligible for Medicaid if their family income is below 133 percent of federal poverty level and makes children of state employees eligible.

CHIP Reporting:  This provision does not require the Secretary of Health and Human Services to calculate or publish a national or a State-specific error rate for fiscal year 2009 and 2010. 

Electronic Health Records:  This provision changes the level of Medicaid reimbursement to providers from other sources not in excess of 85 percent of the net average allowable cost.  

Medicare Improvement Fund:  This provision takes $400 million out of the Medicare Improvement Fund. 

 

Background

Extension of Hospital Wage Rate Reclassifications: CMS reimburses hospitals based on a number of factors, including their location.  Hospitals located in areas (usually Metropolitan Statistical Areas), with higher labor costs get a higher wage index when calculating reimbursement rates.  Section 508 requires CMS to establish a process under which hospitals can apply for wage index reclassification, and therefore, if approved, get a higher reimbursement rate.  The deadline for applying will expire on September 30, 2010.

Funding for Claims Reprocessing:  H.R. 3590, the Patient Protection and Affordable Care Act, extended certain Medicare payment policies for calendar year 2010 retroactively, which requires CMS to reprocess Medicare claims back to January 1, 2010. Some of these claims have already been paid at a different rate, but because of the missed deadlines must now be repaid.

Graduate Medical Education (GME):   Residency slots are allocated to hospitals, and under current law, CMS is not able to look at the relationship between affiliated hospitals that share slots and redistributes residency slots if they are not filled.   

Part B Enrollment for TRICARE Beneficiaries:   TRICARE beneficiaries who are eligible for Medicare are required to enroll in Medicare to retain their TRICARE eligibility.  H.R. 3590 created a new 12-month special Medicare Part B enrollment period (SEP) for those seniors who had previously declined Part B coverage during their initial enrollment period (IEP).  This bill clarifies H.R. 3950 to specify that coverage begins at either the first day of the month in which the beneficiary enrolls in Part B or the first month after the IEP.  

Repeal Skilled Nursing Facility (SNF) Payment Delay:   In its final rule for FY2010, CMS established a revised case-mix classification methodology (RUG-IV), a new payment system, to account for facilities caring for medically complex individuals.  Under H.R. 3950, the Secretary of Health and Human Services was prohibited from implementing the new “RUG-IV” payment system prior to October 1, 2011. 

Inclusion of Orphan Drugs:  Orphan drugs are medicines that treat diseases affecting less than 200,000 people.  Under section 340B, certain health care outpatient facilities provide discounted prescription drugs for specific populations. 

Repeal of Section 6502 of Public Law 111-114, the Patient Protection and Affordable Care Act:  Section 6502 would have allowed state agencies to exclude from participation in Medicaid anyone if they own an entity that has delinquent unpaid overpayments.

Medicaid Eligibility:  This clarifies Medicaid enrollment for children at 133 percent of federal poverty level and makes children of state employees eligible.

CHIP Reporting:  Under CHIP, the Secretary of HHS cannot publish any state or national specific error rate until the system in is effect in all states. 

Electronic Health Records:  H.R. 1, the American Recovery and Reinvestment Act, included a provision allowing a reduction in electronic health payments to Medicaid providers if those providers were getting reimbursed from another source.

Medicare Improvement Fund:  The Secretary of Health and Human Services has a fund to make improvements in Medicare Part A and B. 

Cost

This bill will be paid for by using $400 million from the Medicare Improvement Fund.