S. Amendment to H.R. 4994: Senate Amendment to H.R. 4994—Medicare and Medicaid Extenders Act of 2010

S. Amendment

Senate Amendment to H.R. 4994—Medicare and Medicaid Extenders Act of 2010

Sen. Max Baucus

December 9, 2010 (111th Congress, 2nd Session)

Staff Contact

Floor Situation

The Senate Amendment to H.R. 4994 is expected to be considered on the House floor on Thursday, December 9, 2010, under a suspension of the rules, requiring a two-thirds majority vote to pass.  Senator Baucus introduced the senate amendment to H.R. 4994 on December 7, 2010, and the Senate approved the legislation by unanimous consent on December 8. 

Bill Summary

Doc Fix:  This provision would extend current Medicare provider payment rates through December 31, 2011.  Doctors are scheduled to receive a 25 percent reduction in their reimbursement rates on January 1, 2011. 


Extension of Medicare Modernization Act (MMA) section 508 reclassifications:  The bill would extend hospital geographic reclassifications through fiscal year 2011. Hospitals may apply for and be granted reclassification based on their location.  Reclassifying permits hospitals to get higher Medicare reimbursement payments.  


Extension of Medicare work geographic adjustment floor:  Under current law, the Medicare fee schedule is adjusted geographically for three factors to reflect differences in the cost of resources needed to produce physician services: physician work, practice expense, and medical malpractice insurance.  The provision would extend the existing 1.0 floor on the “physician work” index under the Medicare fee schedule through December 31, 2011. 


Extension of exceptions process for Medicare therapy caps: Current law places annual per beneficiary payment limits for all outpatient therapy services provided by nonhospital providers.  The Secretary was required to implement an exceptions process for cases in which the provision of additional therapy services was determined to be medically necessary.  This provision would extend the outpatient therapy services exceptions process through December 31, 2011. 


Extension of payment for technical component of certain physician pathology services:  The provision would extend the ability of independent laboratories to receive direct payments for the technical component for certain pathology services through December 31, 2011.


Extension of ambulance add-ons:  The provision would extend the increased Medicare rates for ambulance services, including in rural areas, through December 31, 2011. 


Extension of physician fee schedule mental health add-on payment:  The provision would extend the five percent increase in payments for certain Medicare mental health services through December 31, 2011. 


Extension of outpatient hold harmless provision:  This provision extends the outpatient hold harmless provision through December 31, 2011. 


Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas:  This provision would extend cost reimbursement of laboratory services provided by rural hospitals until July 1, 2011. 


Extension of the qualifying individual (QI) program:  This provision would extend the QI program, which allows Medicaid to pay the Medicare part B premiums for low-income Medicare beneficiaries, until December 2011.  Eligible individuals must have incomes between 120 percent and 135 percent of poverty. 


Extension of Transitional Medical Assistance (TMA):   The bill would extend the Transitional Medical Assistance (TMA), which allows low-income families to maintain their Medicaid coverage as they transition into employment and increase their earnings, until December 31, 2011. 


Special Diabetes Programs:  This provision would extend the Special Diabetes Program, which funds research for type I diabetes and supports diabetes treatment and prevention initiatives for American Indians and Alaska Natives, until December 31, 2013.    


Clarification of effective date of part B special enrollment period for disabled TRICARE beneficiaries:  This provision would clarify the effective date of the special enrollment periods (SEP) to ensure that beneficiaries can use it.  Under current law, disabled Medicare beneficiaries who are also eligible for TRICARE are eligible for a 12-month SEP in order to ensure that they properly enroll in Medicare Part B and retain their TRICARE eligibility.


Repeal of delay of RUG–IV:  The provision would repeal the Resource Utilization Groups (RUG IV) delay and allow RUG IV to go into effect on October 1, 2010, which is consistent with the final skilled nursing facilities (SNF) payment regulation for fiscal year 2011.


Clarification for affiliated hospitals for distribution of additional residency positions:  The provision would clarify that residency positions that are being shared between teaching hospitals under an “affiliation agreement” would not be redistributed to other hospitals. 


Continued inclusion of orphan drugs in definition of covered outpatient drugs with respect to children’s hospitals under the drug discount program:  The provision would ensure the continued inclusion of orphan drugs in the definition of covered outpatient drugs with respect to children’s hospitals under the 340B drug discount program.


Medicaid and CHIP technical corrections:  The provision would make technical corrections to Medicaid and CHIP relating to exclusion from participation, income eligibility levels for children, measurement of payment error rates, coverage of children of state employees, and payment for electronic health records. 


Funding for claims reprocessing:  This provision would allocate $200 million for the Centers for Medicare & Medicaid Services (CMS) to reprocess claims back to January 1, 2010 as part of Medicare payment policies.   


Revision to the Medicare Improvement Fund:  This provision would reduce the amount of money in the Medicare Improvement Fund by $275 million, which was created in 2008 to make improvements to the Medicare fee for service program.   


ObamaCare tax credit reconciliation:  This provision would increase the existing limits of $250 and $400 and would replace the across-the-board structure with a scaled structure that starts with lower limits for those with lower incomes.  ObamaCare requires an individual to return part or all of the excess tax credit payment if an individual’s income turns out to be higher than the amount that was used to calculate the advanced premium tax credit.  ObamaCare limits the amount that would be repaid to $250 for individuals and $400 for families for those at or below 400 percent of the Federal Poverty Level. 


CBO estimates that the doc fix and the other provisions will increase spending by $19.2 billion, but it is paid for by reducing spending in certain programs.