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Ensuring Seniors and Military Families Can Continue Seeing Their Doctors

On December 9th, the House passed the Senate Amendments to H.R. 4994, the Medicare and Medicaid Extenders Act, by a vote of 409-2.  This bill ensures seniors and military families will be able to continue to see their doctors.  This bipartisan legislation blocks the 25 percent cut in Medicare payments to doctors, scheduled for January 1, through 2011.   The Senate passed this legislation on December 8 by unanimous consent.  Passage of the bill by the House sends it to the President's desk for his signature.

The legislation protects the access to doctors for both Medicare beneficiaries and military families.  (The provision also protects military families because payment rates for doctors in TRICARE -- the health care program for active-duty service members, National Guard and Reserve members, military retirees, and their families -- are tied to Medicare rates.)

The legislation provides a year-long solution to provide the certainty doctors need and the stability patients deserve.  This bill means that seniors and military families across the country can now have the peace of mind of knowing they can continue to get the best care possible. 

The legislation also includes extensions of other key expiring health care provisions, including Transitional Medical Assistance, and the Qualifying Individual (QI) program (which allows Medicaid to pay the Medicare Part B premiums for low-income Medicare beneficiaries.)

In addition, it includes several other provisions, including clarifying the enrollment period for veterans who participate in Medicare Part B and TRICARE, ensuring that eligible children's hospitals still have access to discounts for expensive drugs that treat rare disorders, and ensuring that residency positions shared between teaching hospitals under an “affiliation agreement” won't be redistributed to other hospitals.

The bill is fully paid for; indeed, according to CBO, the bill would reduce the deficit by $2.8 billion over the next 10 years.  The bill is paid for by modifying the policy, under the Affordable Care Act, regarding overpayments of tax credits provided in the Exchanges to help individuals afford insurance, beginning in 2014.  This bill's provisions fully PROTECT the tax credits for which people are eligible based on their income.  What the provisions change is the way people pay back overpayments when they have received a larger tax credit than they are eligible for because their income ended up being higher than expected in a given year.

This legislation is supported by several organizations, including the AARP and the American Medical Association. 

Key provisions:

Extensions of Key Health Care Provisions
Extension of Current Medicare Physician Payment Rates/Blocking the Scheduled 25% Cut.  Medicare physician payment rates are scheduled to be reduced by 25 percent on January 1, 2011.  This provision would block that reduction and instead extend current Medicare payment rates through December 31, 2011.

Extension of Transitional Medical Assistance (TMA).  Transitional Medical Assistance (TMA) allows low-income families to maintain their Medicaid coverage as they transition into employment and increase their earnings.  TMA expires December 31, 2010.  This bill extends TMA through December 31, 2011.

Extension of the Qualifying Individual (QI) Program.  This program allows Medicaid to pay the Medicare Part B premiums for low-income Medicare beneficiaries with incomes between 120 percent and 135 percent of poverty.  The QI program expires December 31, 2010.  This bill extends the QI program through December 31, 2011. 

Extension of Exceptions Process for Medicare Therapy Caps.  Current law sets annual per beneficiary payment limits for all outpatient therapy services provided by non-hospital providers.  HHS was required to implement an exceptions process for cases in which the provision of additional therapy services was determined to be medically necessary.  The bill extends the therapy caps exception process through December 31, 2011.

Extension of Several Other Health Care Provisions.  The bill also extends several other provisions, including the Special Diabetes Programs, the Medicare physician fee schedule mental health add-on payment, and the Medicare outpatient hold harmless provision.

Other Provisions

Clarification of the Enrollment Period for Veterans Who Participate in Medicare Part B and TRICARE.  The bill clarifies that disabled veterans making Medicare Part B elections on and after March 23, 2010 are eligible for a 12-month special enrollment period to ensure that they properly enroll in Medicare Part B and retain their TRICARE eligibility.

Inclusion of Orphan Drugs for Children's Hospitals Under the 340B Drug Discount Program.  The bill clarifies that eligible children's hospitals retain access to 340B drug discounts on orphan drugs.

Addition of Clarification for Affiliated Hospitals For Distribution of Residency Positions.  The bill makes a technical correction to clarify that residency positions that are being shared between teaching hospitals under an “affiliation agreement” would not be redistributed to other hospitals.  There are more than 300 hospitals in 36 states with affiliation agreements in place that are currently using these residency slots.

Medicare Payments to Skilled Nursing Facilities.  Under current law, implementation of a refined payment system reimbursing skilled nursing facilities under Medicare is delayed until October 1, 2011.  The bill repeals the delay and allows the payment system to go into effect on October 1, 2010.

Various Other Provisions.  The bill also includes various other miscellaneous provisions, including technical corrections to Medicaid and CHIP.

The Bill's Offset
The bill is paid for by modifying the policy, under the Affordable Care Act, regarding overpayments of tax credits provided in the Exchanges to help individuals afford insurance, beginning in 2014.  The bill's provisions fully PROTECT the tax credits for which people are eligible based on their income.  What the provisions change is the way people pay back overpayments when they have received a larger tax credit than they are eligible for because their income ended up being higher than expected in a given year.

Under current law, there is a flat cap of $250 for individuals and $400 for families on the amount of the tax credit people are required to pay back when they have received an overpayment.  Under current law, this payback cap is the same for people earning 160 percent of the federal poverty level or 360 percent of the federal poverty level.  Under this bill's revisions to these provisions on correcting overpayments, the cap on the payback amount will be on a sliding scale based on the income of the recipient of the tax credit, making the policy fairer to both recipients and all taxpayers.