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As part of the recent passage of the Payroll Tax Bill (officially, "H.R. 3630 -- Temporary Payroll Tax Cut Continuation Act of 2012" ) many health provisions were readdressed (after being previously addressed and extended by Congress in December).
Most importantly, the new legislation freezes current physician payment rates throughout the remainder of 2012 and (finally) requires the GAO and HHS to work with Congress to devise a long-term solution .
Other important issues resolved or extended by the legislation:
Outpatient Therapy Caps – these are extended through December 31, 2012, with added requirements that reviewing physicians are detailed on the claims, that claims above the cap be rejected if they do not include the proper billing modifier. The spending caps ($1,880 in 2012), in effect since 2006, are extended to include hospital outpatient departments.
HHS is now also required to collect data to assist in reforming the payment system for therapy services. MedPAC is required to recommend improvements to the outpatient therapy benefit to reflect the individual needs of patients.
Physician Pathology Services – extends through June, 21012 the provision that allows Independent labs to bill Medicare directly for surgical pathology services.
Ambulance Add-On Payments – extend through December, 2012, add-on geographic payments that reflect differences in the cost of practice in different geographic areas for physician work, practice expense, and malpractice expense. The new legislation requires reports from the GAO and MedPAC on costs and whether the ambulance fee schedule should be reformed or discontinued.
Higher Wage Payments to Section 508 Hospitals – This Medicare program under which payments are adjusted by a wage index reflecting the cost of labor in the area the hospital serves will end March 31, 2012.
Hospital Outpatient Hold Harmless Payments – eliminates an expansion that was created in the PPACA and extends the outpatient hold harmless payments for eligible rural hospitals and sole community hospitals (SCHs) with fewer than 100 beds through December 31, 2012.
Qualifying Individual (QI) Program – extends the Medicare QI program, which provides federal reimbursement for states to cover Part B premiums for seniors with incomes between 120 and 135 percent of poverty, through December 31, 2012.
Transitional Medical Assistance (TMA) - extends TMA, through December 31, 2012, for low-income families transitioning into employment.
Bad Debt Payments – phases down bad debt reimbursements under Medicare and Medicaid to 65 percent beginning in FY2013 for providers who are currently being reimbursed at 70 percent, while phasing in the reduction to 65 percent over three years for those who are reimbursed at 100 percent of their bad debt.
Clinical Laboratory Payment Rates – reduces payment rates 2% for clinical laboratory services starting in 2013 as a way to partially fund a comprehensive SGR fix.
Medicaid Disproportionate Share Hospital (DSH) Allotments – rebases the DSH allotments for FY2021.
Medicaid “Federal Disaster” Matching Rate – eliminates funding for the “Louisiana Purchase” contained in PPACA beginning in FY 2014.
Prevention and Public Health Fund – reduces funding of the “Prevention and Public Health Fund” created in the PPACA, which provides the Secretary of HHS unlimited authority to spend above and beyond appropriated levels for any activity authorized by the Public Health Service Act.
*Thanks to the HBMA for providing the full legislative report this article is based on.
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