Fee Schedule Update [06-04-10]

Filed under: Industry Updates — Editor @ 10:50 am

House Passes Limited Extension of Physician Fee Schedule But Senate Recesses Before Acting on House Bill.  In order to avoid disruptions in service and payment, CMS, once again, has advised contractors to hold claims for Medicare reimbursement for 10 business days—until June 14th when they will have to start to process claims from June 1st.

Late last week, House Democratic leaders unveiled a third version (within a week) of an extenders/”doc fix” proposal. The changes were made after strident Blue Dog opposition imperiled the bill’s chances in the House. The modified bill (H.R. 4213) reduced the legislation’s overall cost and impact on the deficit by approximately $31 billion. To get to this point, two major provisions were dropped from the bill: (1) an extension of federal health insurance subsidies for laid-off workers ($6.8 billion/10 years) and (2) the extension of the enhanced Medicaid FMAP match for six months ($24.1 billion/10 years). These and other adjustments brought the estimated cost of the bill to $113 billion.

The “doc fix” was pared back by providing for a 2.2 percent increase in the fee schedule for the remainder of 2010 and a 1 percent increase for 2011. After that, the rates would be calculated under the sustainable growth rate pursuant to current law. Use of the existing SGR in 2012 would yield approximately a 33 percent reduction in fee schedule payments. The cost of the newest iteration of this provision is about $22.9 billion.

The House considered the bill last Friday morning and took two separate votes as follows:

  • One vote was on the extension of unemployment (UI) benefits through November and tax extenders. This includes other provisions targeting jobs (summer jobs, Build America Bonds, SBA loans, and tax credits for families). This vote also covered the foreign tax revenue raisers and other revenue offsets. The House voted 215-204 to agree to these provisions of the bill.
  • The second vote was on the “doc fix” fix. The House agreed to the physician pay provisions by a 245-171 vote.

The Senate recessed for the Memorial Day recess without taking up the bill. Majority Leader Reid has said that the Senate will consider it right after it returns from recess on June 7th. During the recess, labor unions, Medicaid groups, and states are lobbying Senators in the states to restore the two provisions cut by the House to respond to the Blue Dogs. In addition, these groups will be running grassroots in Blue Dog districts criticizing them for putting the deficit over jobs.

The Senate will have to move relatively quickly because most of the critical provisions needed to be addressed prior to June 1. If the Senate changes any provision in the bill, it will have to be taken up by the House again.

From The National Association of Rehabilitation Providers & Agencies.  Marden Supports NARA.

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