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NACo > Legislation & Policy > Washington Watch > Posts > ​Congress on Track to Enact Medicare Physician Reimbursement “Doc Fix”
December 13
​Congress on Track to Enact Medicare Physician Reimbursement “Doc Fix”

On December 12, Congress acted to prevent cuts to Medicare physician reimbursements that were scheduled to take place on January 1, 2014 under the Medicare Sustainable Growth Rate Act (SGR). The extension, which will delay for three months a scheduled 24 percent cut in reimbursements, was included in the budget agreement.

The extension may provide lawmakers in both chambers enough time to pass pending legislation that would permanently repeal SGR: the House Ways and Means Committee has approved the Medicare Patient Access and Quality Improvement Act (H.R. 2810), while the Senate Finance Committee has passed the SGR Repeal and Medicare Beneficiary Improvement Act (bill number unavailable.)  Further movement on each measure will likely occur in the new year.

While the SGR repeal legislation only affects Medicare, which is not a county program, in the past, Congress has paid for the temporary fix by extending cuts in Medicaid Disproportionate Share Hospitals (DSH) payments program. The extension included in the budget deal includes DSH changes: it would eliminate the DSH cuts scheduled for FY2014 and FY2015, but it doubles the FY2016 cut from $600 million to $1.2 billion, and would extend DSH cuts to 2023.

Additionally, the Senate Finance Committee bill has three provisions of interest to counties:

  • The Committee adopted an amendment by Senator Debbie Stabenow (D-Mich.) that establishes a five-year 10-state demonstration program for community mental health clinics, which will allow the clinics to receive Medicaid reimbursement for a variety of services.
  • The underlying bill includes an extension of Transitional Medicaid Assistance (TMA) until December 31, 2018. TMA provides medical assistance to families who lose eligibility as a result of increase income, work and child support or spousal support collections. TMA expires at the end of the year.
  • ​​The underlying bill also includes $85 million a year for the Health Professions Opportunity Grants demonstration project through FY2015. The program, which expires at the end of FY2014, provides grants to help low-income individuals receive education and training in health care jobs. Local workforce investment boards are eligible for the grants.

During the mark-up, Senator Rob Portman (R-Ohio) offered an amendment to include mental health providers under the HITECH Act. Sen. Stabenow joined Sen. Portman in co-sponsoring the amendment. The amendment was subsequently withdrawn, as were many of the amendments offered, but there is hope that an agreement will be worked out when the bill goes to the Senate floor next year. 

Contact: Paul Beddoe at pbeddoe@naco.org or 202.942.4234

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