Highlights of H.R. 6331: Medicare Improvements for Patients and Providers Act of 2008

July 14, 2008

• Provides 18-month Medicare physician payment fix, stopping the 10.6% Medicare physician payment cut on July 1, 2008, and the 5.4% cut on Jan. 1, 2009, extending the June 2008 rates through Dec. 31, 2008, and providing an additional 1.1% update for 2009.
• According to CBO cost estimates, a 1% update for 2009 funded in a way that produces no budgetary effects after 2009 would lead to a 21% cut in January 2010. Establishes a Medicare Improvement Fund and deposits $19.9 billion for use in 2014-17.
• Requires that budget neutrality adjustments for 2007 and 2008 relative value changes be applied to the conversion factor, instead of work relative values, effective in 2009.
• Extends work GPCI floor through 2009 and provides a 1.5 work GPCI for Alaska starting in 2009.
• Extends PQRI reporting for 2 years and provides a 2% bonus payment for reporting.
• Adds new funding and expanded authority for the Medical Home Demonstration Project.
• Provides a 5% pay increase for certain mental health services from July 1, 2008, through Dec. 1, 2009.
• Provides teaching anesthesiologists 100% payment for two concurrent cases starting in 2010.
• Extends the exceptions process for therapy caps through December 31, 2009.
• Allows independent laboratories to bill for pathology services furnished to hospital patients through 2009.
• Permanently extends the accommodation for physicians ordered to active duty in the armed services so that they can engage in substitute billing arrangements for more than 60 days.
• Delays Medicare durable medical equipment (DMEPOS) competitive bidding program for 18 months (offset with reduced DMEPOS payments).  Allows HHS to permanently exempt physician suppliers of DMEPOS from DME accreditation.
• Increases asset limits for beneficiaries to qualify for Part D low-income subsidy.
• Expands coverage of Medicare preventive services, including the “Welcome to Medicare” visit.
• Provides Medicare coverage of cardiac and pulmonary rehabilitation services.
• Phases in a reduction in copays for mental health to the same level as other outpatient services (20%).
• Allows Part D coverage of benzodiazepines and barbiturates.
• Provides the same standard for off-label drug coverage under Part D as under Part B.
• Phases out double payment to Medical Advantage plans for indirect medical education. 
• Establishes prohibited federal marketing practices and confers states with authority to regulate Medicare Advantage and Part D marketing abuses.  Prohibitions include no marketing activities in physician offices.  
• Eliminates the ability of MA private fee-for-service (PFFS) plans to “deem” physicians where there are two or more Medical Advantage HMO or PPO plans in an area, beginning in 2011.
• Provides a 2% bonus in 2009 and 2010 for e-prescribing by eligible physicians, reduced to 1% in 2011 and 2012 and 0.5% in 2013. If eligible physicians do not e-prescribe, imposes penalties of  -1% in 2012, -1.5% in 2013, and -2% in 2014 and beyond.  Provides hardship exceptions.
• Requires physicians and other suppliers that furnish advanced diagnostic imaging services (MRI, CT, and nuclear medicine/PET) to meet Medicare accreditation standards by January 1, 2012.
• Extends the Federal Payment Levy program to Medicare providers.  This is an IRS program to collect revenues from federal contractors who fail to pay their taxes.

Source: American Medical Association

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