Medicaid: President Bush, on June 30, signed an Iraq war spending bill, H.R. 2642(pdf), that includes a HAP-supported moratorium until April 2009 on Medicaid regulations covering certified public expenditures, intergovernmental transfers, and graduate medical education. The moratorium is expected to save the Pennsylvania Medicaid program more than $270 million during the next year. Congress excluded from the moratorium a proposed Medicaid rule that narrowly would define hospital outpatient services, jeopardizing community-based services such as screening, diagnostic, and dental services for children, as well as lab and ambulance services. HAP and the AHA continue to oppose the Medicaid outpatient rule. The U.S. House, prior to the regulations inclusion in H.R. 2642, voted on stand alone legislation to halt the regulations. Eighteen of the 19 members of the Pennsylvania House delegation voted in favor of HAP’s position.
Medicare: On July 15, 2008, H.R. 6331(pdf), the Medicare Improvements for Patients and Providers Act, became law via a congressional override on a Presidential veto of the legislation. Several HAP-supported provisions were included in the legislation.
H.R. 6331 previously passed the U.S. House on June 24, by a vote of 355-59. Seventeen of the 19 members of the Pennsylvania congressional delegation voted in favor of the legislation. Representative John Peterson did not vote, and Representative Joe Pitts voted against.
After several failed attempts, the U.S. Senate passed H.R. 6331 on July 9 by a vote of 69-40. Both Senators Specter and Casey voted in the affirmative. On July 15, the President vetoed the bill, and during the same day, both the House and Senate acted to override the bill by solidifying a two-thirds majority in support of passage. The entire House and Senate Pennsylvania delegation voted to override the veto.
Key Provisions of H.R. 6331 Supported by HAP
Hospital Outpatient “Hold-Harmless” Extends a hold-harmless provision for payment of outpatient services at 85 percent for rural hospitals with 100 or fewer beds for one year.
Expands this provision to include SCHs with 100 or fewer beds.
Sole Community Hospitals Allow SCHs to choose between base years.
Critical Access Hospitals Allow CAHs to receive 101 percent of reasonable costs for clinical laboratory services.
Section 151: Federally Qualified Health Centers Increase the existing per-visit amount cap on Medicare payments to CHCs.
Hospital Area Wage Index Extends “Section 508” wage index reclassifications for one year through Sept. 30, 2009.
Quality Reporting Requires CMS to contract with a consensus-based entity regarding quality measurement.
Requires the contracted entity to promote the development and use of EHRs.
Payment Update Provides a 0.5 percent update from June 1 through December 31, 2008.
1.1 percent update for 2009.
DME Delay “Round 1” of the DMEPOS competitive bidding program until January 1, 2010.
Delay “Round 2” and subsequent applications of the program for 18 to 24 months.
Pay for this delay with a 9.5 percent nationwide reduction in Medicare payment during 2009 for the categories of services originally selected for “Round 1.”
Indirect Medical Education (IME) Payments Phase out IME payments to Medicare Advantage plans.
Private Fee-For-Service (PFFS) Plans Require PFFS plans to enter into written contracts with providers.
Health Information Technology: The U.S. House Committee on Energy and Commerce has approved a bill that would promote the widespread adoption of health information technology (IT) and the electronic exchange of health information. H.R. 6357 would authorize grants and loans to states, hospitals, and physicians to purchase IT systems; requires the development of interoperability standards by the federal government; and provides patient privacy and security protections. The hospital community has raised concerns about a provision in the bill relating to patient consent that has the potential to negatively impact provider quality improvement projects and medical research endeavors. Committee member Tim Murphy (R-PA) requested confirmation that the intent of the bill would not impede hospitals from quality, safety, and research efforts. Committee Chairman John Dingell (D-MI) signaled that he will work with Murphy to ensure that the intent is clear in the language that directs the Secretary of Health and Human Services in moving forward. The U.S. House Committee on Ways and Means is expected to vote on similar legislation during September.
