MEDICARE PROVIDER PROVISIONS
Rural Health Care Improvements
• Equalize payments for rural and small urban hospitals
• Wage index changes: labor-related share for hospitals with a wage index below 1.0 is 68% for FY03-05; current law for hospitals with a wage index above 1.0
• Medicare disproportionate share (DSH) payments: increases the DSH adjustment for rural providers to 10% (phased-in over ten years)
• Temporary relief for non-teaching hospitals
• Extend hold harmless from outpatient PPS for small rural hospitals for one year
• 5% add-on for clinic and ER visits for small rural hospitals
• 2-year reasonable cost payments for diagnostic lab tests in SCHs
• Critical Access Hospital (CAH) improvements
• Equalize payments for physicians in rural areas for 2003-2005
• Incentive payments for physicians in underserved areas
• Extension of 10% rural add-on for home health through 2004
• 10% add-on for frontier hospice
• Ground Ambulance: 5% increase for rural
• Capital infrastructure loan program
Provisions Relating to Medicare Part A
• Full update for sole community hospitals and “market basket" minus -0.25% for all other hospitals
• IME Adjustment: 6.50% in FY03, 6.50% in FY04; 6.0% in FY05
• Puerto Rico: 75%-25% Federal-Puerto Rico blend beginning in FY 03
• Geriatric GME
• Increase to nursing component of RUGs:13% in FY03, 11% in FY04, 9% in FY05
• Require collection of staffing data; require staffing measure in CMS quality initiative
• Allow payment for hospice consultation services
• Permit hospices to contract for services with other hospices for extraordinary, exigent, and other non-routine circumstances
Provisions Relating to Medicare Part B
• Physician payment increase (same as House-passed version)
• Extension of treatment of certain physician pathology services for 2 years
• Competitive bidding for DME: Continue demos for FY 03; begin national phase-in FY 04; only applies to MSAs over 500,000
• ESRD: Increase composite rate 1.2% in 2003-2004
• Air Ambulance: medical necessity criteria for air ambulance services
• Exempt orphan drugs from outpatient pass-through
Provisions Relating to Medicare Parts A and B
• Eliminate 15% reduction for home health services; adjust updates in FY03-05
• Geriatric care assessment demonstration program
Medicare+Choice Provisions
• Increase minimum updates from 2% to 4% in 2003 and 3% in 2004
• Extend cost contracts for 5 years
• Extend the Social HMO Demonstration through 2005
• Extend specialized plans for special needs beneficiaries for 5 years (Evercare)
• Extend 1% entry bonus for M+C for 2 years. Bonus does not apply for private fee-for-service or demonstration plans
• Clarifies Secretary’s authority to disapprove unreasonable cost-sharing
MEDICAID/CHIP PROVISIONS
• Medicaid DSH: Extend inflation updates to 2003, 2004 and 2005 allotments
• Low Medicaid DSH: 3% cap for FY 03-05
• FMAP increase: Temporary increase in Medicaid matching rate for one year; $1 billion increase in Social Services Block Grant
• CHIP Redistribution: Does not fill CHIP dip, allows certain states to use a portion of unspent CHIP money to buy out Medicaid programs
• Section 1115 waiver process improvements
• 340-B for inpatient drug prices
BENEFICIARY PROVISIONS
• HOPD coinsurance buy-down
• Improved coverage of immunosuppressive drugs
• Therapy Caps: 2-year extension of moratorium
• Waiver of Part B late enrollment penalty for certain military retirees
• Cholesterol and Lipid Screening
• Extend funding for Special Diabetes Programs
• Five year extension of QI-1 Program
Source: Ranking Member’s News
