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Cuts To
Rural Medicare Providers Prevented
On
July 9, the Senate overwhelmingly voted to clear a
procedural hurdle on critical legislation to protect
access to health care in rural America by a vote of 69
to 30. H.R. 6331, the Medicare Improvements for Patients
and Providers Act, provides $2 billion in necessary
rural health care dollars and fixes the cuts to Medicare
reimbursement rates to physicians.
The legislation earlier
passed the House 355 to 59. Both votes were sufficient
to override a threatened presidential veto.
In an unexpected turn of
events, Sen. Edward Kennedy (D-MA) joined in this
historic vote. As a long-time champion of vulnerable
populations, his influence was a catalyst for the vote.
The National Rural Health
Association (NRHA) strongly advocates for passage of the
bill which provides critical dollars to rural America
and eliminates the pending 10.6 percent cut in Medicare
payments to physicians through December 2009. The rural
health care provisions total more than $2 billion.
“This is a decisive victory
for the health of America’s rural seniors. H.R. 6331
contains a strong rural package that will both protect
the rural health safety net and the health of the tens
of millions of seniors who call rural home,” said Alan
Morgan, CEO of the NRHA.
Rural provisions in H.R.
6331 include:
-
Improves payments for
sole community and critical access hospitals. The
Medicare Improvements for Patients and Providers Act
(MIPPA) includes provisions that require CMS to use
updated data when setting reimbursement rates for
sole community hospitals. This will mean, in most
cases, an increase in payments to these facilities.
The bill also directly increases payments for
critical access hospitals, particularly for critical
lab services such as blood testing and other
diagnostic services.
-
Extends FLEX grants for
health care in rural communities. The Medicare Rural
Hospital Flexibility Program provides grants that
rural health care providers can use to improve the
quality of care facilities provide, and to
strengthen health care networks. Funds can be used
for services ranging from ambulance transport to the
development of small local hospitals. MIPPA will
extend the FLEX Grant program through 2010, and will
add a new component making mental health services
more accessible to rural veterans and rural
residents.
-
Improves access to
ambulance services. The legislation increases
Medicare payments for ground ambulance services in
rural areas by three percent, and recognizes the
importance of ambulance services to urban seniors
with a two percent increase. The bill also protects
rural air ambulance providers by requiring more
consideration of a physician’s recommendation for
air ambulance services when Medicare seeks
justification for the expense, and by stopping
payment cuts to rural providers that have been
reclassified as urban air ambulance providers.
-
Extends expiring rural
provisions. The Medicare Modernization Act of 2003
created a number of provisions benefiting rural
providers, several or which are expiring this year.
MIPPA extends:
-
Payments for rural
physicians. Prior to 2003, the Medicare
reimbursement formula penalized doctors for
practicing in rural areas by paying them less
for their work, even though they have the same
training as their urban counterparts. MIPPA
extends for 18 months a provision that sets a
“floor,” or minimum payment adjustment, for
payments for physicians’ work.
-
Special treatment of
certain physician pathology services. Many rural
hospitals do not have their own laboratories.
Congress has allowed independent labs to bill
Medicare directly for the physician pathology
services they provide to hospitals, if the
hospital was using such a lab prior to the
issuance of a particular physician payment rule
by the Centers for Medicare and Medicaid
Services in November 1999. MIPPA would extend
this allowance for direct Medicare billing by
independent labs, ensuring that rural hospitals
can continue to work with the labs to provide
health analysis and care.
-
Exceptions process
for therapy caps. Medicare sets caps for total
expenditures on physical, occupational and
speech-language therapies in order to control
costs. Some patients, however, legitimately need
more therapy than is allowed under the cap.
MIPPA extends an exceptions process for the
therapy caps through 2009, ensuring providers
are properly paid when they give seniors the
therapy they need.
-
Improves access to
speech-language pathology services. H.R. 6331 allows
for speech language pathologists in private practice
to bill Medicare directly for their services rather
than through a doctor’s office, making it easier for
speech language pathologists to be paid and to
continue delivering services to seniors in rural
areas where doctors may be scarce.
-
Improves access to
telehealth services. When medical facilities are few
and far between, and fewer providers serve a larger
region, telemedicine can bring far-away resources
close to rural seniors in need. MIPPA will make
telehealth services to seniors available through
Medicare at more types of health facilities,
including hospital-based renal dialysis facilities,
skilled nursing facilities, and community mental
health centers.
-
Retains access to
Medicare Advantage. The vast majority of rural
beneficiaries continue to receive care under the
traditional Medicare Fee-For-Service program. Only 6
percent of rural beneficiaries join Medicare
Advantage, most of who have joined private
fee-for-service (PFFS) plans. While MIPPA requires
that PFFS plans in counties with several plan
choices must create provider networks, PFFS plans in
rural areas without other plan options can continue
to operate as they do today.
-
Helps pharmacists serve
seniors. Requires prescription drug plans and
Medicare Advantage plans to promptly pay pharmacies.
The bill also delays implementation of a new
Medicaid payment system that would prove harmful to
rural pharmacists.
NRHA Update
On the same day President
Bush vetoed H.R. 6331, Congress overwhelmingly overrode
that veto. The House of Representatives voted 383-41 to
override the veto shortly before 5 p.m. A little more
than an hour later, the Senate followed suit with a vote
of 70-26. Both the House and Senate had more votes to
override the veto than were originally cast to send the
bill to the president.
The NRHA strongly supported
passage of H.R. 6331, the Medicare Improvements for
Providers and Patients Act of 2008. The legislation
provides nearly $2 billion critical dollars to rural
America and eliminates the pending 10.6 percent cut in
Medicare payments to physicians through December 2009.
The cuts, required by law, took effect on July 1, and
CMS was scheduled to begin mailing the reduced
reimbursements to providers today. Based on previous
conversations, we expect the administration to work with
providers and Congress to make sure services rendered
since July 1 receive the full payment rate.
“The final passage of the
Medicare package is a significant victory for rural
America. I thank each and every one of our members who
took action to protect rural Medicare patients and
providers,” said Alan Morgan, CEO of the NRHA.
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