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PPACA: Congress Blinks on Medicare Physician Fees

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Members of Congress have agreed to once again postpone implementing a repeatedly postponed Medicare program cost-control measure.

The measure, H.R. 4994, the Medicare and Medicaid Extenders Act,: will extend a “fix” to the Medicare physician payment formula through 2011, officials say.

The Senate approved the “doc fix” Wednesday by a voice vote, and the House approved the today doc fix by a 409-2 vote.

Earlier Congress approved a 1-month fix.

Congress stepped in to prevent a 25% cut in Medicare physician payment rates from taking effect Jan. 1, 2011.

Congress has built the “sustainable growth rate” formula into budgets many times over the years, in an effort to address concerns that the Medicare Part B physician services program is consuming Doc fixa rapidly growing share of the U.S. gross domestic product.

Physicians and patients have objected to the idea of actually implementing the payment formula, and budget analysts at the Congressional Budget Office noted that questions about whether Congress ever will let the payment formula take effect raise doubts about the validity of federal budget forecasts.

Many private health insurers and TRICARE — a health care program for active-duty service members, National Guard and Reserve members, retirees and their families – base their own payment rates on Medicare rates.

Lawmakers paid for the doc fix by changing the rules governing overpayments of the health care affordability tax credit.

“The proposal would change the way people pay back overpayments when they have received more credit than they are eligible for because, for example, they earned more money than expected in a given year,” officials say in a summary of the doc fix measure provisions.

Under current law there is a flat cap of $250 for individuals and $400 for families

on the amount of the health care affordability tax credit people are required to pay back when they received an overpayment. This payback cap is the same for people earning 160% of the federal poverty level and 360% of the federal poverty level.

Under the doc fix proposal for correcting overpayments, the cap on the payback amount would be on a sliding scale based on the income of the recipient of the tax credit.

Senate Majority Leader Harry Reid, D-Nev., joined with Senate Minority Leader Mitch McConnell, R-Ky., in welcoming Senate passage of the doc fix legislation.

“This bipartisan agreement gives peace of mind to seniors and military families in Nevada and across the nation,” Reid said in a statement.

Reid praised Sens. Max Baucus, D-Mont., and Charles Grassley, R-Iowa, the leaders of the Senate Finance Committee, for their work in getting the doc fix measure passed.

“I’m encouraged that we were able to work together in a bipartisan way and protect access to care for America’s 45 million Medicare beneficiaries in a fiscally responsible manner,” McConnell said.

House Speaker Nancy Pelosi, D-Calif., said commends “all colleagues” who supported the legislation.

Health and Human Services Secretary Kathleen Sebelius says she and President Obama are pleased to see the bipartisan effort to pass the doc fix.

“And, I look forward to working with the new Congress on a permanent solution to fix Medicare’s physician payment system once and for all,” Sebelius says.


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