"Doc-Fix" Agreement Reached in Congress

The Senate has released its plan to address the potential 25 percent Medicare physician payment cut via the sustainable growth rate (SGR) formula.  The Doc-Fix, as it is commonly referred to, will be extended for one year until December 31, 2011 under the plan.  Senate Democrats and Republicans have agreed to use a tax provision in the health reform law to offset, or pay for, its cost, so a unanimous consent agreement is expected on the Senate floor rather than a full vote.  The provision they will use, which requires individuals enrolled in the health insurance exchanges to pay back any overpayments in subsidies they receive, will be altered to allow the federal government to recoup more of those overpayments. It was previously believed that the offset would use cuts to the Prevention and Public Health Fund, also created under health reform, but Congress (likely in the face of significant opposition because of the potential funding cut) ultimately opted against that plan and used the tax provision above. The bill, the Medicare and Medicaid Extenders Act of 2010, also includes the list of rural Medicare extenders included in my last email to the group.  They are: -          Extension of MMA section 508 reclassifications. -          Extension of Medicare work geographic adjustment floor -          Extension of exceptions process for Medicare therapy caps -          Extension of payment for technical component of certain physician pathology services -          Extension of ambulance add-ons -          Extension of physician fee schedule mental health bonus payment -          Extension of outpatient hold harmless provision -          Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas Additionally, the legislation would include a technical correction for children's hospitals and their ability to utilize the 340B prescription drug discount program for orphan, or rare disease, drugs.  The orphan drug exclusion, however, still applies to the newly eligible 340B entities, such as critical access hospitals (CAHs).  Orphan drugs are used by many rural providers and patients, and while the fix for children's hospitals represents a positive step, we are still very concerned that without a similar fix for the newly eligible entities, patient access to these important medications will be severely limited or non-existent. Therefore, the NRHA will continue to fight to fix this orphan drug exclusion, and please contact your members of Congress and urge them to do the same. Though many issues on our plate were not included in this legislation, such as a fix for rural health clinics and their electronic health record incentives, reinstating states' ability to deem hospitals as "necessary providers," and a large list of others, we will continue to fight for further issues during this lame duck session and on into upcoming Congress.