With the elections over and the lame duck session the only thing left between Congressional staff and their Christmas break, the National Rural Health Association would like to provide you with a brief update before the end of the 111th Congress.
Senate
The Senate, on Friday, passed its temporary fix to the Sustainable Growth Rate formula that would otherwise lead to a 23 percent drop in Medicare physician reimbursement (known as the “Doc-Fix”). The fix would be very temporary, only lasting one month until the end of December, with hopes that Congress can devise a more long-term solution between now and then. The bill will cost the federal government $1 billion, but would reduce therapy service payments to providers who perform multiple services on the same day in order to offset that cost.
House
Before this one-month fix becomes law, though, it needs to pass the House, which plans on taking it up when it returns from Thanksgiving break on November 29th. In order to stop the cuts, the House must then pass the legislation before December 1st.
Lame Duck and Rural Provisions
During the end of the lame duck session in December, the NRHA will be working to attach other legislation to the longer-term SGR fix. Though this may be tough considering Congress’ desire to move the bill quickly to the President’s desk, there are still important issues looming. These include: extending certain expiring Medicare programs (NRHA's list of “rural extenders”), a fix to the 340b orphan drug exclusion for newly eligible entities under health reform, a fix to recent CMS regulations regarding hospitals’ ability to include provider taxes on their cost reports, and other important issues.
So, please contact your members of Congress to ensure these important issues are addressed before the end of the 111th Congress. For more information or questions about the issues above, please feel free to contact Danny Fernandez or anyone at NRHA.
HHS Secretary Announcement Today – Insurance Company Medical Loss Ratios
HHS Secretary Sebelius is set to make a huge announcement today regarding the health insurance industry medical loss ratio (MLR) requirements included in health reform. The MLR formula would require that 85 percent of insurance provider premiums go toward “clinical services and activities related to quality of care,” with 15 percent going to administrative and advertising costs, and profits. (for smaller insurance providers, this ratio is adjusted to 80:20.) The regulations relating to this were released today through the White House Office of Management and Budget.
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