Document: GOP Payroll Tax Bill - Summary, Text Of Health Care Sections
Dec 11, 2011
On Friday, Dec. 9, House Republicans unveiled a bill, titled the Middle Class Tax Relief and
Job Creation Act, which would extend the payroll-tax cut scheduled to expire at
the end of 2011, extend unemployment insurance and avoid the scheduled cut to
Medicare reimbursement rates for physicians - the "doc fix."
According
to The Hill, the House Rules Committee "scheduled a hearing on
the legislation for Monday to craft procedures for its consideration on the
floor. A vote could then come as early as Tuesday. The 369-page bill ... is
sponsored by Rep. Dave Camp (R-Mich.), chairman of the tax-writing Ways and
Means Committee."
Below is the section of a summary of the bill that deals with
health care policy, as released by Speaker John Boehner's office. It is followed
by the language in the bill itself that deals with health care:
SUMMARY
Includes Two-Year gDoc Fix,h Further
Defunds ObamaCare
The bill provides a two-year gdoc fixh and
savings to offset the cost, including further defunding the Presidentfs health
care law. A two-year gdoc fixh extension is the longest stretch of time in
nearly a decade. Bringing this level of stability to physicians will pave the
way for a permanent solution. Specifically, the bill:
Extends certain
Medicare payment policies, including a two-year gdoc fixh to protect Medicare
physicians from large reimbursement cuts scheduled to take place next year.
Repeals $8 billion in ObamaCare mandatory funding from the unaccountable
gprevention and public health fund,h which the House voted to defund earlier
this year (saves $8 billion).
Forces greater repayment of improper taxpayer-funded subsidies in ObamaCare
to reduce waste, fraud and abuse in the Democratsf health care law (reduces
deficit by $13.4 billion).
Updates certain provider payment methodologies to reduce wasteful spending
(saves $21.5 billion). ...
Spending Cuts – Not Tax Hikes on Job Creators
– to Offset Payroll/UI Extension
The bill includes spending cuts in government programs – not tax increases on
job creators – to fully pay for extending current payroll tax relief and
unemployment insurance benefits. This includes extending the current pay freeze
for federal workers, including Members of Congress, eliminating government
benefits for millionaires & billionaires, targeting fraud and abuse, and
reforming entitlement programs – many ideas for which President Obama has
already expressed support. Specifically, the bill ... Gradually increases
Medicare premiums for high income beneficiaries (saves $31 billion).
THE BILL
Subtitle C—Medicare Extensions; Other Health Provisions
PART
1—MEDICARE EXTENSIONS
SEC. 2201. Physician payment update.
(a) In
general.—Section 1848(d) of the Social Security Act (42 U.S.C. 1395w–4(d)) is
amended by adding at the end the following new paragraph:
g(13) UPDATE
FOR 2012 AND 2013.—
g(A) IN GENERAL.—Subject to paragraphs (7)(B),
(8)(B), (9)(B), (10)(B), (11)(B), and (12)(B), in lieu of the update to the
single conversion factor established in paragraph (1)(C) that would otherwise
apply for 2012 and for 2013, the update to the single conversion factor shall be
1.0 percent for the year.
g(B) NO EFFECT ON COMPUTATION OF CONVERSION
FACTOR FOR 2014 AND SUBSEQUENT YEARS.—The conversion factor under this
subsection shall be computed under paragraph (1)(A) for 2014 and subsequent
years as if subparagraph (A) had never applied.h
(b) Mandated Studies on
Physician Payment Reform.—
(1) STUDY BY SECRETARY ON OPTIONS FOR BUNDLED
OR EPISODE-BASED PAYMENT.—
(A) IN GENERAL.—The Secretary of Health and
Human Services shall conduct a study that examines options for bundled or
episode-based payments, to cover physiciansf services currently paid under the
physician fee schedule under section 1848 of the Social Security Act (42 U.S.C.
1395w–4), for one or more prevalent chronic conditions (such as cancer,
diabetes, and congestive heart failure) or episodes of care for one or more
major procedures (such as medical device implantation). In conducting the study
the Secretary shall consult with medical professional societies and other
relevant stakeholders. The study shall include an examination of related private
payer payment initiatives.
(B) REPORT.—Not later than January 1, 2013,
the Secretary shall submit to the Committees on Ways and Means and Energy and
Commerce of the House of Representatives and the Committee on Finance in the
Senate a report on the study conducted under this paragraph. The Secretary shall
include in the report recommendations on suitable alternative payment options
for services paid under such fee schedule and on associated implementation
requirements (such as timelines, operational issues, and interactions with other
payment reform initiatives).
(2) GAO STUDY OF PRIVATE PAYER
INITIATIVES.—
(A) IN GENERAL.—The Comptroller General of the United
States shall conduct a study that examines initiatives of private entities
offering or administering health insurance coverage, group health plans, or
other private health benefit plans to base or adjust physician payment rates
under such coverage or plans for performance on quality and efficiency as well
as demonstration of care delivery improvement activities (such as adherence to
evidence based guidelines and patient shared decision making programs). In
conducting such study, the Comptroller General shall consult, to the extent
appropriate, with medical professional societies and other relevant
stakeholders.
(B) REPORT.—Not later than January 1, 2013, the
Comptroller General shall submit to the Committees on Ways and Means and Energy
and Commerce of the House of Representatives and the Committee on Finance in the
Senate a report on the study conducted under this paragraph. Such report shall
include an assessment of applicability of the payer initiatives described in
subparagraph (A) to the Medicare program and recommendations on modifications to
existing Medicare performance-based payment initiatives.
(3) MEDPAC
STUDY OF ALIGNING PAYMENT INCENTIVES.—Not later than March 1, 2013, the Medicare
Payment Advisory Commission shall conduct a study, and submit to the Committees
on Ways and Means and Energy and Commerce of the House of Representatives and
the Committee on Finance in the Senate a report, that examines the feasibility
of aligning private payer quality and efficiency programs with those in the
Medicare program. In conducting such study, the Medicare Payment Advisory
Commission shall consult with medical professional societies and other relevant
stakeholders. Such report shall include recommendations on how to achieve such
alignment.
(4) COLLABORATION.—The Secretary, Comptroller General, and
Commission may collaborate to the extent beneficial in conducting their
respective studies and submitting their respective reports under this
subsection.
(c) Study and review of measures to improve physician
payments, health outcomes, and efficiency.—During the 112th Congress, the
Committees on Energy and Commerce and Ways and Means of the House of
Representatives and the Committee on Finance in the Senate shall each study and
review value-based measures and practice arrangements which may improve health
outcomes and efficiency in the Medicare program to the end of replacing the
Medicare sustainable growth rate in a fiscally responsible manner and
establishing a sustainable payment system. In conducting such study and review,
the committees shall solicit comments from stakeholder physician groups,
including State medical associations.
SEC. 2202. Ambulance
add-ons.
(a) Ground ambulance.—Section 1834(l)(13)(A) of the
Social Security Act (42 U.S.C. 1395m(l)(13)(A)), as amended by section 106(a) of
the Medicare and Medicaid Extenders Act of 2010 (Public Law 111–309), is
amended—
(1) in the matter preceding clause (i), by striking g2012h and
inserting g2013h; and
(2) in each of clauses (i) and (ii), by striking
g2012h and inserting g2013h each place it appears.
(b) Super rural
ambulance.—Section 1834(l)(12)(A) of the Social Security Act (42 U.S.C.
1395m(l)(12)(A)), as amended by section 106(c) of the Medicare and Medicaid
Extenders Act of 2010 (Public Law 111–309), is amended in the first sentence by
striking g2012h and inserting g2013h.
(c) GAO report update.—Not later
than October 1, 2012, the Comptroller General of the United States shall update
the GAO report GAO-07-383 (relating to Ambulance Providers: Costs and Expected
Medicare Margins Vary Greatly) to reflect current costs for ambulance providers.
(d) MedPAC report.—The Medicare Payment Advisory Commission shall
conduct a study of—
(1) the appropriateness of the add-on payments for
ambulance providers under paragraphs (12)(A) and (13)(A) of section 1834(l) of
the Social Security Act (42 U.S.C. 1395m(l));
(2) the effect these
additional payments have on the Medicare margins of ambulance providers; and
(3) whether there is a need to reform the Medicare ambulance fee
schedule under such section and, if so, what should such reforms be, including
rolling the add-on payments into the base rate.
Not later than July
1, 2012, the Commission shall submit to the Committees on Ways and Means and
Energy and Commerce of the House of Representatives and the Committee on Finance
of the Senate a report on such study and shall include in the report such
recommendations as the Commission deems appropriate.
(e) Effective
date.—The amendments made by subsections (a) and (b) shall apply to ambulance
services furnished on or after January 1, 2012.
SEC. 2203.
Medicare payment for outpatient therapy services.
(a)
Application of additional requirements.—Section 1833(g)(5) of the Social
Security Act (42 U.S.C. 1395l(g)(5)) is amended—
(1) by inserting g(A)h
after g(5)h;
(2) by striking gDecember 31, 2011h and inserting gDecember
31, 2013h;
(3) in the first sentence, by inserting gand if the
requirement of subparagraph (B) is meth after gmedically necessaryh;
(4)
in the second sentence, by inserting gmade in accordance with such requirementh
after greceipt of the requesth; and
(5) by adding at the end the
following new subparagraphs:
g(B) In the case of outpatient therapy
services for which an exception is requested under the first sentence of
subparagraph (A), the claim for such services contains an appropriate modifier
(such as the KX modifier used as of the date of the enactment of this
subparagraph) indicating that such services are medically necessary as justified
by appropriate documentation in the medical record involved.
g(C)(i) In
applying this paragraph with respect to a request for an exception with respect
to expenses that would be incurred for outpatient therapy services (including
services described in subsection (a)(8)(B)) that would exceed the threshold
described in clause (ii) for a year, the request for such an exception, for
services furnished on or after July 1, 2012, shall be subject to a manual
medical review process that is similar to the manual medical review process used
for certain exceptions under this paragraph in 2006.
g(ii) The threshold
under this clause for a year is $3,700. Such threshold shall be applied
separately—
g(I) for physical therapy services and speech-language
pathology services; and
g(II) for occupational therapy services.h
(b) Application of therapy cap to therapy furnished as part of hospital
outpatient services.—Paragraphs (1) and (3) of section 1833(g) of such Act are
each amended by striking gbut not described in section 1833(a)(8)(B)h and
inserting gbut (with respect to services furnished before July 1, 2012) not
described in subsection (a)(8)(B)h.
(c) Requirement for inclusion on
claims of NPI of physician who reviews therapy plan.—Section 1842(t) of such Act
(42 U.S.C. 1395u(t)) is amended—
(1) by inserting g(1)h after g(t)h; and
(2) by adding at the end the following new paragraph:
g(2) Each
request for payment, or bill submitted, for therapy services described in
paragraph (1) or (3) of section 1833(g) furnished on or after July 1, 2012, for
which payment may be made under this part shall include the national provider
identifier of the physician who periodically reviews the plan for such services
under section 1861(p)(2).h
(d) Implementation.—The Secretary of Health
and Human Services shall implement such claims processing edits and issue such
guidance as may be necessary to implement the amendments made by this section in
a timely manner. Notwithstanding any other provision of law, the Secretary may
implement the amendments made by this section by program instruction. Of the
amount of funds made available to the Secretary for fiscal year 2012 for program
management for the Centers for Medicare & Medicaid Services, not to exceed
$7,500,000 shall be available for such fiscal year to carry out section
1833(g)(5)(C) of the Social Security Act (relating to manual medical review), as
added by subsection (a). Of the amount of funds made available to the Secretary
for fiscal year 2013 for such program management, not to exceed $7,500,000 shall
be available for such fiscal year to carry out such section.
(e)
Effective date.—The amendments made by subsection (a) shall apply to services
furnished on or after January 1, 2012.
(f) MedPAC report on improved
Medicare therapy benefits.—Not later than March 1, 2013, the Medicare Payment
Advisory Commission shall submit to the Committees on Energy and Commerce and
Ways and Means of the House of Representatives and to the Committee on Finance
of the Senate a report making recommendations on how to improve the outpatient
therapy benefit under part B of title XVIII of the Social Security Act. The
report shall include recommendations on how to reform the payment system for
such outpatient therapy services under such part so that the benefit is better
designed to reflect individual acuity, condition, and therapy needs of the
patient. Such report shall include an examination of private sector initiatives
relating to outpatient therapy benefits.
(g) Collection of additional
data.—
(1) STRATEGY.—The Secretary of Health and Human Services shall
implement, beginning on January 1, 2013, a claims-based data collection strategy
that is designed to assist in reforming the Medicare payment system for
outpatient therapy services subject to the limitations of section 1833(g) of the
Social Security Act. Such strategy shall be designed to provide for the
collection of data on patient function during the course of therapy services in
order to better understand patient condition and outcomes.
(2)
CONSULTATION.—In proposing and implementing such strategy, the Secretary shall
consult with relevant stakeholders.
(h) GAO report on manual medical
review process implementation.—Not later than May 1, 2013, the Comptroller
General of the United States shall submit to the Committees on Energy and
Commerce and Ways and Means of the House of Representatives and to the Committee
on Finance of the Senate a report on the implementation of the manual medical
review process referred to in section 1833(g)(5)(C) of the Social Security Act.
Such report shall include aggregate data on the number of individuals and claims
subject to such process, the number of reviews conducted under such process, and
the outcome of such reviews.
SEC. 2204. Work geographic
adjustment.
(a) In general.—Section 1848(e)(1)(E) of the Social
Security Act (42 U.S.C. 1395w–4(e)(1)(E)) is amended by striking gJanuary 1,
2012h and inserting gJanuary 1, 2013h.
(b) Report.—Not later than June
1, 2012, the Medicare Payment Advisory Commission shall submit to the Committees
on Ways and Means and Energy and Commerce of the House of Representatives and
the Committee on Finance of the Senate a report that assesses whether any
geographic adjustment is needed under section 1848 of the Social Security Act
(42 U.S.C. 1395w–4) to distinguish the difference in work effort by geographic
area and, if so, what that level should be and where it should be applied. The
report shall also assess the impact of the work geographic adjustment under such
section, including the extent to which the floor impacts access to care.
PART 2—OTHER HEALTH PROVISIONS
SEC. 2211.
Qualifying individual (QI) program.
(a) Extension.—Section
1902(a)(10)(E)(iv) of the Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is
amended by striking gDecember 2011h and inserting gDecember 2012h.
(b)
Extending total amount available for allocation.—Section 1933(g) of such Act (42
U.S.C. 1396u-3(g)) is amended—
(1) in paragraph (2)—
(A) by
striking gandh at the end of subparagraph (O);
(B) in subparagraph (P),
by striking the period at the end and inserting a semicolon; and
(C) by
adding at the end the following new subparagraphs:
g(Q) for the
period that begins on January 1, 2012, and ends on September 30, 2012, the total
allocation amount is $450,000,000; and
g(R) for the period that begins
on October 1, 2012, and ends on December 31, 2012, the total allocation amount
is $280,000,000.h; and
(2) in paragraph (3), in the matter preceding
subparagraph (A), by striking gor (P)h and inserting g(P), or (R)h.
SEC. 2212. Extension of Transitional Medical Assistance
(TMA).
(a) Extension.—Sections 1902(e)(1)(B) and 1925(f) of the
Social Security Act (42 U.S.C. 1396a(e)(1)(B), 1396r–6(f)) are each amended by
striking gDecember 31, 2011h and inserting gDecember 31, 2012h.
(b)
Extending application of termination of eligibility based on income to initial
extension period.—
(1) INCOME REPORTING REQUIREMENTS.—Subsection
(b)(2)(B)(i) of section 1925 of such Act (42 U.S.C. 1396r–6) is amended—
(A) by striking gadditional extended assistance under this subsectionh
and inserting gcontinued extended assistance under subsection (a)h; and
(B) by inserting g(and, in the case of a State that makes an election
under subsection (a)(5), the 7th month and the 11th month)h after g4th monthh.
(2) TERMINATION.—Subsection (a)(3) of such section is amended—
(A) in subparagraph (B)—
(i) by inserting gor (D)h after
gsubparagraph (A)h; and
(ii) by striking the period at the end and
inserting the following: g, which notice shall include (in the case of
termination under subparagraph (D)(ii), relating to no continued earnings) a
description of how the family may reestablish eligibility for medical assistance
under the State plan. No termination shall be effective under subparagraph (D)
earlier than 10 days after the date of mailing of such notice.h;
(B)
in subparagraph (C)—
(i) by designating the matter beginning with gWith
respect toh as a clause (i) with the heading gDependent children.—h and
appropriate indentation; and
(ii) by adding at the end the following new
clause:
g(ii) MEDICALLY NEEDY.—With respect to an individual who
would cease to receive medical assistance because of subparagraph (D) but who
may be eligible for assistance under the State plan because the individual is
within a category of person for which medical assistance under the State plan is
available under section 1902(a)(10)(C) (relating to medically needy
individuals), the State may not discontinue such assistance under such
subparagraph until the State has determined that the individual is not eligible
for assistance under the plan.h; and
(C) by adding at the end the
following new subparagraph:
g(D) QUARTERLY INCOME REPORTING AND
TEST.—Subject to subparagraphs (B) and (C), extension of assistance during the
6-month period described in paragraph (1) to a family shall terminate (during
the period) at the close of the 4th month of the 6-month period (or 4th, 7th, or
11th month in case of a State that makes an election under paragraph (5)) if—
g(i) the family fails to report to the State, by the 21st day of such
month, the information required under subsection (b)(2)(B)(i), unless the family
has established, to the satisfaction of the State, good cause for the failure to
report on a timely basis;
g(ii) the caretaker relative had no earnings
in one or more of the previous 3 months, unless such lack of any earnings was
due to an involuntary loss of employment, illness, or other good cause,
established to the satisfaction of the State; or
g(iii) the State
determines that the family's average gross monthly earnings (less such costs for
such child care as is necessary for the employment of the caretaker relative)
during the immediately preceding 3-month period exceed 185 percent of the
official poverty line (as defined by the Office of Management and Budget, and
revised annually in accordance with section 673(2) of the Omnibus Budget
Reconciliation Act of 1981) applicable to a family of the size involved.
Information described in clause (i) shall be subject to the restrictions
on use and disclosure of information provided under section 402(a)(9). Instead
of terminating a family's extension under clause (i), a State, at its option,
may provide for suspension of the extension until the month after the month in
which the family reports information required under subsection (b)(2)(B)(i), but
only if the family's extension has not otherwise been terminated under clause
(ii) or (iii). The State shall make determinations under clause (iii) for a
family each time a report under subsection (b)(2)(B)(i) for the family is
received.h.
(3) EFFECTIVE DATE.—
(A) IN GENERAL.—The amendments
made by this subsection shall, subject to subparagraph (B), apply to assistance
furnished for months beginning with January 2012.
(B) TRANSITION FOR
CURRENT BENEFICIARIES.—
(i) IN GENERAL.—Subject to clause (ii), such
amendments shall not apply to any individual who is receiving extended
assistance under subsection (a) of section 1925 of the Social Security Act for
December 2011 during the period of assistance that includes such month.
(ii) SPECIAL RULE FOR INDIVIDUALS ELIGIBLE FOR 12 MONTHS EXTENDED
ASSISTANCE.—In the case of a State that makes an election under paragraph (5) of
such section, such amendments shall apply to an individual who is receiving such
extended assistance for such month if such month is within the first 6 months of
the 12-month period referred to in such paragraph but only with respect to the
second 6 months of such 12-month period.
SEC. 2213. Modification
to requirements for qualifying for exception to Medicare prohibition on certain
physician referrals for hospitals.
(a) In general.—Section
1877(i) of the Social Security Act (42 U.S.C. 1395nn(i)) is amended—
(1)
in paragraph (1)(A)—
(A) in the matter preceding clause (i), by striking
ghadh;
(B) in clause (i), by inserting ghadh before gphysician
ownershiph; and
(C) by amending clause (ii) to read as follows:
g(ii) either—
g(I) had a provider agreement under section 1866
in effect on such date; or
g(II) was under construction on such date.h;
and
(2) in paragraph (3)—
(A) by amending subparagraph (E) to
read as follows:
g(E) APPLICABLE HOSPITAL.—In this paragraph, the term
eapplicable hospitalf means a hospital that does not discriminate against
beneficiaries of Federal health care programs and does not permit physicians
practicing at the hospital to discriminate against such beneficiaries.h; and
(B) in subparagraph (F)(iii), by striking gsubparagraph (E)(iii)h and
inserting gsubparagraph (E)h.
(b) Effective date.—The amendments made by
subsection (a) shall be effective as if as if included in the enactment of
subsection (i) of section 1877 of the Social Security Act (42 U.S.C. 1395nn).
PART 3—OFFSETS
SEC. 2221.
Adjustments to maximum thresholds for recapturing overpayments resulting from
certain Federally-subsidized health insurance.
The table
specified in clause (i) of section 36B(f)(2)(B) of the Internal Revenue Code of
1986 is amended to read as follows:
gIf the household income (expressed
as a percent of poverty line) is: Less than 100 percent
The applicable
dollar amount is: $600
At least 100 percent and less than 150 percent
/ $800
At least 150 percent but less than 200 percent / $1,000
At
least 200 percent but less than 250 percent / $1,500
At least 250 percent
but less than 300 percent / $2,200
At least 300 percent but less than 350
percent / $2,500
At least 350 percent but less than 400 percent / $3,200.h
SEC. 2222. Prevention and Public Health Fund.
Section 4002(b) of the Patient Protection and Affordable Care
Act (42 U.S.C. 300u–11(b)) is amended—
(1) in paragraph (3), by adding
at the end gandh; and
(2) by striking each of paragraphs (4) through (6)
and inserting the following:
g(4) for fiscal year 2013 and each
subsequent fiscal year, $640,000,000.h
SEC. 2223. Parity in
Medicare payments for hospital outpatient department evaluation and management
office visit services.
Section 1833(t) of the Social Security
Act (42 U.S.C. 1395l(t)) is amended—
(1) in paragraph (3)—
(A)
in subparagraph (D), by striking gThe Secretaryh and inserting gSubject to
subparagraph (H), the Secretaryh; and
(B) by adding at the end the
following new subparagraph:
g(H) PARITY IN FEE SCHEDULE AMOUNT FOR
SPECIFIED EVALUATION AND MANAGEMENT SERVICES.—
g(i) IN GENERAL.—In the
case of covered OPD services that are specified evaluation and management
services furnished during 2012 or a subsequent year, there shall be substituted
for the medicare OPD fee schedule amount established under subparagraph (D) for
such services and year, before application of any geographic or other
adjustment, an amount equal to the product of the conversion factor established
under section 1848(d) for such year and the amount by which—
g(I) the
non-facility practice expense relative value units under the fee schedule under
section 1848 for such year for physiciansf services that are such specified
evaluation and management services; exceeds
g(II) the facility practice
expense relative value unit under such fee schedule for such year and services.
g(ii) BUDGET NEUTRALITY.—In determining the adjustments under
paragraph (9)(B) for 2012 or a subsequent year, the Secretary shall not take
into account under such paragraph or paragraph (2)(E) any changes in
expenditures that result from the application of this subparagraph.
g(iii) SPECIFIED EVALUATION AND MANAGEMENT SERVICES DEFINED.—For the
purposes of this subparagraph, the term especified evaluation and management
servicesf means the HCPCS codes in the range 99201 through 99215 as of January
1, 2011 (and such codes as subsequently modified by the Secretary).h; and
(2) in paragraph (9)(B), by striking gIf the Secretaryh and inserting
gSubject to paragraph (3)(H)(ii), if the Secretaryh.
SEC.
2224. Reduction of bad debt treated as an allowable cost.
(a)
Hospitals.—Section 1861(v)(1)(T) of the Social Security Act (42 U.S.C.
1395x(v)(1)(T)) is amended—
(1) in clause (iii), by striking gandh at
the end;
(2) in clause (iv)—
(A) by striking ga subsequent
fiscal yearh and inserting gfiscal years 2001 through 2012h; and
(B) by
striking the period at the end and inserting g, andh; and
(3) by adding
at the end the following:
g(v) for cost reporting periods beginning
during fiscal year 2013, by 35 percent of such amount otherwise allowable,
g(vi) for cost reporting periods beginning during fiscal year 2014, by
40 percent of such amount otherwise allowable, and
g(vii) for cost
reporting periods beginning during a subsequent fiscal year, by 45 percent of
such amount otherwise allowable.h
(b) Skilled nursing
facilities.—Section 1861(v)(1)(V) of such Act (42 U.S.C. 1395x(v)(1)(V)) is
amended—
(1) in the matter preceding clause (i), by striking gwith
respect to cost reporting periods beginning on or after October 1, 2005h and
inserting gand (beginning with respect to cost reporting periods beginning
during fiscal year 2013) for covered skilled nursing services described in
section 1888(e)(2)(A) furnished by hospital providers of extended care services
(as described in section 1883)h;
(2) in clause (i), by striking greduced
byh and all that follows through gallowable; andh and inserting the following:
greduced by—
g(I) for cost reporting periods beginning on or after
October 1, 2005, but before fiscal year 2013, 30 percent of such amount
otherwise allowable;
g(II) for cost reporting periods beginning during
fiscal year 2013, by 35 percent of such amount otherwise allowable;
g(III) for cost reporting periods beginning during fiscal year 2014, by
40 percent of such amount otherwise allowable; and
g(IV) for cost
reporting periods beginning during a subsequent fiscal year, by 45 percent of
such amount otherwise allowable; andh; and
(3) in clause (ii), by
striking gsuch section shall not be reduced.h and inserting gsuch section—
g(I) for cost reporting periods beginning on or after October 1, 2005,
but before fiscal year 2013, shall not be reduced;
g(II) for cost
reporting periods beginning during fiscal year 2013, shall be reduced by 15
percent of such amount otherwise allowable;
g(III) for cost reporting
periods beginning during fiscal year 2014, shall be reduced by 30 percent of
such amount otherwise allowable; and
g(IV) for cost reporting periods
beginning during a subsequent fiscal year, shall be reduced by 45 percent of
such amount otherwise allowable.h
(c) Certain other providers.—Section
1861(v)(1) of such Act (42 U.S.C. 1395x(v)(1)) is amended by adding at the end
the following new subparagraph:
g(W)(i) In determining such reasonable
costs for providers described in clause (ii), the amount of bad debts otherwise
treated as allowable costs which are attributable to deductibles and coinsurance
amounts under this title shall be reduced—
g(I) for cost reporting
periods beginning during fiscal year 2013, by 15 percent of such amount
otherwise allowable;
g(II) for cost reporting periods beginning during
fiscal year 2014, by 30 percent of such amount otherwise allowable; and
g(III) for cost reporting periods beginning during a subsequent fiscal
year, by 45 percent of such amount otherwise allowable.
g(ii) A provider
described in this clause is a provider of services not described in subparagraph
(T) or (V), a supplier, or any other type of entity that receives payment for
bad debts under the authority under subparagraph (A).h
(d) Conforming
amendment for hospital services.—Section 4008(c) of the Omnibus Budget
Reconciliation Act of 1987, as amended by section 8402 of the Technical and
Miscellaneous Revenue Act of 1988 and section 6023 of the Omnibus Budget
Reconciliation Act of 1989, is amended by adding at the end the following new
sentence: gEffective for cost reporting periods beginning on or after October 1,
2012, the provisions of the previous two sentences shall not apply.h
SEC. 2225. Rebasing of State DSH allotments for fiscal year 2021.
Section 1923(f) of the Social Security Act (42 U.S.C.
1396r-4(f)) is amended—
(1) by redesignating paragraph (8) as paragraph
(9);
(2) in paragraph (3)(A) by striking gparagraphs (6) and (7)h and
inserting gparagraphs (6), (7), and (8)h; and
(3) by inserting after
paragraph (7) the following new paragraph:
g(8) REBASING OF STATE DSH
ALLOTMENTS FOR FISCAL YEAR 2021.—With respect to fiscal 2021 and each subsequent
fiscal year, for purposes of applying paragraph (3)(A) to determine the DSH
allotment for a State, the amount of the DSH allotment for the State under
paragraph (3) for fiscal year 2020 shall be treated as if it were such amount as
reduced under paragraph (7).h.
Subtitle F—Health Care Provisions
SEC. 5501.
Increase in applicable percentage used to calculate Medicare part B and part D
premiums for high-income beneficiaries.
(a) In general.—Section
1839(i)(3)(C)(i) of the Social Security Act (42 U.S.C. 1395r(i)(3)(C)(i)) is
amended—
(1) by striking gIn general.—h and inserting gIn general.—(I)
For calendar years prior to 2017:h; and
(2) by adding at the end the
following new subclause:
g(II) For calendar year 2017 and each
subsequent calendar year:
gIf the modified adjusted gross is: More than
$80,000 but not more than $100,000
The applicable percentage is: 40.25
percent
More than $100,000 but not more than $150,000 / 57.5 percent
More than $150,000 but not more than $200,000 / 74.75 percent
More than
$200,000 / 90 percent.h
(b) Conforming amendment.—Section
1839(i)(3)(A)(i) of the Social Security Act (42 U.S.C. 1395r(i)(3)(A)(i)) is
amended, by inserting gand yearh after gindividualh.
SEC.
5502. Temporary adjustment to the calculation of Medicare part B and part D
premiums.
(a) In general.—Section 1839(i)(6) of the Social
Security Act (42 U.S.C. 1395r(i)(6)) is amended in the matter preceding
subparagraph (A) by striking gDecember 31, 2019h and inserting gDecember 31 of
the first year after the year in which at least 25 percent of individuals
enrolled under this part are subject to a reduction under this subsection to the
monthly amount of the premium subsidy applicable to the premium under this
section.h
(b) Application of inflation adjustment.—Section 1839(i)(5) of
the Social Security Act (42 U.S.C. 1395r(i)(5)) is amended—
(1) in
subparagraph (A), by striking gIn the caseh and inserting gSubject to
subparagraph (C), in the caseh; and
(2) by adding at the end the
following new subparagraph:
g(C) TREATMENT OF YEARS AFTER TEMPORARY
ADJUSTMENT PERIOD.—In applying subparagraph (A) for the first year beginning
after the period described in paragraph (6) and for each subsequent year, the
12-month period ending with August 2006 described in clause (ii) of such
subparagraph shall be deemed to be the 12-month period ending with August of the
last year of such period described in paragraph (6).h.
© 2011 Henry J. Kaiser Family Foundation.