Companion SGR bill unveiled, pays for repeal with steep levies on tax scofflaws

Bill calls for stiffer fines for tax delinquent Medicare service providers, keeping reimbursement for acute care providers to 1 percent and by upping premiums for wealthier Medicare beneficiaries.

Less than a week after bipartisan House leaders introduced a bill to repeal the sustainable growth rate, the committee on Tuesday released more detailed plans on how it will pay for the $200 billion bill.

The “Medicare Access and CHIP Reauthorization Act of 2015” calls for stiffer fines for tax delinquent Medicare service providers, keeping reimbursement for acute care providers to 1 percent and by upping premiums for wealthier Medicare beneficiaries.

The bill also extends funding for the Children’s Health Insurance Program (CHIP) for two years, but does not increase it.

The House is expected to consider the bill this week, days before an April 1 deadline for Congress to act prior to physicians facing a 21 to 25 percent pay cut in Medicare reimbursements.

[Also: Lawmakers pitch SGR replacement]

Under current law, the Department of the Treasury may impose a levy of up to 30 percent against Medicare service providers with tax delinquencies. The bill would permit the Treasury to impose a levy of up to 100 percent on tax delinquent Medicare service providers.

The bill would also increase the percentage wealthy Medicare beneficiaries pay for Medicare Part B and Part D premiums, from 50 to 65 percent. This relates to single individuals having an income between $133,501 and $160,000 and couples with an income between $267,001 and $320,000. Beneficiaries who have incomes at $160,001 and above, or $320,001 for a couple, would pay 80 percent, according to the bill.

Under the American Taxpayer Relief Act of 2012, requiring CMS to recoup $11 billion in Medicare overpayments to hospitals, hospitals are scheduled to receive a one-time 3.2 percentage point payment increase in 2018. To offset that, the new bill mandates that increase to be phased in at 0.5 percentage points per year over six years beginning in fiscal year 2018.

[Also: What's in the SGR bill]

The bill also delays the reduction in Medicaid DSH payments to hospitals serving a disproportionate number of low-income patients, scheduled for 2017, until 2018.

It also delays changes to the two-midnight rule for patient stays until Sept. 30. The two-midnight rule qualifies patients for inpatient status.

The bill also pushed back the “primary care cliff” for Community Health Centers, the National Health Service Corps Fund and Teaching Health Centers. Funding was set to expire in September 2015, but under the new bill it would be extended for two additional years through fiscal year 2017.

“America’s Health Centers stand firmly with House leaders today in support of this proposal, which would protect healthcare for the 23 million people served by health centers,” said Dan Hawkins, senior vice president for public policy and research at the National Association of Community Health Centers in a statement. “This proposal is good for low-income Americans – it makes smart investments in their care and in the workforce necessary to provide that care.”

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According to the House Energy and Commerce, and Ways and Means Committees, the bill also boosts payments for the work component of physician fees in areas where labor cost is lower than the national average. The provision extends the existing 1.0 floor on the “physician work” cost index until January 1, 2018.

It also extends the increased patient hospital payment adjustment for certain low-volume hospitals. CMS traditionally provided an additional payment to hospitals for the higher costs associated with operating a hospital with a low volume of discharges. This provision extends special add-on payments until October 1, 2017.

It extends a therapy cap and the add-on payment for ground ambulance services, including in very remote rural areas until January 1, 2018.

The bill extends special payments to Medicare-dependent hospitals until Oct. 1, 2017. This policy extends a 3 percent add-on to payments made for home health services provided to patients in rural areas through January 1, 2018.

The agreement builds upon last week’s “SGR Repeal and Medicare Provider Payment Modernization Act,” which in addition to repealing the SGR, would set up new conditions for value-based reimbursements for physicians.

“Finally, after a decade of trying, we have a bipartisan bill that will permanently repeal the flawed SGR and move Medicare to a health care system based on quality and efficiency, that is good for seniors and doctors alike,” said Energy and Commerce Committee Ranking Member Frank Pallone, D-New Jersey.

That pay cut has been averted 17 times over the last 20 years. The new bill would permanently replace SGR and end the “doc fixes.”

Twitter: @SusanMorseHFN