Legislation tacked on to the budget bill would extend a host of expiring Medicare and other healthcare programs, such as the Medicare-dependent hospital program, which increases payments to small rural hospitals with significant Medicare populations; the Medicare inpatient payment adjustment for low-volume hospitals; and the so-called ambulance “add-on” payments, which increase the base Medicare reimbursement rates for ground ambulance trips.
While “doc fixes” in previous years have left the nation's physicians relieved but still frustrated, this year's patch comes with signs of hope that a permanent SGR repeal is within reach. That's because the House Ways and Means Committee and Senate Finance Committee last week advanced legislation that would eliminate the SGR and replace it with a payment system that rewards quality over volume. And the short-term SGR patch tucked inside the House-passed budget agreement buys those committees more time to agree on a permanent solution.
As those two panels and members of the House Energy and Commerce Committee hammer out their differences on an SGR repeal bill, their toughest challenge will be how to pay for it, which the CBO now estimates will cost about $116.5 billion over 10 years, far less than its earlier estimates of nearly $300 billion. There is no indication, however, of any agreement on the pay-for, which likely would involve pain for powerful interest groups.
The House-passed budget bill would pay for the three-month SGR patch and extension of Medicare and other healthcare programs—which the CBO estimates would cost about $8.3 billion over 10 years—largely by reshaping the payment system for long-term acute-care hospitals.
As part of those changes, Medicare discharges from LTACs would continue to be paid at full LTAC prospective-payment system rates under two conditions—if a patient has spent at least three days in an acute-care hospital's intensive-care unit before a long-term hospital stay, or if the patient has been on a ventilator for more than 96 hours in the LTAC and had stayed at an acute-care hospital immediately before entering the long-term-care facility.
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