View Full Version : U.S. Issues Health Card Bill. What is contains, what is in the bill inside this thread.
09-16-2009, 10:43 AM
Actual Bill and what it proposes
For Immediate Release Contact: Scott Mulhauser
September 16, 2009 Erin Shields
BAUCUS INTRODUCES LANDMARK PLAN TO LOWER HEALTH CARE COSTS,
PROVIDE QUALITY, AFFORDABLE COVERAGE
Congressional Budget Office estimates the fully paid
will increase quality health coverage and reduce federal deficit within ten years
Senate Finance Committee Chairman Max Baucus (D‐Mont.) today
introduced the America’s Healthy Future Act, landmark health care reform legislation to
lower costs and provide quality, affordable health care coverage. The Chairman’s Mark
will make it easier for families and small businesses to buy health care coverage, ensure
Americans can choose to keep the health care coverage they have if they like it and slow
the growth of health care costs over time. It will bar insurance companies from
discriminating against people based on health status, denying coverage because of preexisting
conditions, or imposing annual caps or lifetime limits on coverage. The bill
would improve the way the health care system delivers care by improving efficiency,
quality, and coordination. The $856 billion dollar package will not add to the federal
deficit. The Finance Committee will meet to begin voting on the Chairman’s Mark next
“The cost of America’s broken health care system has stretched families, businesses
and the economy too far for too long. For too many, quality, affordable health care is
simply out of reach,”
said Baucus. “This is a unique moment in history where we can
finally reach an objective so many of us have sought for so long. The Finance
Committee has carefully worked through the details of health care reform to ensure
this package works for patients, for health care providers and for our economy. We
worked to build a balanced, common
‐sense package that ensures quality, affordable
coverage and doesn’t add a dime to the deficit. Now we can finally pass legislation
that will rein in health care costs and deliver quality, affordable care to the American
Provisions included in the legislation to ensure
Americans have quality, affordable,
Create health care affordability tax credits to help low and middle income
families purchase insurance in the private market;
Provide tax credits for small businesses to help them offer insurance to their
Allow people who like the coverage they have today the choice to keep it;
Reform the insurance market to end discrimination based on pre‐existing
conditions and health status ;
Eliminate yearly and lifetime limits on the amount of coverage plans provide;
Create web‐based insurance exchanges that would standardize health plan
premiums and coverage information to make purchasing insurance easier;
Give consumers the choice of non‐profit, consumer owned and oriented plans
Standardize Medicaid coverage for everyone under 133 percent of the federal
Provisions included in the legislation to improve the
quality of care, increase efficiency
within the health care system, and
lower health care costs would:
Shift incentives in Medicare to reward better care, not just more care;
Increase the number of primary care doctors in the system;
Aggressively fight fraud, waste, and abuse in Medicare;
Encourage all of a patient’s doctors to coordinate care and reduce duplication
Create incentives for health care providers to improve quality by using safer,
more cost effective health technology like electronic medical records; and
Increase health care research so doctors know what care works best for which
Provisions included in the legislation to promote
preventive health care and wellness
Provide annual “wellness visits” for Medicare participants and their doctors to
focus on prevention;
Eliminate out‐of‐pocket costs for screening and prevention services in Medicare;
Create incentives in Medicare and Medicaid for completing healthy lifestyle
Increase federal Medicaid funding for states that cover recommended
preventive services and immunizations for enrollees at no extra cost; and
Provide free tobacco cessation services for pregnant women in Medicaid.
The Congressional Budget Office estimates the Chairman’s Mark would make an $856
billion investment in the health care system over ten years. That investment would be
fully paid for mostly through increased focus on quality, efficiency, prevention and
adjustments in federal health program payments, without adding to the federal deficit.
A summary of the Chairman’s Mark follows below. The full text of the America’s
Healthy Future Act is available at:
“The America’s Healthy Future Act”
Providing Quality Coverage to All Americans
Americans who like their health insurance and want to keep it can do so. For the
millions of Americans who don’t have or can’t afford employer
‐provided coverage, or
who are being denied coverage due to a pre
‐existing condition, the Chairman’s Mark
reforms the individual and small
‐group markets, making coverage affordable and
Individual Market Reforms –
The Mark would require insurance companies to issue
coverage to all individuals regardless of health status; insurers would no longer be
allowed to limit coverage based on pre
‐existing conditions. Limited variation in
premium rates would be permitted for tobacco use, age, and family composition.
Variation in rating would be allowed between geographic areas, but would not differ
within a geographic area.
Small Group Market Reforms –
Rating rules for the individual market would also apply to
the small group market, as defined by states. This would include groups of one to 50
employees, but could include companies with up to 100 employees, depending on
current state law.
Health Insurance Exchanges –
The Mark would make purchasing health insurance
coverage easier and more understandable by using the Internet to present consumers
with available plans. The Mark would create state
‐based web portals, or “exchanges”
that would direct consumers purchasing plans on the individual market to every health
coverage option available in their zip code. The exchanges would offer standardized
health insurance enrollment applications, a standard format companies would use to
present their insurance plans, and standardized marketing materials. The
exchanges would have a call center for customer support. The exchanges would also
enable users to determine whether they are eligible for health care affordability tax
credits or public programs and would enable consumers without access to the Internet
to enroll through the mail or in person in a variety of locations.
Small Group Purchasing Through SHOP Exchanges
Under the Chairman’s Mark, small
businesses would have access to state
‐based Small Business Health Options Program
(SHOP) exchanges. These exchanges – like the individual market exchanges – would be
web portals that make comparing and purchasing health care coverage easier for small
Transitioning to a Reformed Insurance Market –
Once the insurance market reforms
take effect, people who want to keep the insurance they have today can do so. Plans
would be allowed to continue to offer the coverage they offer today and this coverage
would be grandfathered. These grandfathered plans would only be available to those
people who are enrolled today or, in the case of a small employer, to new employees
and their dependents. People who qualify for the health care affordability tax credits in
the reformed market would not be able to use the credits to purchase grandfathered
plans. Tax credits would be offered only to purchase plans created in the reformed
market that meet the new benefit standards.
Transitioning for Rating Requirements
Federal rating rules for the individual market
(other than for grandfathered plans) would take effect by January 1, 2013. Federal
rating rules for the small group market would be phased in over a period of up to five
years, as determined by each state, with approval from the Secretary of HHS.
The Chairman’s Mark would standardize Medicaid eligibility for all parents,
children, pregnant women and childless adults at or below 133 percent of the Federal
Poverty Level (FPL), or $30,000 a year for a family of four ($14,400 for an individual),
beginning in 2014. Individuals between 100 percent of FPL and 133 percent of FPL
would be given the choice of enrolling in either Medicaid or in a private health insurance
plan offered through a health insurance exchange. The federal government would
provide additional funding to states for services for newly eligible Medicaid
beneficiaries. The Chairman’s Mark would also guarantee prescription drug benefits to
all Medicaid beneficiaries.
Prescription Drug Benefits –
Medicare beneficiaries who enroll in the Medicare Part D
prescription drug program will receive significant help purchasing prescription drugs
when they hit the coverage gap portion, or “donut hole” of the benefit. Instead of
paying 100 percent of their drug costs in the gap, Part D beneficiaries with low to
moderate incomes will receive a 50 percent discount on the price of brand
covered by their plan. The discount makes expensive medicines more affordable and
helps beneficiaries stay on treatments that their doctors prescribe.
Children’s Health Insurance Program –
The Chairman’s Mark would not make changes to
the Children’s Health Insurance Program (CHIP) until after September 30, 2013, when
the current reauthorization period ends. Then, states would be required to provide
children between Medicaid eligibility levels and at least 250 percent of FPL with
wraparound coverage to supplement the core benefit package available through the
exchange. These additional services would be the early and periodic screening,
diagnosis and treatment (EPSDT) services available to children in Medicaid. Current
‐sharing protections would continue to apply. CHIP benefits under this new
form of delivery would be equally as or more generous than the current structure.
09-16-2009, 10:45 AM
Addressing Health Care Disparities – The Chairman’s Mark would require federal health
programs to collect uniform data on race, ethnicity, gender and disability to help
program administrators and researchers work to end disparities among these groups.
Promoting Maternal and Child Health – The Chairman’s Mark would provide funding to
states, tribes and territories to develop and implement one or more evidence-based
Maternal, Infant and Early Childhood Home Visitation programs. Program options
would provide training and consultation aimed at reducing infant and maternal
mortality and its related causes by producing improvements in prenatal, maternal and
newborn health, child health and development, parenting skills, school readiness,
juvenile delinquency and family economic self-sufficiency.
Making Coverage Affordable
The cost of health insurance has increased five times faster than wages over the last
eight years. Estimates show that just seven years from now, most Americans will spend
nearly half their income on health insurance. American businesses pay nearly three
times more than our major trading partners for health care benefits. Unaffordable
coverage prevents these companies from competing in the global market. The Mark
makes coverage more affordable by providing tax credits for low and middle-income
individuals and small businesses, and by strengthening public programs.
Options for Standard Benefits – The Mark creates four benefit categories for the
reformed health insurance market: bronze, silver, gold and platinum. No policies
(except grandfathered policies) would be issued in the individual or small-employer
market that do not comply with one of the four categories. All insurers would have to
offer coverage in the silver and gold categories. All plans would be required to provide
primary care and first-dollar coverage for preventive services, emergency services ,
medical and surgical care, physician services, hospitalization, outpatient services, day
surgery and related anesthesia, diagnostic imaging and screenings, including x-rays,
maternity and newborn care, pediatric services (including dental and vision care),
prescription drugs, radiation and chemotherapy, and mental health and substance
abuse services. Plans would not be allowed to set lifetime limits on coverage or annual
limits on any benefits. Plans would have out-of-pocket limits at least equal to the limits
for Health Savings Accounts (HSAs), which will be $5,950 for an individual and $11,900
for a family in 2010.
Health Care Affordability Tax Credits –The Mark would provide an advanceable,
refundable tax credit for low and middle-income individuals to subsidize the purchase of
health insurance. Beginning in 2013, tax credits would be available on a sliding scale for
individuals and families between 134-300 percent of FPL (Federal Poverty Level) to help
offset the cost of private health insurance premiums. Beginning in 2014, the credits are
also available to individuals and families between 100-133 percent of FPL. The credits
would be based on the percentage of income the cost of premiums represents, rising
from three percent of income for those at 100 percent of poverty to 13 percent of
income for those at 300 percent of poverty. Individuals between 300-400 percent of
FPL would be eligible for a premium credit based on capping an individual’s share of the
premium at a flat 13 percent of income. A cost-sharing subsidy would be provided to
limit the amount of cost-sharing that individuals and families between 100-200 percent
of FPL have to pay. Undocumented immigrants are prohibited from benefiting from the
Small Business Health Care Affordability Tax Credits – This proposal would provide a tax
credit to small businesses that offer health insurance to their employees. In 2011 and
2012, eligible employers can receive a small business credit for up to 35 percent of their
contribution. Once the exchanges are up and running in 2013, qualified small employers
purchasing insurance through the exchanges can receive a tax credit for two years that
covers up to 50 percent of the employer’s contribution. Small businesses with 10 or
fewer employees and with average taxable wages of $20,000 or less will be able to claim
the full credit amount. The credit phases out for businesses with more than 10
employees and average taxable wages over $20,000, with a complete phase out at 25
employees or average taxable wages of $40,000.
Cafeteria Plan Changes - This proposal creates a Simple Cafeteria Plan – a vehicle
through which small businesses can provide tax-free benefits to their employees. This
change would ease the participation restrictions and include self-employed individuals
as qualified employees. The proposal also exempts employers who make contributions
for employees under a simple cafeteria plan from pension plan nondiscrimination
requirements applicable to highly compensated and key employees. Finally, the
proposal allows for qualified long-term care insurance to be provided under a cafeteria
plan to the extent the amount of such contributions does not exceed the eligible longterm
care premiums for the contract. This proposal is effective beginning on January 1,
Consumer Owned and Oriented Plan (CO-OP) – The Mark creates authority for the
formation of the Consumer Owned and Oriented Plan (CO-OP). These plans can operate
at the state, regional or national level to serve as non-profit, member-run health plans
to compete in the reformed non-group and small group markets. These plans will offer
consumer-focused alternatives to existing insurance plans. Six billion dollars of federal
seed money would be provided for start-up costs and to meet solvency requirements.
Personal Responsibility – The Mark would create a personal responsibility requirement
for health care coverage, with exceptions provided for a variety of reasons including
religious conscience (as defined in Medicare) and an exemption for undocumented
Individuals who fail to meet the requirement are subject to a penalty. If an individual’s
income is between 100 and 300 percent of poverty, the penalty for failing to obtain
health coverage is $750 per person per year with a maximum of $1,500 per family. If an
individual’s income is above 300 percent of poverty, the penalty for failing to obtain
coverage is $950 per person per year with a maximum of $3,800 per family.
Exemptions from the penalty will be made for individuals where the full premium of the
lowest cost option available to them (net of subsidies and employer contribution, if any)
exceeds ten percent of their adjusted gross income (AGI); those below 100 percent of
FPL; any health arrangement provided by established religious organizations comprised
of individuals with sincerely held beliefs (e.g., such as those participating in Health
Sharing Ministries); those experiencing hardship situations (as determined by the
Secretary of Health and Human Services); and an individual who is an Indian as defined
in section 4 of the Indian Health Care Improvement Act. Additionally, in 2013,
individuals at or below 133 percent of FPL will be exempt from the penalty. When
making these determinations, income from individuals not subject to the mandate
should not be considered.
Responsibility for Employers – The Mark would not require employers to offer health
insurance. However, effective January 1, 2013, all employers with more than 50
employees who do not offer coverage will have to reimburse the government for each
full-time employee (defined as those working 30 or more hours a week) receiving a
health care affordability tax credit in the exchange equal to 100 percent of the average
exchange subsidy up to a cap of $400 per total number of employees whether they are
receiving a tax credit or not.
As a general matter, if an employee is offered employer-provided health insurance
coverage, the individual would be ineligible for a health care affordability tax credit for
health insurance purchased through a state exchange. An employee who is offered
coverage that does not have an actuarial value of at least 65 percent or who is offered
unaffordable coverage by their employer, however, can be eligible for the tax credit.
Unaffordable is defined as 13 percent of the employee’s income. A Medicaid-eligible
individual can always choose to leave the employer’s coverage and enroll in Medicaid.
In this circumstance, the employer is not required to pay a fee.
09-16-2009, 10:46 AM
Strengthening Coverage of Preventive Services in Medicare and Medicaid
For the nearly one in three Americans covered under Medicare or Medicaid, the
Chairman’s Mark makes critical investments in policies that will promote healthy living
and help prevent costly chronic conditions like diabetes, cancer, heart disease, obesity
and mental illness. Preventive screenings enable doctors to detect diseases earlier
when treatment is most effective averting more serious, costly health problems later.
Providing Personalize Prevention Plan and Wellness Visit
‐ The Chairman’s Mark provides
Medicare beneficiaries with a free visit to their primary care provider every year to
create and update a personalized prevention plan to address health risks and chronic
health problems and to design a schedule for regular recommended preventive
Improving Access to Preventive Services
The Mark eliminates out‐of‐pocket costs for
recommended preventive services for Medicare beneficiaries. Beneficiaries will no
longer face financial deterrents for seeking preventive care. The Chairman’s Mark also
encourages states to cover preventive services recommended by the U.S. Preventive
Services Task Force (USPSTF) and immunizations recommended by the Advisory
Committee on Immunizations (ACIP) to adults enrolled in Medicaid. States that opt to
cover recommended services and immunizations without cost‐sharing would receive a
one percent increase in the federal share of the FMAP reimbursement rate for those
services. All states would be required to provide comprehensive tobacco cessation
services to pregnant women enrolled in Medicaid.
Moving Toward Patient
‐Centered Care ‐
The Chairman’s Mark creates a new state
option and rewards states for providing chronically ill individuals enrolled in Medicaid
with a health home. Participating enrollees will receive comprehensive care
coordination and management, transitional care and, if relevant, referral to communitybased
programs and social services. States that take up this option will receive an
enhanced match for two years.
Rewarding Healthy Lifestyles
The Mark establishes an initiative that will reward
Medicare and Medicaid participants for healthier choices. Funding will be available to
provide participants with incentives for completing evidence‐based, healthy lifestyle
programs and improving their health status. Programs will focus on lowering certain
risk factors linked to chronic disease such as blood pressure, cholesterol and obesity.
Reforming the Health Care Delivery System
Medicare currently reimburses health care providers on the basis of the volume of care
they provide. For every test, scan or procedure conducted, providers receive payment –
regardless of whether the treatment contributes to helping a patient recover. Medicare
must move to a system that reimburses health care providers based on the quality of
care they provide. The Chairman’s Mark includes various proposals to move the
Medicare fee‐for‐service system towards paying for quality and value. These proposals
include the following:
‐Based Purchasing ‐
The proposal would establish a value‐based
purchasing program for hospitals starting in 2012. Under this program, a percentage of
hospital payment would be tied to hospital performance on quality measures related to
common and high‐cost conditions, such as cardiac, surgical and pneumonia care. Quality
measures included in the program (and in all other quality programs in this section) will
be developed and chosen in cooperation with external stakeholders.
‐Based Purchasing ‐
This provision would strengthen and expand the
Physician Quality Reporting Initiative (PQRI) program, including requiring all eligible
health professionals to participate by 2011. It would also improve the Medicare
physician feedback program and penalize physicians who utilize significantly more
resources than their peers.
Medicare Home Health Agency and Skilled Nursing Facility Value
CMS is currently testing value
‐based purchasing models for these providers. Building on
this effort, this provision would direct the Secretary to submit a plan to Congress by
2011 related to home health providers and 2012 related to skilled nursing facilities
outlining how to effectively move these providers into a value‐based purchasing
Quality Reporting for Other Providers
‐ This provision would set providers – long‐term
care hospitals, inpatient rehabilitation facilities, PPS‐exempt cancer hospitals and
hospice providers – on a path toward value‐based purchasing by requiring the Secretary
to implement quality measure reporting programs for certain providers. Providers who
do not successfully participate in the program would be subject to a reduction in their
annual market basket update.
Encouraging Collaboration Among Health Care Providers
Patients receive the best possible care when doctors collaborate and work together to
coordinate care. Current payment systems often discourage such care coordination.
When providers in different settings – like doctor’s offices, hospitals, nursing homes and
rehabilitation facilities – work together, patients benefit from receiving better care and
costs in the system are lower.
Payment for Accountable Care
− To encourage providers to improve patient care and
reduce costs, the Mark would allow high‐quality providers that coordinate care across a
range of health care settings to share in savings they achieve to the Medicare program.
CMS Innovation Center
‐ This provision would establish an Innovation Center at the
Centers for Medicare & Medicaid Services (CMS) that would have the authority to test
new patient‐centered payment models that encourage evidence‐based, coordinated
care. Payment reforms that are shown to improve quality and reduce costs could be
expanded throughout the Medicare program.
National Pilot Program on Payment Bundling
The Chairman’s Mark would direct the
Secretary to develop a voluntary pilot program encouraging hospitals, doctors and postacute
care providers to achieve savings for the Medicare program through increased
collaboration and improved coordination of patient care by allowing the providers to
share in such savings.
Reducing Avoidable Hospital Readmissions
‐ To improve quality of care, this provision
would direct CMS to track national and hospital‐specific data on the readmission rates
of Medicare participating hospitals for certain high‐cost conditions that have high rates
of potentially avoidable hospital readmissions. Starting in 2012, hospitals with
readmission rates above a certain threshold would have payments for the original
hospitalization reduced by 20 percent if a patient with a selected condition is rehospitalized
with a preventable readmission within seven days or by 10 percent if a
patient with a selected condition is re‐hospitalized with a preventable readmission
within 15 days.
09-16-2009, 10:47 AM
Infrastructure Investments: Tools to Reduce Costs and Improve Quality
Efforts to reduce costs and improve quality in the health care delivery system will
require equal efforts to modernize the system with new tools that support coordinated
quality care. Investments in the health care infrastructure are essential to creating a
more effective, efficient delivery system.
Strengthening the Quality Infrastructure - Additional resources would be provided to the
Department of Health and Human Services (HHS) to strengthen the quality measure
development processes for purposes of improving quality, informing patients and
purchasers, and updating payments under federal health programs. Specifically, the
Secretary of HHS would be directed to develop a national quality strategy; establish an
interagency working group on health care quality; provide additional resources for
quality measure development and endorsement; and establish a process for HHS to
work with external stakeholders, such as the National Quality Forum, to select quality
measures to be included in Medicare value-based purchasing and pay-for-reporting
Research and Information - The Mark would invest in research on what treatments
work best for which patients and ensure that information is available and accessible to
patients and doctors, such as through the establishment of an independent institute to
research the effectiveness of different health care treatments and strategies. These
provisions are carefully crafted so that patients would never be denied treatment based
on age, disability status or other related factors as a result of the research findings.
Transparency - To increase transparency, the Chairman’s Mark would provide patients
with information about physician-industry relationships – so called “physician payment
sunshine,” close loopholes in physician self-referral laws that allow conflicts of interest,
and provide patients and families with more information about nursing home facilities
and hospital charges to help them make better decisions. The Chairman’s Mark would
also require drug manufacturers and distributors to report information they already
collect regarding the number and type of drug samples given to physicians. The Mark
would also require the nation’s hospitals to make their average charge information for
commercial payers and self-pay patients available to the public.
Strengthening Primary Care and Other Healthcare Workforce Improvements
Primary care physicians play a critical role in our health care system. They are vital to
reducing costs and improving quality in the health care system. Primary care doctors
provide preventive care, help patients make informed medical decisions, assist with care
management, and help coordinate with a patient’s other care providers. Despite their
critical function, primary care doctors receive significantly lower Medicare payments
than other doctors, which has played a role in the current shortage of primary care
Promoting Primary Care – To encourage more primary care doctors to be part of the
system, the Chairman’s Mark would provide primary care practitioners and targeted
general surgeons with a Medicare payment bonus of ten percent for five years.
Health Care Workforce - Ensuring America’s health care system has a sufficient supply
of health care professionals to meet the demands of a changing and aging population is
essential to maintaining focus on high-quality, cost efficient care. To strengthen the
health care workforce, the Mark would be increase graduate medical education (GME)
training positions through a slot re-distribution program for currently unused training
slots and priority would be given to increasing training in primary care and general
surgery. The proposal would also encourage additional training in outpatient settings
and ensure communities retain vital training slots if a hospital closes. It would establish
a Workforce Advisory Committee made up of external stakeholders tasked with working
with HHS and other relevant federal agencies to develop and implement a national
workforce strategy. The Chairman's Mark establishes competitive demonstration grant
programs designed to help low-income individuals obtain the education and training
needed for well-paying, high-demand health care jobs. The Mark also includes
demonstration grants for up to six states to develop training and certification programs
for personal and home care aides.
Ensuring Beneficiary Access and Payment Accuracy in Medicare
The Chairman’s Mark ensures that Medicare beneficiaries will continue to have access
to physicians and other critical health care providers. The Mark also improves the
accuracy of Medicare payments to providers. Reducing overpayments to providers
saves money for seniors and taxpayers without limiting beneficiary access.
Physicians – Due to the flawed Sustainable Growth Rate (SGR) formula, physician
payments are scheduled to be reduced by 22 percent in 2010. To ensure that Medicare
beneficiaries continue to have access to physician services, the Chairman’s Mark
replaces the impending cut with a positive update next year.
Medicare Advantage – Private insurers that participate in Medicare should bring value
to the program and to beneficiaries. The Chairman’s Mark would improve the value of
Medicare Advantage by reforming payments so that they appropriately reimburse
insurers for their costs and promote plans that offer high quality, efficient health care
Specifically, the Mark would transition current Medicare Advantage payments which are
based on statutory benchmarks to payments based on competitive bids from the
insurers. It would eliminate overpayments to Medicare Advantage plans and addresses
the inequitable distribution of rebates paid to plans by making any extra payment
contingent on plan performance. Under the Mark, plans would be eligible for bonus
payments based on their performance on quality measures and the operation of
evidence-based care management programs. Plans that provide care at lower costs
than traditional Medicare would also be eligible for an efficiency bonus. Rebates and
bonuses paid to MA plans would need to be used to provide additional benefits that are
not covered under Medicare. The Mark would preserve plans’ ability to offer benefit
packages that differ from or supplement traditional Medicare. The Mark would add
important protections and transparency for beneficiaries by limiting cost sharing for
certain services, like chemotherapy and skilled nursing care, and by creating more
consistency in the extra benefits that plans can offer beneficiaries throughout the
Medicare Disproportionate Share Hospital Payments - This provision would require the
Secretary to update hospital payments to better account for hospitals’ uncompensated
care costs. Starting in 2015, hospitals’ Medicare Disproportionate Share Hospital (DSH)
payments would be reduced to reflect lower uncompensated care costs relative to
increases in the number of insured.
Home Health Payment Reform - The Secretary would be directed to improve payment
accuracy through rebasing home health payments in 2013 based on an analysis of the
current mix of services and intensity of care provided to home health patients. It would
also establish a 10 percent cap on the amount of reimbursement a home health
provider can receive from outlier payments, which are designed to help providers cover
the costs of treating sicker patients. The Chairman’s mark would also reinstate an addon
payment for rural home health providers from 2010-2015.
Hospice Reform - Based on recommendations by the Medicare Payment Advisory
Commission (MedPAC), this provision would require the Secretary to update Medicare
hospice claims forms and cost reports. Based on this information, the Secretary would
be required to implement changes to the hospice payment system to improve payment
accuracy. The Secretary would also impose certain requirements on hospice providers
designed to increase accountability in the Medicare hospice program.
Appropriate Payment for High-cost Imaging Services - Because payment rates for
imaging services should reflect the rate by which they are used, the Mark would
increase the utilization rate assumption for advanced imaging equipment. In addition,
the Mark pays more accurately for multiple imaging services performed during a single
Updating Outpatient Payments for PPS-Exempt Cancer Hospitals - The Secretary of
Health and Human Services would be directed to update payment rates for outpatient
care provided by cancer hospitals that are exempt from the prospective payment
09-16-2009, 10:47 AM
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09-16-2009, 10:48 AM
Rural Health Care Protections
The Chairman’s Mark includes several provisions to ensure rural health care facilities
and providers have the resources they need to continue delivering quality care in their
communities. Specifically, the Mark would extend and improve many rural access
protections, including the following:
FLEX Grants for Health Care in Rural Communities
‐ The Medicare Rural Hospital
Flexibility Program provides grants that rural health care providers can use to improve
the quality of health care, and to strengthen health care networks. Funds can be used
for services ranging from ambulance transport to the development of small local
hospitals. The Chairman’s Mark will extend the FLEX Grant program through 2012, and
will add a new component that Flex grant funding to be used to support rural hospitals’
efforts to implement delivery system reform programs, such as value‐based purchasing
programs, bundling, and other quality programs.
Extend Hospital Outpatient Department Hold Harmless for Small Rural Hospitals
rural hospitals that are not sole community hospitals (SCHs) can receive additional
Medicare payments if their outpatient payments under a new payment system are less
than under the prior reimbursement system. The Chairman’s Mark would ensure that
small rural hospitals receive 85 percent of the payment difference in 2010 and 2011.
Reasonable Cost Reimbursement for Laboratory Services in Small Rural Hospitals
Certain rural areas with low population densities used to receive reasonable cost
reimbursement for laboratory services, but this policy ended in 2008. The Chairman’s
Mark would reinstate reasonable cost reimbursement, thus improving access to
laboratory services for those in rural communities.
Extend Rural Community Hospital Demonstration Program
The Centers for Medicare &
Medicaid Services has been conducting a demonstration program to test the feasibility
of reasonable cost reimbursement for small rural hospitals. The Chairman’s Mark
extends the program for two years and expands eligible sites to additional rural states.
Extend Medicare Dependent Hospital Program
Small rural hospitals with a high
proportion of patients who are Medicare beneficiaries receive special treatment,
including higher payments. This assistance for Medicare dependent hospitals (MDHs) is
scheduled to expire in September 2011. In order to protect access to health care in
rural communities, the Chairman’s Mark will extend crucial support to MDHs for an
additional two years.
Temporary Medicare Hospital Payment Improvements
‐ The Chairman’s Mark would
temporarily increase payment for certain low‐volume hospitals, ensuring that rural
hospitals are adequately reimbursed for serving their communities.
Community Health Integration Models in Certain Rural Counties
demonstration project allowed eligible rural entities to develop and test new models for
the delivery of health care services in order to improve access to, and integrate the
delivery of, acute care, extended care and other essential health care services to
Medicare beneficiaries. The Chairman’s Mark will expand the 2008 project to more
eligible counties, and will also allow physicians to participate in the demonstration
Transparency and Accountability for Insurance Companies
The provision improves the transparency of insurance products to ensure that
individuals know what they are purchasing, the services which are covered and the
associated out‐of‐pocket costs. The Mark creates standards that will ensure that each
individual receives an outline of coverage which is presented in a uniform format that
does not exceed 4 pages in length and does not include print smaller than 12‐point
font. The Mark would also require insurance companies to publish the share of their
premium revenue that is used for administrative expenses and not medical benefits. In
addition, the Mark would impose new requirements on insurers to meet standards for
the electronic exchange of payment and other health care information with hospitals,
doctors and other providers. By 2014, insurers must comply with standards for certain
transactions or face a penalty fee assessed annually by the Secretary of Health and
Human Services and collected by the Secretary of the Treasury. The fee would
represent the inefficiency cost that an insurer imposes on the health care system when
its electronic transactions with providers are not conducted in a standard way.
Combating Fraud, Waste, and Abuse
Reducing fraud, waste, and abuse in Medicare and Medicaid will reduce costs and
improve quality throughout the system. The Medicare improper payment rate for 2008
was 3.6 percent, or $10.4 billion, and the National Health Care Anti‐Fraud Association
estimates that fraud amounts to at least three percent of total health care spending, or
more than $60 billion per year. The Chairman’s Mark will combat fraud, waste, and
abuse by requiring the review of health care providers prior to granting billing privileges,
leveraging technology to better evaluate claims, educating providers to promote
compliance with program requirements, monitoring programs more vigilantly, and
penalizing fraudulent activity swiftly and sufficiently.
Ensuring Medicare Sustainability
Sharply rising costs throughout the health system threaten Medicare’s sustainability in
the long term. If costs are not constrained, the Medicare program will be insolvent by
2017. To ensure the fiscal solvency and sustainability of the Medicare program, the
Chairman’s mark includes the following provisions.
Revisions to Annual Market
‐Basket Adjustments for Part A Providers
‐ The provision
would reduce annual market basket updates for hospitals, home health providers,
nursing homes, hospice providers, long‐term care hospitals and inpatient rehabilitation
facilities, including adjustments to reflect expected gains in productivity.
Part B Productivity Adjustments
‐ This provision would reduce payment updates for Part
B providers by an estimate of increased productivity.
Reduce Part D Premium Subsidy for High
– This provision would
reduce the premium subsidy under Part D for beneficiaries with incomes at or above the
Part B income thresholds.
‐ The Chairman’s Mark creates a 15‐member, independent
Medicare Commission tasked with presenting Congress with comprehensive proposals
to reduce excess cost growth and improve quality of care for Medicare beneficiaries. In
years when Medicare costs are projected to be unsustainable, the Commission’s
proposals will take effect unless Congress passes an alternative measure. Congress
would be allowed to consider an alternative proposal on a fast‐track basis. The
Commission would be prohibited from making proposals that ration care, raise taxes, or
change Medicare benefit or eligibility standards.
‐‐ The Chairman’s Mark would express the Sense of the Senate that
health care reform presents an opportunity to address issues related to medical
malpractice and medical liability insurance. The Mark would further express the Sense
of the Senate that states should be encouraged to develop and test alternatives to the
current civil litigation system as a way of improving patient safety, reducing medical
errors, encouraging the efficient resolution of disputes, increasing the availability of
prompt and fair resolution of disputes, and improving access to liability insurance, while
preserving an individual’s right to seek redress in court. The Mark would express the
Sense of the Senate that Congress should consider establishing a state demonstration
program to evaluate alternatives to the current civil litigation system.
Financing an Investment in Quality, Affordable, Health Care
High Cost Insurance Excise Tax
Beginning in 2013, this proposal would levy a nondeductible
excise tax of 35percent on insurance companies and plan administrators for
any health insurance plan that is above the threshold of $8,000 for singles and $21,000
for family plans. The tax would apply to the amount of the premium in excess of the
threshold. The tax would apply to self‐insured plans and plans sold in the group market,
but not to plans sold in the individual market. The threshold would be indexed for
inflation, and a transition rule would increase the threshold for the 17 highest cost
states for the first three years.
Increasing Transparency in Employer W
‐2 Reporting of Value of Health Benefits
proposal would require employers to disclose the value of the benefit provided by the
employer for each employee’s health insurance coverage on the employee’s annual
Form W‐2. This would be effective beginning in 2010. This proposal has a negligible
revenue impact over ten years.
Limit Health FSA Contributions
‐ This proposal would limit the amount of contributions
to health Flexible Spending Accounts (FSAs) to $2,000 per year, beginning in 2013.
Eliminate Deduction for Employer Part D Subsidy
This proposal would eliminate the
deduction for the subsidy for employers who maintain prescription drug plans for their
Medicare Part D eligible retirees. This would be effective beginning in 2011.
Standardize the Definition of Qualified Medical Expenses
Beginning in 2011, this
proposal would conform the definition of qualified medical expenses for Health Savings
Accounts (HSAs), health FSAs, and HRAs to the definition used for the itemized
deduction. An exception to this rule would allow amounts paid for over‐the‐counter
medicine with a prescription to still qualify as medical expenses.
09-16-2009, 10:57 AM
Increase the Penalty for Use of HSA Funds for Non
‐qualified Medical Expenses ‐
proposal would increase the additional tax for HSA withdrawals prior to age 65 that are
not used for qualified medical expenses from 10 percent to 20 percent, beginning in
Corporate Information Reporting
‐ This proposal would require businesses that pay any
amount greater than $600 during the year to corporate providers of property and
services to file an information report with each provider and with the IRS. Information
reporting already is required on payments for services to non‐corporate providers. This
applies to payments made after December 31, 2011.
‐profit Hospitals ‐
This proposal would establish new requirements applicable to
nonprofit hospitals beginning in 2010. The requirements would include a periodic
community needs assessment.
Pharmaceutical Manufacturers Fee
This proposal would impose an annual flat fee of
$2.3 billion on the pharmaceutical manufacturing sector, beginning in 2010. This nondeductible
fee would be allocated across the industry according to market share and
would not apply to companies with sales of branded pharmaceuticals of $5 million or
Medical Device Manufacturers Fee
This proposal would impose an annual flat fee of $4
billion on the medical devices manufacturing sector, beginning in 2010. This nondeductible
fee would be allocated across the industry according to market share and
would not apply to companies with sales of medical devices in the U.S. of $5 million or
less. The fee does not apply to sales of Class I products under the FDA product
Health Insurance Provider Fee
This proposal would impose an annual flat fee of $6
billion on the health insurance sector, beginning in 2010. This non‐deductible fee would
be allocated across the industry according to market share.
Clinical Laboratories Fee
This proposal would impose an annual flat fee of $0.75 billion
on clinical laboratories, beginning in 2010. This non‐deductible fee would be allocated
across the industry according to market share and would not apply to clinical
laboratories with revenue of $500,000 or less.
09-16-2009, 05:17 PM
BRC, you really should seek help.
09-16-2009, 05:28 PM
BRC, you really should seek help.
Why? All I did was copy and paste the bill.
09-16-2009, 05:32 PM
Save money and get help with Jaz, you both need it.
09-16-2009, 05:33 PM
Save money and get help with Jaz, you both need it.WTF dude. I don't even support this bill. Moron. Pay attention.
09-16-2009, 05:54 PM
Why? All I did was copy and paste the bill.
None of what you posted is the bill itself.
09-16-2009, 06:10 PM
None of what you posted is the bill itself.
09-16-2009, 06:15 PM
I'm still not seeing the part where the feds have the Constitutional authority to do this.
LMAO Like anyone cares.
09-16-2009, 06:30 PM
I hope we are not expected to read all that.
09-16-2009, 07:10 PM
None of what you posted is the bill itself.
It's Bacus's official release.
09-16-2009, 07:13 PM
I hope we are not expected to read all that.Don't waste your time. It's a piece of trash. Dead on arrival.
Raise my taxes, give away to insurance companies. This was written by the lobbyist for the insurance compnies.
The gall of this bill makes me so :cuss:
09-16-2009, 07:16 PM
It's Bacus's official release.
Yes, I know what it is that you pasted. Would you like a link to the actual bill?
09-16-2009, 07:19 PM
Yes, I know what it is that you pasted. Would you like a link to the actual bill?
Don't bother. It's already dead.
09-17-2009, 12:51 PM
I'm Such A Shitty Senator
By Sen. Max Baucus (D-MT)
I've been "serving" the great state of Montana in the U.S. Senate since 1978. You'll notice I put "serving" in quotes, because, let's face it, I suck. My wife has been pleading with me not to say this publicly, insisting that it's not true, that I'm a capable and dedicated public servant, blah, blah, blah. Bless her dear heart, but she's just being nice. Because, folks, I am telling you, I am hands-down the shittiest senator in the history of the Senate. The worst.
The other day, I was in my office, thumbing through some old pieces of legislation I'd either authored or co-sponsored. The whole time, I was thinking, "Christ, what a hack I am." Take my 1993 masterwork, S.915, the Semiconductor Investment Act. Section 2a of the bill states, "IN GENERAL–Section 168(e)(3)(A) of the Internal Revenue Code of 1986 (relating to three-year property) is amended by striking 'and' at the end of clause (i), by striking the period at the end of clause (ii), and by inserting at the end the following: '(iii) any semiconductor manufacturing equipment.'"
What the hell is that shit? As I recall, it had something to do with semiconductor manufacturing equipment. But you'd never know, what with the way I buried its meaning under a tidal wave of I-know-all-the-fancy-schmancy-bill-writing lingo. I was trying to look like Mr. Big Shot, but little did I know what a conceited ass I came off as. When the bill was pitched, Sen. Bob Packwood (R-OR) was nice enough to say some introductory words of support on the floor. But now I think he was just embarrassed for me and wanted to help a fellow senator save face, however little I deserved it. I forget what happened to that bill. Hopefully, it died without ever coming to a vote.
There's a huge stack of old bills in my office, each containing tons of that sort of hackwork. I'm tempted to burn down the entire Hart Office Building and cleanse the planet of every physical trace of my senatorial presence. But, no, that wouldn't do any good, because every facet, every aspect of my incredible suckiness is piledriven into the memories of those I so ineptly represent.
God. God. I am so, so, so sorry, folks.
Here's another stupid-ass thing I did. Every Wednesday, when the Senate is in session, I invite Montanans who happen to be in Washington to stop by my office to enjoy an informal breakfast with my staff and myself. It's a way for me to keep abreast of the needs of my constituents. A neat idea, right? Well, it would be, if I weren't actually there, fucking things up.
Anyway, one morning, this very nice woman named Shirley Besser, who is from my hometown of Helena, stopped by while vacationing in D.C. She wanted to know why I supported permanent normal trade relations with China, given its oppressive government and history of human-rights violations. I thought this was a good question, and I started to say, "Well, Sheila..." But, before I could say another word, she interrupted to point out that her name was Shirley. Stupid, son-of-a-bitch, no-listening-skills senator. She had just told me her name a second ago, and here I was, already forgetting it! I apologized profusely, but she just smiled politely and said it was okay. It wasn't.
Whether ladling too much stew onto the tray of a homeless person at a Missoula soup kitchen or making repeated mixed metaphors during a speech praising the efforts of those who fought Western wildfires last summer, I can't imagine why the people of Montana continue to put up with my crap.
I should just quit. Actually, I should have quit a long time ago. But I never did, because the people kept insisting I run for another term. I've been re-elected three times, and every time I am, I get the notion that maybe, if I made a real conscious effort, I could stop being such a lousy legislator.
I sometimes make an effort, but every time I do, before I know it, I've made another inexcusable flub like mentioning, during an appearance on Montana Politics Today, that the Gallatin Land Consolidation Act Of 1998 was introduced during the 104th Congress instead of the 105th. Christ on a crutch!
No, don't try to talk me out of it. I'm definitely quitting this time. I'm not sure what I'm going to do with myself once I leave the Senate, though. I can't go back to Montana, that's for sure. Facing all those constituents I failed so badly day after day, year after year? I don't think so. Maybe I'll go to Maine instead. No one knows me there. Set up a small law practice, hang my shingle, buy a quaint little saltbox on the outskirts of Bangor. Of course, I'm sure I'd somehow manage to fuck up everything there, too. What the hell was I thinking? God, I'm such a bonehead. I should go live in a cave somewhere, someplace far away from all humanity where I can't poison everything I touch.
So, people from the great state of Montana, forget you ever even heard the name Max Baucus. Max Baucus... more like Trash... Ruckus.
I can't even pun well.
09-17-2009, 12:55 PM
09-17-2009, 12:57 PM
That thing is even longer than a TFG post!
Needs larger fonts in some places though.
And cowbell. Almost forgot that.
09-17-2009, 05:53 PM
That thing is even longer than a TFG post!
Needs larger fonts in some places though.
And cowbell. Almost forgot that.
09-17-2009, 06:06 PM
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