Prepared by the Committees on Energy and Commerce and Ways and Means Democratic Staffs
Medicare and Medicaid. This provision extends authority for SNPs through 2015. Due to the timing of the MA contracting cycle, extension is needed by early 2014 in order for these plans to continue in 2015.
Medicare Reasonable Cost Contracts.
Starting on January 1, 2014, Medicare cost contract plans may not be extended or renewed in areas that, during the previous year, had two or more Medicare Advantage coordinated care plans operating. The effect of this policy is that plans will not be renewed during 2014 and will cease to operate in 2015. This provision extends cost contracts until January 1, 2015. Due to the timing of the MA contracting cycle, extension is needed by early 2014 in order for these plans to continue in 2015.
Qualifying Individual (QI) program.
This program assists low-income Medicare beneficiaries with incomes between 120% and 135% of poverty in covering the cost of their Medicare Part B premium. This provision extends the QI program through March of 2014.
Transitional Medical Assistance (TMA).
Transitional Medical Assistance allows low-income families to maintain their Medicaid coverage for up to one year as they transition from welfare to work. This provision extends TMA through March of 2014.
National Quality Forum Funding.
This provision allows the funding provided to the National Quality Forum (NQF) for quality measure review and endorsement activities to be available until expended.
Outreach and Assistance for Low-Income Programs.
This provision provides additional funds for outreach and education activities by State Health Insurance Programs (SHIPs) and Area Agencies on Aging (AOA) for Medicare beneficiaries. An additional $3.75 million is available to each program through March of 2014. The provision also provides an additional $2.5 million to both the National Center for Benefits Outreach (NCBO) and enrollment and Aging and Disability Resource Centers (ADRC) through March of 2014.
Family-to-Family Health Information Centers.
The Family-to-Family Health Information Centers (F2F HIC) assist families of children/youth with special health care needs in making informed choices about health care in order to promote good treatment decisions, cost-effectiveness, and improved health outcomes. This provision provides $2.5 million for activities through March of 2014.
Health Offsets included in Amendment to H.J.Res. 59, the Pathway for SGR Reform Act of 2013: Long-Term Care Hospital Payment Reform.
Long-term care hospitals (LTCHs) serve patients with clinically complex problems, such as multiple acute or chronic conditions, who may need hospital care for relatively extended periods of time. This policy creates criteria for the types of patients for whom care may be paid at the higher Medicare LTCH rate, limiting such payments to patients with stays longer than three days in an Intensive Care Unit or who are on a ventilator. Patients not meeting this criteria will be paid at a lower rate that is comparable to the inpatient rate paid at acute care hospitals. The provision also delays application of the 25% rule for three years.
Additional Medicaid DSH Cuts.
Disproportionate Share Hospital (DSH) payments provide additional payments to hospitals that serve a disproportionate number of low-income patients. The Affordable Care Act (ACA) reduced DSH payments, starting in 2014, to reflect the expected decrease in uncompensated care as reform increases the number of patients with insurance. This policy would (1) delay Medicaid DSH cuts until FY16, eliminating the FY14 cuts and moving the FY15 cuts one year later, to FY16; and (2) take another year of Medicaid DSH cuts in 2023.