On July 15, 2008, the House and Senate overrode the President’s veto of H.R. 6331, the “Medicare Improvements for Patients and Providers Act of 2008” (MIPPA). The law rescinds a 10.6% cut in physician payments and delays a controversial medical equipment competitive bidding program, both of which temporarily went into effect July 1, 2008, and makes numerous other Medicare and Medicaid policy changes. Highlights of the law include the following:
- Physician Payments: MIPPA cancels a 10.6% Medicare physician fee schedule cut that was triggered on July 1, 2008 and provides a 1.1% increase for 2009 (rather than the forecasted 5.4% cut). The law also expands the Physician Quality Reporting Initiative, promotes electronic prescribing, and requires non-hospital advanced imaging providers to be accredited by 2012.
- DMEPOS Competitive Bidding. MIPPA delays and reforms the Centers for Medicare & Medicaid Services’ (CMS) competitive bidding program for certain categories of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). H.R. 6331 terminates contracts awarded under round one, rebids those areas in 2009, and delays round two bidding until 2011. The delay is financed by cutting fee schedule payments for round one items by 9.5% nationwide beginning January 1, 2009. MIPPA also includes a series of procedural improvements to the bidding process. A detailed Reed Smith analysis of the MIPPA DMEPOS bidding provisions is available on our website.
- Therapy Caps Exception Process. MIPPA extends through December 31, 2009 the outpatient therapy service cap exceptions process.
- Clinical Laboratory Services. The act repeals the clinical lab competitive bidding demonstration project and reduces the clinical lab fee schedule update by 0.5% in each of the next 5 years.
- Medicare Advantage (MA) Provisions. MIPPA makes a series of MA payment and policy changes, including a $1.8 billion cut in the regional MA stabilization fund in 2012 and a phase-out of the adjustment for indirect medical education.
- Medicare Part D Drug Plans. MIPPA sets timeframes for plan payments to pharmacies and long-term care pharmacy submission of claims; mandates coverage of certain classes of drugs; clarifies the use of Part D drug data; limits certain sales and marketing activities; and makes other Part D reforms.
- End-Stage Renal Disease (ESRD) Provisions. The law updates the ESRD composite rate by 1.0% for 2009 and 2010, and mandates a fully-bundled ESRD payment system and quality incentive program by January 1, 2011.
- Medicaid Drug Reimbursement. MIPPA delays the adoption of Medicaid payment based on average manufacturer price (AMP) for multiple source drugs and prevents publication of AMP data until October 1, 2009.
Reed Smith is preparing a client memo analyzing the new law, which will be available on our web site.