The Protecting Access to Medicare Act: In Brief
The Protecting Access to Medicare Act (H.R. 4302; P.L. 113-93) is an “extender” bill, a bill that extends expiring program authorizations and/or appropriations and provides for the necessary “offsets” to pay for the extensions. Extension bills also may amend existing programs, authorize new programs and provide direction to federal agencies regarding existing programs. Often the extension bill extends program extensions from the previous year(s).
This is the case with the current act. The previous extension bills were: The American Taxpayers Relief Act of 2012, signed into law on Jan. 2, 2013 as P.L. 112-240 and the Continuing Appropriations Resolution, 2014 was signed into law as P.L. 113-67 and included the Bipartisan Budget Agreement and the Pathway to SGR Reform Act of 2013. The Protecting Access to Medicare Act was signed into law on April 1, 2014, just in time to prevent a scheduled 24 percent reduction in Medicare physician reimbursement rates.
The Protecting Access to Medicare Act extends the authorization for physician reimbursement under Medicare under current law (Sustainable Growth Rate or SGR) through March 31, 2015, postponing the efforts to reform and improve Medicare physician reimbursement methodology or the “Doc Fix” yet again. It also extends a number of Medicare program authorizations, including a number of provisions of particular interest to rural health providers. The act extends the following Medicaid programs:
- Qualified Individuals (QI)
- Temporary Medical Assistance (TMA)
- The Medicaid and CHIP Express Lane Eligibility Programs.
It also proposes savings from the Medicaid Disproportionate Share Hospital (DSH) Program, amending similar provisions in the previous extension bills. The act also delays the implementation of previously adopted Medicaid third party liability changes from Oct. 1, 2014, to Oct. 1, 2016. Among the other program extensions of note are the extensions of the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program and two teen pregnancy prevention programs.
Finally, the act authorizes two new mental health programs: (1) a demonstration program to improve community mental health services; and (2) a grant program that would provide assisted outpatient treatment for individuals with serious mental illness. Many of the provisions in this act will expire prior to the end of FY 2015, which would then require another extension bill early next year if no other action is taken to address the expiring program authorizations or appropriations.
- Medicare Sustainable Growth Rate (SGR) Formula Extension (“Doc Fix”)—Section 101: The act extends the current Medicare physician reimbursement rates until April 1, 2015, preventing the 23.7 percent cut that was scheduled to occur April 1, 2014. The $15.8 billion cost of the one-year doc fix and the cost of other extensions is fully offset by $22.1 billion in health-related spending reductions, resulting in $1.2 billion in deficit reduction over 10 years. Estimated cost $25.2 billion.
- Extension of the Medicare Work Geographic Adjustment—Section 102: The act extends the adjustment through 2013 the Medicare Work Geographic Adjustment through April 1, 2015. Estimated cost $300 million.
- Extension of the Exemptions for Outpatient Therapy Payments—Section 103: The act extends the payment cap exemptions for outpatient therapy payments through March 31, 2015. Medicare sets annual per beneficiary payment caps for non-hospital outpatient therapy services, but permits providers to seek an exemption if the therapy is deemed medically necessary. Estimated cost $800 million.
- Extension of Ambulance Add-on Payments—Section104: Extension of the Ground Ambulance and Super Rural Ambulance Add-On Payment –The act extends the add-on payments through April 1, 2015. Extension of the Air Ambulance Add-On Payment - The act extends the add-on payments through April 1, 2015. Estimated cost $100 million.
- Extension of the Medicare Inpatient Hospital Payment Adjustment for Low-Volume Hospitals—Section 105: The act extends the Low Volume Hospital Program through March 31, 2015. Estimated cost $300 million.
- Extension of the Medicare-Dependent Hospital Program—Section 101: The act extends the Medicare Dependent Hospital (MDH) Program through March 31, 2015. Estimated cost $100 million.
- Extension of the Special-Needs Medicare Advantage Plans—Section 107: The act extends until Jan. 1, 2017 the availability of Medicare Advantage Plans available to individuals with special needs. Estimated cost $200 million.
- Extension of Medicare Reasonable Cost Contracts—Section 108: The act extends Medicare Reasonable Cost Contracts through Jan. 1, 2016. Estimated cost $100 million.
- Extension of Funding for Quality Measure Endorsement, Input and Selection—Section 109: Makes available $12.5 million for the first six months of 2015 for a contract with a consensus-based entity to make recommendations on an integrated national strategy and priorities for health care performance measurements and quality measure endorsements. The funds would remain available until expended. Estimated cost less than $50 million.
- Extension of Funding Outreach and Assistance for Low-Income Programs—Section 110: The act extends through March 31, 2015, and provides additional funding by direct appropriation to the programs below.
- State Health Insurance Programs – Appropriates $7.5 million for FY 2014; and $3.75 million for FY 2015, before April 1, 2015.
- Additional Funding for Area Agencies on Aging – Appropriates $7.5 million for FY 2014; and $3.75 million for FY 2015 before April 1, 2015.
- Additional Funding for Aging and Disability Resource Centers – Appropriates $7.5 million for FY 2014; and $3.75 million for FY 2015, before April 1, 2015.
- Additional Funding for Contract with the National Center for Benefits and Outreach Enrollment – Appropriates $5 million for FY 2014; and $2.5 million for FY 2015 before April 1, 2015. Estimated cost less than $50 million.
- Extension of Two-Midnight Rule–Section 111–The act allows HHS to continue medical review activities described in the notice "Selecting Hospital Claims for Patient Status Reviews: Admissions On or After October 1, 2013," through the first six months of FY 2015. It bars HHS from conducting patient status reviews, however, on a post-payment basis through recovery audit contractors unless there is evidence of systematic gaming, fraud, abuse or delays in the provision of care.  Estimated cost is less than $50 million.
- Technical Change to Medicare Long-term Care Hospital Amendments–Section 112–The act makes technical and other changes to the treatment of Medicare Long Term Care Hospitals (LTCHs). The technical amendments become effective on the date of enactment. Estimated cost $100 million.
Medicaid and Childrens Health Insurance Program (CHIP) Extensions
- Qualified Individual (QI) Program Extension—Section 201: The act extends the Qualified Individual (QI) program and funds it through March 2015. The Act allocates the funding as follows: $485 million for the period ending Sept. 30; $300 million for the period Oct. 1 – Dec. 31; and $250 million for Jan. 1- March, 31 in 2015. Estimated cost $100 million.
Other Health Extensions
Other Health Provisions
- Realignment of the Medicare Sequester for FY 2024—Section 222: The act amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to adjust the 2 percent maximum reduction for specified Medicare programs for FY 2024 under any presidential sequester order to make it 4 percent for the first six months of FY 2024 and 0 percent for the last 6 months. Estimated savings over 10 years $4.9 billion.
 The Medicare physician fee schedule is adjusted to reflect the differences in the cost of providing services in different geographic areas. The adjustment is based on three factors: (1) physician work; (2) practice expense and; (3) the cost of medical malpractice insurance.