AMA Summary of Benefits Extension and Quality Improvement Act
American Academy of Sleep Medicine
Thursday, December 7, 2006
The American Medical Association has prepared this summary of the Benefits Extension and Quality Improvement Act. Please note the provisions detailed below are subject to change based on the actions of Congress.
- 2007 Update for Medicare Physician Services: Provides a one year, zero percent update for 2007. Establishes a quality reporting system for eligible professionals using consensus-based quality measures for 2007 beginning July 1, 2007 through December 31, 2007. Physicians and other eligible practitioners who submit data on applicable quality measures will receive bonus incentive payments of 1.5 percent for covered services beginning July 1, 2007 through December 31, 2007.
- Extension of expiring Medicare Modernization Act Provisions:
- Floor on Medicare Work Geographic Adjustment: Extends the 1.0 floor in the work geographic index for any locality for which the index is less than 1.0 established in the Medicare Modernization Act for services furnished from January 1, 2007 through December 31, 2007.
- Medicare Reasonable Costs for Rural Clinical Labs: Extends cost-based payments for clinical diagnostic laboratory tests covered under Part B for an additional year from July 1, 2006 through June 30, 2007.
- Extension of Medicare Wage Index: Extends 6 month duration of certain area wage index reclassifications and requires study on Medicare wage index classification system and alternative methodologies to compute the wage index.
- Extension of Therapy Caps: One year extension of DRA policy on Medicare therapy caps.
- Funding for Health Care Fraud and Abuse Control Account: Provides annual funding updates based on changes in the consumer price index.
- Spending Under the Medicare Advantage Stabilization Fund: Limits spending under the Medicare Advantage (MA) Stabilization Fund between January 1, 2007 and September 30, 2011.
- Deficit Reduction Act (DRA) Technical Corrections: Makes technical clarifications to the DRA.
- Access of Congressional Support Agencies to Medicare Advantage and Prescription Drug Plan Data: Ensures that the Congressional Budget Office (CBO), Government Accountability Office (GAO), Medicare Payment Advisory Commission (MedPAC), and Congressional Research Service (CRS) have access to data submitted to the Centers for Medicare and Medicaid Services (CMS) by MA and Prescription Drug Plans.
- Implementation Funding: Provides $45 million in FY 07 and 08 for purposes of implementing provisions included in and amendments made by this Title.
Medicaid/SCHIP Extender Provisions
- Medicaid Provider Tax Rate Codification: Codifies the maximum rate at which a state can tax its health care providers under their Medicaid plan at 5.5 percent through Fiscal Year 2011. Under current rules, the maximum rate is set at 6 percent, a rate likely to be reduced to 3 percent under an anticipated proposed rule.
- Transitional Medical Assistance (TMA)/Abstinence Education: Provides TMA for two quarters of FY 07. TMA is the continuation of Medicaid benefits for up to 1 year for certain low-income families who would otherwise lose coverage because of changes in their income, due to increased hours of work or income from employment or due to child or spousal support. Provides funding for matching grants to states to provide abstinence education for two quarters of FY 07.
- State Children’s Health Insurance Plan (SCHIP) Redistribution Plan: Redirects existing unspent FY 04 and FY 05 SCHIP funds to prioritize reducing FY 07 federal funding gaps. States, receiving redistributed funds, that have expanded SCHIP coverage to populations other than children and pregnant women would be eligible for a Medicaid funding match for these individuals. It has been estimated that redistributed funds will defer shortfalls through June, 2007. Extends a provision enacted in the DRA allowing certain states that had expanded Medicaid eligibility before SCHIP was enacted to use up to 20 percent of their FY 06 and 07 SCHIP allotments to fund coverage for Medicaid children.
- DRA Technical Corrections: Makes technical clarifications to the DRA.