Bipartisan leaders of the House Energy and Commerce and House Ways and Means Committees today introduced H.R. 2, the Medicare Access and CHIP Reauthorization Act, to permanently replace Medicare’s Sustainable Growth Rate (SGR). The agreement builds upon H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act, bipartisan, bicameral legislation to replace the SGR formula with a stable payment system that promotes higher quality care for seniors. The bipartisan committee leaders on Friday released a working framework of these additional proposals some of which will help to offset the costs of this package. Read the complete bill online here. Read a section-by-section online here. The bill has been filed with the Rules Committee to be available to send to the House floor for a vote.
To the extent that workers’ compensation fee schedules are tied to the Medicare fee schedule there may be an impact of this bill on reimbursement rates under workers’ compensation. One amendment of particular interest is Section 220 of the proposal which provides for a further delay in effective date to October 1, 2017 of provisions enacted in the Bipartisan Budget Act of 2013 that expanded authority of state Medicaid plans to seek recovery of Medicaid expenditures from third parties that have a legal liability to pay for care and services.
Although the number of individuals who qualify for Medicaid and workers’ compensation is small, as UWC reported earlier, the language enacted in 2013 could have an impact on workers’ compensation settlements involving individuals who are also covered under Medicaid. The further delay in effective date to October 1, 2017 provides additional time to assess the potential impact of the provision. The extended effective date applies to the following language from 2013.
RECOVERY OF MEDICAID EXPENDITURES FROM BENEFICIARY LIABILITY SETTLEMENTS.—
(1) STATE PLAN REQUIREMENTS
.—Section 1902(a)(25) of the Social Security Act (42 U.S.C. 1396a(a)(25)) is amended—
(A) in subparagraph (B), by striking ‘‘to the extent of such legal liability’’; and
(B) in subparagraph (H), by striking ‘‘payment by any other party for such health care items or services’’ and
inserting ‘‘any payments by such third party’’.
(2) ASSIGNMENT OF RIGHTS OF PAYMENT
.—Section 1912(a)(1)(A) of such Act (42 U.S.C. 1396k(a)(1)(A)) is amended
by striking ‘‘payment for medical care from any third party’’
and inserting ‘‘any payment from a third party that has a legal liability to pay for care and services available under the plan’’.
.—Section 1917(a)(1)(A) of such Act (42 U.S.C.1396p(a)(1)(A)) is amended to read as follows:
‘‘(A) pursuant to—
‘‘(i) the judgment of a court on account of benefits incorrectly paid on behalf of such individual, or
‘‘(ii) rights acquired by or assigned to the State in accordance with section 1902(a)(25)(H) or section 1912(a)(1)(A), or’’.
(c) EFFECTIVE DATE
.—The amendments made by this section shall take effect on October 1, 2014.
Note: the effective date was delayed to October 1, 2016 and under the new proposal would be further delayed to October 1, 2017.