U.S. House Considers CHAMP Act, Medicare Physician Payments

The U.S. House of Representatives is scheduled to vote on H.R. 3162, the Children’s Health and Medicare Protection Act (CHAMP Act) on Thursday, August 2, 2007. This legislation reauthorizes the State Children’s Health Insurance Program (SCHIP), and replaces projected cuts for Medicare Physician Payments of 10% in 2008 and 5% in 2009 with positive payment updates of 0.5% in both years so the five-year score for the physician provisions remains at about $20 billion.

In order to comply with its budgetary rules that the bill’s 10-year costs will not exceed its offsetting revenue enhancing and cost-cutting provisions, the House will need to scale back the long-term “cost” of the SCHIP, Medicare beneficiary and physician payment provisions. In order to meet this requirement, the following stipulations will be included in the bill:

Bonus payments to states to facilitate SCHIP enrollment of eligible children would sunset in 2013 and SCHIP coverage would end at age 21 instead of 24.

H.R. 3162 would also spend $20 billion over 5 years and $67 billion over 10 years to implement the following Medicare Physician Payment policies:

  • Positive updates in 2008 and 2009 of 0.5%. Physicians would face cuts of 11 or 12 percent in 2010 and 2011. According to the House staff the cuts are temporary and should be viewed with the understanding that new legislation would be pursued in 2009 to avert these cuts.
  • The target for primary care and prevention services would be MEI + 2.5% rather than MEI + 3%.
  • Retained policy to gradually equalize cost sharing for mental health services
  • Retained expanded medical home demonstration
  • Retained policy to prospectively remove drugs from payment formula in 2010
  • Retained panel external to RUC to look at "over-valued” services
  • Retained provision granting HHS Secretary to reduce payments for services that grow by 10% more than overall growth in MD spending
  • Retained specialty hospital ban
  • Retained reductions in payments for imaging services as well as certification and accreditation requirements.

Please note that this will not be the final version of the bill since another cycle of negotiations will take place after the House vote with concerned stakeholders. AASM will keep members abreast of any new developments to the bill.

To view the entire bill please visit https://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_bills&docid=f:h3162rh.txt.pdf

2007-08-02T00:00:00+00:00 August 2nd, 2007|Professional Development|