Exámenes Complementarios 56-

Secretary is given waiver authority and may implement the program by program instruction.

Program is funded by a Medicare Hospital Insurance Trust Fund transfer of $500 million for the period FY 2011 to FY 2015, with funds remaining available until expended. The Secretary may continue or expand the scope and duration of the program based on a determination, certified by the CMS chief actuary, that expansion would reduce Medicare spending without reducing quality.

Sec. 3027. Extension of gainsharing demonstration.

Extends from 12/31/2009 to 9/30/2011 the gainsharing demonstration enacted as part of the Deficit Reduction Act of 2005.

Subtitle B—Improving Medicare for Patients and Providers

PART I—ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER SERVICES

Sec. 3101. Increase in the physician payment update (as modified by sec. 10310).

Sec. 10310 repeals sec. 3101, which would have updated the physician fee schedule conversion factor by 0.5% in 2010 and would have stipulated that the conversion factors for 2011 and subsequent years be computed as if the increase in 2010 had never applied. PPACA includes no provision pertaining to the physician update or the sustainable growth rate (SGR).

Sec. 3102. Extension of the work geographic index floor and revisions to the practice expense geographic adjustment under the Medicare physician fee schedule (as modified by sec. 1108 of HCERA).

Extends the work geographic adjustment floor through CY 2010. [3102(a)] For 2010 and 2011, changes the geographic adjustment for practice expenses to reflect 50% (rather than 100%) of the difference in costs of employee wages and rents between each fee schedule area and the national average. Holds harmless areas that would lose under the revised formula. Requires the Secretary to study improvements in the methodology for calculating practice expense adjustments and to implement changes beginning in 2012. [3102(b) as modified by sec. 1108 of HCERA]

Sec. 3103. Extension of exceptions process for Medicare therapy caps.

The therapy caps exceptions process is extended for one year through 12/31/2010.

Sec. 3104. Extension of payment for technical component of certain physician pathology services.

In 1999, CMS (then known as the Health Care Financing Administration), proposed terminating an exception to a payment rule that had permitted laboratories to receive direct payment from Medicare when providing technical pathology services that had been outsourced by certain hospitals. Congress enacted provisions in BIPA to delay the termination. The special provision has been periodically extended, most recently through December 31, 2009 by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Section 3104 extends the provision through 2010.

Sec. 3105 Extension of ambulance add-ons (as modified by Sec. 10311).

Ambulance services are paid on the basis of a national fee schedule, which is being phased in. The fee schedule establishes seven categories of ground ambulance

services and two categories of air ambulance services. The national fee schedule is fully phased in for air ambulance services. For ground ambulance services, payments

through 2009 are equal to the greater of the national fee schedule or a blend of the national and regional fee schedule amounts. The portion of the blend based on national rates is 80% for 2007-2009. In 2010 and subsequently, the payments in all areas will be based on the national fee schedule amount.. The ambulance fee schedule payment equals a base rate for the level of service plus payment for mileage. Geographic adjustments are made to a portion of the base rate. For the period July 2004 to December 2009, mileage payments are increased for ground ambulance services originating in rural low population density areas. For the period July 1, 2004 before January 1, 2009, there was a 25% bonus on the mileage rate for trips of 51 miles and more. Payments for ground transports originating in rural areas or rural census tracts are increased by 3% for the period of October 1, 2008 before January 1, 2010. MIPPA specifies that any area designated as rural for the purposes of making payments for ambulance services on December 31, 2006, will be treated as rural for the purpose of making air ambulance payments during the period July 1, 2008 ending on December 1, 2011.

The provision would extend the bonus payments and the increased ground ambulance payments until January 1, 2011. The provision to pay certain urban air ambulance services as rural would be extended until January 1, 2011, as well.

Sec. 3106. Extension of certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities (as modified by Sec. 10312).

Extends the regulatory relief provided by the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA, P.L. 110-173), Section 114(c) by two years. Also extends the moratorium on the development of new long-term care facilities for two additional years (MMSEA, Section 114(d)).

Sec. 3107. Extension of physician fee schedule mental health add-on.

Extends through 12/31/2010 an existing 5% bonus payment for certain psychiatric therapeutic procedures (originally intended to offset the impact of the budget neutrality adjustment to work values required as a result of the most recent 5-year review of relative values).

Sec. 3108. Permitting physician assistants to order post-hospital extended care services.

Effective 1/1/2011, allows a physician assistant who does not have a direct or indirect employment relationship with a SNF, but who is working in collaboration with a

physician, to certify the need for post-hospital extended care services for Medicare payment purposes.

Sec. 3109. Exemption of certain pharmacies from accreditation requirements.

Allows pharmacies furnishing Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items and services until 1/1/2011 to submit evidence of

accreditation required by section 1834(a)(20) of the SSA.

Exempts pharmacies from the accreditation requirements applicable to DMEPOS

suppliers provided certain conditions are met, including a requirement that the pharmacy submit an attestation that its total Medicare DMEPOS billings are and continue to be less than a rolling three year average of 5% of its total pharmacy sales.

Sec. 3110. Part B special enrollment period for disabled TRICARE beneficiaries.

Provides a special Medicare Part B 12-month enrollment period for TRICARE

beneficiaries, effective for elections made with respect to initial enrollment periods that end after 03/23/2010, during which any Part B premium penalty otherwise applicable is to be waived.

Sec. 3111. Payment for bone density tests.

Restores payment for dual-energy x-ray absorptiometry (DXA) bone mass scan services furnished during 2010 and 2011 to 70 percent of the Medicare rate paid in 2006 (using the geographic adjustment factor that would apply in 2010 and 2011, respectively). Provides for an Institute of Medicine study of the impact of Medicare payment reductions for dual-energy x-ray absorptiometry during 2007, 2008, and 2009 on beneficiary access to bone mass density tests.

Sec. 3112. Revision to the Medicare Improvement Fund.

Sec. 3113. Treatment of certain complex diagnostic laboratory tests.

Creates a 2-year Medicare demonstration program starting 7/1/2011 to test the impact of direct payments for certain complex laboratory tests on Medicare quality and costs. Subject tests are the analysis of gene protein expression, topographic genotyping, or a cancer chemotherapy sensitivity assay. Direct payment may be made to a hospital- based or independent laboratory for tests performed after the hospitalization on specimens collected during an inpatient hospital stay. Total demonstration program payments may not exceed $100 million. Report to Congress due two years after completion of the demonstration. Provides direct transfer of $5 million from Medicare Part B Trust Fund for administering and evaluating the demonstration.

Sec. 3114. Improved access for certified nurse-midwife services.

Effective 1/1/2011, deletes a provision limiting Medicare reimbursement of nurse- midwives to 65% of what a physician would be paid for the same service.

Sec. 10336. GAO study and report on Medicare beneficiary access to high-quality dialysis services.

Directs the Comptroller General to conduct a study on the impact of including oral drugs (for which there is no injectable equivalent) in the Medicare bundled payment for end stage renal disease services on beneficiary access to high quality renal disease services. The study shall analyze the ability of providers to furnish the oral drugs (including compliance with state laws) and the existence of quality measures to safeguard beneficiaries’ care. Report to Congress due 03/23/2011.