Tuesday, December 7, 2010

Doc Fix language

is out tonight (h/t @sarahkliff). Here is a summary of the law in more readable form. The primary pay-for is the next to last paragraph of the third page of the second document. Short version is that the ACA specified that if your income rose during the year such that your end of year income was higher than was projected (which is how amount of subsidy/tax credit was figured), then the maximum amount an individual had to pay back to the government was $250 for individual or $400 for family coverage. Now there is a sliding fee scale based on how much your income turns out to be, with much larger pay backs in force. If your income is 200% poverty, you have to repay up to $600, if it is 450-500% of poverty, you have to repay up to $3,500, with sliding scale in between.

This provision saves around $19 Billion over 10 years. $14.9 Billion of this is used to extend the SGR formula and avoid the scheduled Part B payment cuts (planned for Jan 1, 2011) for one year (now set for Jan 1, 2012)....the so-called doc fix.

The remainder of the money saved is used for other tweaks, such as extensions of enhanced payment for ambulance service, exceptions to Medicare outpatient cap violators, and maintain extra payments for certain mental health services.

The big question is whether Congress and the Administration can come up with a better physician payment formula over the next year and get away from these rolling 'fixes' that are actually just delays of cuts that never happen. It really does start to become a matter of general competence and can we solve problems or not.

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