Medicare Program Changes in H.R. 3962, Affordable Health Care for America Act Page: 2 of 66
The following text was automatically extracted from the image on this page using optical character recognition software:
Medicare Program Changes in H.R. 3962, Affordable Health Care for America Act
Containing scores of provisions affecting Medicare payments, payment rules, and covered
benefits, H.R. 3962 treats the Medicare program as both a funding source for health insurance
reform and a tool to shape future changes in the way that health services are paid for and
delivered. Preliminary estimates from CBO on the introduced bill indicate that, absent interaction
effects, net reductions in Medicare direct spending may approach $129.0 billion from 2010 to
2014 and $461.3 billion from 2010 to 2019. Major savings are expected from constraining
Medicare's annual payment increases, linking payments for Medicare Advantage plans to fee-for-
service payments, and requiring drug manufacturers to provide drug rebates for certain low-
income Medicare beneficiaries. These savings are offset by increases related to payment
incentives for primary care services, expanded assistance for low-income beneficiaries enrolled in
the Medicare prescription drug program, expanded coverage of preventative care services, and
higher payments for various types of providers in rural areas.
With respect to reshaping health care delivery, H.R. 3962 would provide financial incentives to
acute care and critical access hospitals to reduce potentially preventable readmissions and to
improve care coordination starting in FY2012. These policies would be extended to post-acute
care providers starting in FY2015. Another provision would require the Secretary to develop a
detailed plan to bundle payments for post-acute care services within three years of enactment.
Also, by January 1, 2011, the existing physician-hospital bundled payment demonstration would
be converted to a pilot program and expanded to include post acute services.
H.R. 3962 would also alter Medicare payments to a range of providers, physicians, practitioners,
and suppliers. Certain provisions address more systemic issues, such as increasing physician
payments for preventive services. Others provisions are time-limited extensions of existing
payment policies, such as two-year extensions to Section 508 hospital reclassifications, the
physician geographic floor, and rural ambulance add-ons. H.R. 3962 would also change the
regulation of providers. For instance, Medicare providers would be subject to enhanced screening
and oversight in areas designated as high risk for fraud and abuse. Additionally, the Stark whole
hospital and rural exceptions for physician-owned hospitals would be eliminated, except for those
existing physician-owned hospitals that qualify for an exception.
Finally, provisions in H.R. 3962 would improve Medicare benefits provided to individuals. For
instance, the Medicare Part D coverage gap for prescription drugs (the "doughnut hole") would
be eliminated, certain low-income subsidies would be amended by changing Medicare's asset
test, and co-payments would no longer be required for certain preventative care services.
Congressional Research Service
Here’s what’s next.
This report can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Report.
Medicare Program Changes in H.R. 3962, Affordable Health Care for America Act, report, November 5, 2009; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc810680/m1/2/: accessed April 23, 2019), University of North Texas Libraries, Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.