April 2, 2014 – President Obama signed HR 4302 into law April 1. The new law authorizes the seventeenth temporary patch for Medicare physician payments, delays the implementation of the ICD-10 coding system until at least Oct. 2015 and extends the enforcement moratorium on the “two-midnight” rule through March 31, 2015.
The heavily lobbied measure blends $16 billion to address Medicare physicians’ payments with about $5 billion more for a variety of other expiring health care provisions, such as higher Medicare payments to rural hospitals and for ambulance rides in rural areas. Manufacturers of certain drugs to treat kidney disease catch a break, as do dialysis providers and the state of California, which receives increases in Medicare physician fees in 14 counties such as San Diego and Sacramento that are designated as rural and whose doctors therefore receive lower payments than their urban counterparts.
The bill increases spending by $17 billion over the next three years, offsetting the cost with cuts to health care providers. The authors of the bill employed considerable gimmickry to amass the cuts, however, and fully half of them don’t appear for 10 years. For instance, the bill claims $5 billion in savings through a timing shift in Medicare cuts in 2024.
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