News and Updates

The Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) is Law

(July 16, 2008)

Delays competitive bidding while cutting Medicare DMEPOS reimbursement

Yesterday, Congress overrode President Bush’s veto earlier in the day of H.R. 6331 and The Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) became law.  Among its many provisions is a delay in Medicare’s Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) competitive bidding program.  Congress offset the projected cost of the delay by requiring starting January 1, 2009 a 9.5% nationwide reduction in Medicare reimbursement for products and services selected for Round One of competitive bidding, which includes the enteral therapy nutritionals, supplies and equipment often provided by home infusion pharmacies.

Today, the Centers for Medicare & Medicaid Services (CMS) issued its first guidance to providers and patients in the ten Competitive Bidding Areas of the now-postponed Round One of the program.  See it here.  MIPPA requires CMS to terminate its Round One contracts with suppliers and go out for bid again.  In addition, Congress required an overall delay of the program and included provisions intended to fix problems that became visible in the roll out of Round One.

MIPPA has more provisions beyond competitive bidding that are of interest to providers of home infusion therapy and NHIA will be communicating more on them.

In President Bush’s veto statement, he expressed support for forestalling reductions in physician payment but objected to taking away private health plan options (Medicare Advantage) from seniors, undermining the Medicare prescription drug program, and its being fiscally irresponsible.  He also objected to the delay that would be required to the competitive bidding program through which "beneficiaries...are receiving services from quality suppliers at lower prices."  Read more in the President’s letter to Congress.  

The House and Senate promptly proceeded to override the veto.  First, the House passed the act by a margin of 383 - 41.  Then, the Senate passed it with a vote of 70 - 26.  In both chambers, the margins of final passage exceeded the margins by which the act passed with originally before sending it to the President.

At least prior to the President’s veto statement, the competitive bidding program did not appear to be an outstandingly visible political issue on this bill.  Rather, the primary issue dividing the administration and some Republicans from the Democratic-controlled Congress was the offset to fund prevention of a 10.6% cut in physician payments through reduction of funding to the insurance companies that sponsor Medicare Advantage (MA) plans.  Other MA-related objections were about some restrictions to be placed on Private Fee For Service (PFFS) plans.  Physicians, Medicare beneficiaries and the home medical equipment industry among others strongly supported the bill, including targeted television advertising by the American Medical Association in home states of some Republican Senators that had voted against it on June 26. 

The President cited concern with reduced access to MA plans using projections from the Congressional Budget Office (CBO).  These projections are notable for home infusion providers since MA plans usually provide comprehensive coverage of home infusion therapies, in stark contrast to traditional Medicare which does not.  (Learn more and help out with NHIA's advocacy program to close the home infusion gaps in traditional Medicare.)

According to the CBO, under the law prior to MIPAA the total enrollment in MA would be 14.3 million in 2013, of which 5 million individuals will be enrolled in PFFS plans.  Under MIPAA, projected enrollment in MA would total roughly 12 million in 2013, a 2.3 million reduction.  There are currently 9.6 million beneficiaries enrolled in Medicare Advantage plans, including 2.3 million beneficiaries enrolled in PFFS plans.

Find out how your Senators and Representative voted on H.R. 6331, now called MIPAA:

• Senate vote overriding the veto (July 15, 2008).
• House vote overriding the veto (July 15, 2008).
• Senate “cloture” vote passing H.R. 6331 prior to the veto (July 9, 2008).
• Senate “cloture” vote failing to pass H.R. 6331 (June 26, 2008).
• House vote passing H.R. 6331 prior to the veto (June 24, 2008).

 

NHIA members may view the NHIA Competitive Bidding Resource Center to find more detailed information on the act’s requirements for competitive bidding. Medicare’s DMEPOS quality standards, and instructions from CMS about the program delay as they are issued.  NHIA will also provide information on other provisions in the Act and members may view the entire act in NHIA’s Legislative and Advocacy Center News.