BBA RELIEF

1
BBA RELIEF

• Balanced Budget Refinement Act of 1999
• Your Name
• Your Hospital

2
OVERVIEW

• 16.4 Billion over 5 years
• Hospitals - 10.7 billion
• 7.1 billion in legislative fixes
• 3.6 billion in administrative fixes
• SNFs - 2.7 billion
• Home Health - 1.3 billion

3
OVERVIEW

• 16.4 Billion over 5 years
• MedicareChoice - 4 billion
• Other healthcare providers - 800 million
• Medicaid, CHIP, CHCs - 800 million

4
HOSPITALS

• 7.1 Billion in Legislative Fixes
• Modifies outpatient department policies
• Smoothes transition to PPS
• Clarifies budget neutral PPS implementation
• Graduate Medical Education
• Increases IME payments
• Steps towards DME reform
• Increases DSH payments

5
HOSPITALS

• 7.1 Billion in Legislative Fixes
• Increases payments for PPS-exempt hospitals
• Improves rural hospital programs
• Critical Access Hospital provisions
• Extends Medicare Dependent Hospital program
• Exceptions for residency caps for rural GME
• Rebases SCH and full market basket in 2001

6
HOSPITALS

• Administrative Fixes
• Delay expansion of transfer policy
• Stop DSH recoupment
• Delay implementation of volume control and
  refining of ambulatory payment classification
  system under outpatient PPS
• Changes wage threshold for rural hospitals

7
Skilled Nursing Facilities

• 2.7 Billion in Legislative Fixes
• Immediate increases for 12 medically complex RUGs
  and 3 rehabilitation RUGs
• 4 rate increase (2001 2002)
• 2 year moratorium on payment caps

8
Skilled Nursing Facilities

• Administrative Fixes
• Increase payments for high acuity patients
• Exclude some hospital outpatient services from
  SNF PPS.

9
HOME HEALTH

• 1.3 Billion in Legislative Fixes
• Delays 15 reduction in rates
• Increases per beneficiary limits
• Administrative Fixes

10
Beneficiary Improvements

• 300 Million in Legislative Fixes
• Limits beneficiary hospital outpatient
  coinsurance
• Increases coverage of immunosuppressive drugs

11
MANAGED CARE

• 4.0 Billion in Legislative Fixes
• Phases in risk adjustment over 5 years
• Increases rates
• Changes provider participation rules and quality
  standards
• Changes demonstrations

12
OTHER PROVIDERS

• 800 Million in Legislative Fixes
• Fixes fluctuation in physician payments
• Increases payments for Pap smears
• Increases renal dialysis payments
• Increases updates for hospice, DME and oxygen

13
Medicaid, CHIP and CHCS

• 800 Million in Legislative Fixes
• Extends phase-out of cost-based reimbursement for
  CHCs
• Extends availability of 500 million CHIP
  outreach fund
• Makes technical changes to DSH
• Stabilizes CHIP allocation formula