WASHINGTON, D.C. – House Ways and Means Committee Chairman Kevin Brady (R-TX) and Ranking Member Richard Neal (D-MA) today announced a bipartisan agreement relating to Medicare “extenders,” policies that expire unless Congress acts. Congress last extended these policies in the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015.

“This agreement extends, or makes permanent with reforms, numerous expiring Medicare payment policies that will help provide continuity and certainty for both the patients who rely on them and the providers who serve America’s seniors,” said Chairman Brady. “I appreciate Ranking Member Neal’s commitment to reach a bipartisan deal, and I look forward to working with our colleagues in the House and Senate to take action this year.” 

“I’m pleased that Chairman Brady and I have been able to come to an agreement that addresses Medicare extenders in a fair way,” said Ranking Member Neal. “I believe this compromise will provide an important stepping stone as Congress moves forward in addressing this issue before the end of the year.”

Background:

Earlier this month, Congress announced a bipartisan bicameral agreement to make the exceptions process for the cap on therapy services permanent. This bipartisan Ways and Means agreement includes this policy and advances a number of other extenders, as well. Today’s bipartisan Ways and Means announcement includes both the extension of current policies as well as proposed offsets.

The majority of the Medicare extenders expire at the end of the year. For provisions such as the hospital extenders that expired at the end of September, the Centers for Medicare & Medicaid Services (CMS) can appropriately adjust payments to ensure these modifications are accounted for in final provider rates.

The contours of the bipartisan agreement are described below:

Medicare Extender Policies. The bipartisan Ways and Means Medicare extenders agreement provides either a two- or five-year extension of the various MACRA policies. In general, longer-term extensions are coupled with policy changes to improve efficiencies in the Medicare program.

• Two-year straight extension of the Medicare Dependent Hospital Program and the Low-Volume Adjustment Program.
• Five-year straight extension of the Home Health rural add-on.
• Permanent extension of exceptions process for Medicare with the repeal of the therapy caps (previously announced bipartisan agreement).
• Two-year straight extension of the Medicare geographic payment cost index for physician payments.
• Five-year extension of the Ground Ambulance Add-Ons and ground ambulance payment modifications, as reported by Ways and Means.
• Five-year reauthorization of special needs plans (SNPs), as reported by Ways and Means.
• Two-year extension of the State Health Insurance Assistance Programs (SHIP).
• Two-year extension of funding for consensus based entity work on quality measures. 

Medicare Extender Policy Offsets. The bipartisan agreement includes a number of offsets that were reported out of the Ways and Means Committee. In addition, in an effort to promote efficiency in the Medicare program, the agreement looks to work by the Medicare Payment Advisory Commission (MedPAC) and the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) to inform additional offset policies.

• Medicare Advantage telehealth, as reported by the Ways and Means Committee.
• Medicare Advantage termination authority, as reported by the Ways and Means Committee in the 114^th Congress.
• Extension of the current law policy related to misvalued codes for physician services.
• Non-emergency transportation payment modification reduction related to end stage renal dialysis transportation, as reported by the Ways and Means Committee.
• Medicare Improvement Fund rescission.
• Modifications to skilled nursing facility payment, including MedPAC recommendations and building blocks to payment reform.
• Modifications to home health agency payment, including MedPAC recommendations and building blocks to payment reform.
• Modification of payments for critical access hospital swing beds, including HHS OIG recommendations and regulatory relief.