Below is a chronological list of provisions in the Medicare Improvements for Patients and Providers Acts of 2008 (MIPPA), effective retroactively and those effective as of January 2009. MIPPA was passed by a veto override in July 2008 and contains many important provisions in Medicare benefits, marketing guidelines for Medicare Advantage and Part D plans, protections and program extensions for low-income beneficiaries, changes for providers, data collection requirements for addressing health care disparities and language access provisions. Other provisions are effective at different times through 2014.
Provision retroactive to 2003
- Allows beneficiaries to receive federal court reviews of any final decision regarding their eligibility for the Medicare Part D low-income subsidy. The provision takes effect as if it were included in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
Provisions retroactive to July 1, 2008
- Blocks a scheduled 10.6% payment cut to physicians and maintains the current payment rate until December 31, 2008.
- Extends the physician quality reporting initiative (PQRI) through December 31, 2010.
- Extends the exceptions process to Medicare therapy caps, which had expired June 30, 2008. Without this provision, physical therapy and speech therapy services would have been capped at $1,810 per year for each Medicare beneficiary. Similarly, occupational therapy services would have been capped at $1,810 per year for each Medicare beneficiary. The exception process, extended to December 31, 2009, allows Medicare to cover services exceeding the capped amount.
- Extends the qualifying individual (QI) program, one of the Medicare Savings Programs for low-income Medicare beneficiaries, until December 31, 2009. Without the extension, Medicare beneficiaries, who would have qualified, would have had to pay the Medicare Part B premium themselves.
- Delayed Round 1 of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Acquisition Program (CAP) competitive bidding for 18 months.
Provisions effective January 1, 2009
- Codifies current CMS guidance waiving the Part D late enrollment penalty for Medicare beneficiaries eligible for the low-income subsidy (LIS). The provision also gives LIS-eligible beneficiaries an ongoing special enrollment period to enroll in a Medicare Part D plan or Medicare Advantage plan with prescription drug benefits.
- Updates physician payment rate to 1.1% of what they received in 2008.
- Extends the timeframe and eliminates the annual deductible for the “Welcome to Medicare” physical exam. Newly eligible beneficiaries now have 1 year (instead of just 6 months), starting from their Medicare Part B effective date, to get the one-time “Welcome to Medicare” physical exam and pay only a 20% coinsurance even if they have not met the annual deductible.
- Permits speech language pathologists to bill Medicare directly for their services.
- Provides positive incentives for practitioners who use qualified e-prescribing systems from 2009 through 2013. Using such systems will be required starting in 2011.
- Authorizes the Secretary to establish pilot projects to increase awareness, screening, and surveillance systems addressing the prevalence of chronic kidney disease (CKD).
See our recent news article for information on the new MIPPA marketing regulations for Medicare Advantage and Part D plans. Most of these regulations were effective as of September 18, 2008.
Also see the MIPPA marketing regulations and implementation guidance posted online at cms.hhs.gov/HealthPlansGenInfo.