Vote on yearlong doc fix may happen Wednesday

Senate leaders announced late Tuesday night legislation to delay a 25 percent cut in Medicare payments that will take effect Jan. 1 without congressional intervention.

The bill, the Medicare and Medicaid Extenders Act of 2010, taps into subsidies for state-run insurance exchanges created by the new healthcare reform law to pay for the $19.2 billion, one-year "doc fix" to Medicare physician rates.

Majority Leader Harry Reid (D-Nev.), Minority Leader Mitch McConnell (R-Ky.), Finance Committee Chairman Max Baucus (D-Mont.) and ranking member Chuck Grassley (R-Iowa) hammered out the agreement over the past few days and announced it Tuesday night. They are hoping to bring the agreement to a vote by unanimous consent as early as Wednesday, a Senate aide told The Hill.

The healthcare reform law creates state-run exchanges through which certain people may purchase insurance starting in 2014. The law includes subsidies for those under a specified income limit — about $88,000 for a family of four — and includes recapture penalties to those whose income exceeds the limit. The law provided a flat-cap penalty of $250 for individuals and $400 for families, but the doc-fix agreement reached Tuesday night would create a sliding scale for penalties.

The legislation announced last night also extends a number of Medicare provisions, including an extension of the therapy caps exception process through Dec. 31, 2011, for $900 million over 10 years.

It also would repeal a delay in the implementation of the new Medicare payment structure for nursing homes. The nursing home industry had been pushing hard for a repeal of the delay, which was included in the healthcare reform law. The new payment system would be effective Oct. 1, 2010, instead of Oct. 1, 2011, if the doc fix is approved.

A list of all the extenders and other provisions included in the bill can be found here

If approved by Congress, this would mark the fifth patch to Medicare payments this year. The most recent patch, agreed to last month, will only last through the end of the year.