Affordable Healthcare for America Act

Floor Speech

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Ms. WASSERMAN SCHULTZ. Mr. Speaker, I rise today in support of provisions contained in H.R. 3962, which will temporarily fix the Sustainable Growth Rate--or SGR--formula. This legislation will undo the twenty-one percent cut in Medicare reimbursements to physicians that took place on June 1st. Without prompt action, these cuts will do serious harm to physicians and patients alike.

With a 21 percent cut, payments to physicians would be well below their overhead costs and could jeopardize continued access for Medicare beneficiaries to their physicians. We have a duty to our retirees to be there for them when they are in need, so I fully and enthusiastically support the provisions that restore Medicare reimbursement rates.

However, I want to register my profound concern over a provision in H.R. 3962 that utilizes a new application of what's known as the ``72-hour rule'' as an offset for the SGR temporary fix. This provision dictates how a hospital must bundle certain Medicare payments for reimbursement.

My home state of Florida was among the states included in the first round of the Recovery Audit Contractors Program, overseeing the 72-hour rule. Some Florida hospitals that have undergone audits had either inadvertently overbilled or underbilled.

Hospitals that inadvertently overbilled are obligated to repay the appropriate amount, and have already done so. But, hospitals that inadvertently underbilled, would be immediately precluded, if this passes, from resubmitting claims in compliance with existing regulations to recoup underpayments.

It is my understanding that many hospitals are still reviewing a large number of possible underpayments for submittal. If they are precluded from resubmitting claims because of changes in this legislation, Florida hospitals could face $225 million in losses. This retroactive application constitutes changing the rules of the game after the services were provided, and is simply not fair to providers.

We owe it to both our physicians and our hospitals to treat them fairly when they care for our seniors under Medicare. Assuming this legislation becomes law, I strongly encourage the Centers for Medicare and Medicaid Services to administer this new application of the 72-hour rule in the most equitable manner possible and limit the adverse impacts on hospitals to the greatest extent possible.

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